We appreciate the interest our research has garnered. No single study can resolve all questions of interest, and all findings warrant replication. Our focus for this study was examining toxicants in adolescent e-cigarette–only users relative to nonusers. Because a number of adolescents who enrolled in our study were found to also have recently smoked combustible cigarettes (dual users), we included them as a comparison group.
As we stated in our article,1 e-cigarettes do appear to produce lower levels of toxicants than traditional cigarettes based on the literature and on the levels observed among our dual user group. Use of e-cigarettes among adult tobacco smokers was not a focus of our study, and we encourage readers interested in that literature to see the references we noted in our article. Again, we chose to focus on adolescents for whom the paradigm is different than the debate that has been characterized as harm reduction among adults. Rather, the focus of interest with adolescents is harm creation. The comparison of interest is not combustibles, but no use of any tobacco product at all. Specifically, adolescents are by and large using e-cigarettes for recreational use, not as a means of switching from traditional cigarettes. This is evidenced by epidemiological data revealing that the number of adolescents using e-cigarettes outnumbers adolescent tobacco smokers (in the United States), and use by never-smokers is also increasing. Furthermore, studies of adolescents in the United States reveal a reverse trajectory for teenagers from e-cigarettes to traditional cigarettes. Consequently, for adolescents, the question of interest is as follows: are these products more dangerous than no use at all (rather than compared with tobacco-only smoking)? As such, the most relevant groups for comparison would be those with and without e-cigarette exposure, which was the focus of our study.
The relative toxicity of the products is complex to determine. For this reason, we analyzed exposures in a non–e-cigarette using comparison group. That way, readers can compare baseline environmental exposures, which we point out in the article were greater than zero. Again, with the perspective that most adolescents are using e-cigarettes for recreational purposes, our findings provide a warning that they are exposing themselves unnecessarily to cancer-causing toxicants. As we point out in the article (and consistent with other exposures such as secondhand tobacco smoke), the harm from these lower levels of VOCs would likely not present for many years and assumes that these adolescents will continue to be exposed over time (something that as yet remains unknown). Assuming adolescents continue using e-cigarettes for many years, there are data available that can provide an estimate of cancer risk for each of the toxicants we examined, such as the article by St Helen et al2 about compounds in secondhand smoke from motor vehicles.
Again, we appreciate the interest and hope that our research findings provide the impetus for deeper investigation into the potential harms and benefits of e-cigarettes for both adults and young people.
CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest to disclose.
- Rubinstein ML,
- Delucchi K,
- Benowitz NL,
- Ramo DE
- St Helen G,
- Jacob P III,
- Peng M,
- Dempsey DA,
- Hammond SK,
- Benowitz NL
- Copyright © 2018 by the American Academy of Pediatrics