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Vaping: The Threat to Public Health and the ATS Response

Since e-cigarette products first appeared in the marketplace, the ATS has been deeply skeptical of their safety. Now, along with the exponential growth in recreational use by children and young adults, there is increasing evidence of harm. Additionally, with the first deaths directly attributable to e-cigarettes, along with other case reports, it is now abundantly clear that much more needs to be done. 

“For years we’ve known that tobacco cigarettes were dangerous, but short-term use does not send people to the hospital,” said Frank Leone, MD, member of the ATS Tobacco Action Committee. “Now, there is increasing evidence that short-term use of e-cigarettes can send children to the emergency room. The public must be alerted to the dangers of vaping e-cigarette products, and healthcare professionals educated on what to look for in patients suffering from vaping-related respiratory distress.”

Since this public health threat first emerged, ATS has assumed a leadership position on this issue through various actions, including:

  • Meeting with Food and Drug Administration (FDA) officials on several occasions, most recently this past June, to express our concern that the agency was not using its regulatory authority to address this emerging public health issue. Likewise, we have made the regulation of vaping a key issue during our visits with members of Congress.

  • Developing a new Public Health Information Series fact sheet specifically addressing the health effects of vaping (vaping-associated pulmonary illness, or VAPI). It will include tips to detect signs of vaping-related illness. This piece, to be issued in the near future, will be suitable for both medical professionals and the general public.

  • Publishing a Patient Information Series fact sheet on VAPI, to complement the existing fact sheet “Vaping/Electronic Nicotine Delivery Systems.”

ATS involvement in the larger cigarette/tobacco issue has been extensive and is ongoing. During both the Obama and Trump administrations, the ATS called upon the FDA to strictly regulate all tobacco products, including e-cigarettes, in the following ways:

  • Ban the use of menthol as a characterizing flavor agent in all tobacco products
  • Ban the use of sweet, fruity and other child-luring flavors in all tobacco products
  • Require disclosure of all ingredients in e-cigarette products
  • Require the testing of flavoring agents with known or suspected respiratory toxicity
  • Require graphic warning labels on all tobacco products including e-cigarettes
  • Urge stricter regulation of online sales of e-cigarette products
  • Ban advertising and other marketing techniques intended to appeal to youth

In addition, the ATS submits detailed comments on pertinent proposed FDA regulations, files or joins amicus briefs related to ongoing lawsuits, and advocates with legislators to address these issues. For example, the ATS supported the American Academy of Pediatrics lawsuit challenging the FDA for their failure to effectively regulate e-cigarette products, and we are pleased that as a result of this legal action, the court has ordered the FDA to accelerate its review of e-cigarette product applications. The ATS also supports lawsuits bolstering the FDA’s authority to regulate all tobacco products and opposes legislative efforts in Congress that would limit or delay the FDA’s authority to regulate e-cigarettes and candy-flavored cigars. The ATS is also focused on giving clinicians the tools they need to appropriately record cases of e-cigarette–related injuries by petitioning the Centers for Disease Control’s National Center for Health Statistics to create unique ICD 10 codes to report e-cigarette–related injury, disease, and addiction.

Clearly the ATS feels strongly about tobacco and e-cigarette use and is committed to remaining as engaged as possible moving forward.

So, what can you do at this point to help? Report any suspected vaping-related illnesses/injuries to the Centers for Disease Control and FDA by emailing VapingAssocIllness@cdc.gov. These reports will help drive regulatory action. You can also click here to learn more about our tobacco control efforts and to see how you can help with advocacy.

James M. Beck, MD, ATSF, President
Juan C. Celedón, MD, DrPH, ATSF, President-Elect
Polly E. Parsons, MD, ATSF, Immediate Past President
Lynn M. Schnapp, MD, ATSF, Vice President
Gregory P. Downey, MD, ATSF, Secretary-Treasurer
Karen Collishaw, MPP, CAE, Executive Director