In its recently released (16 April) “Final Opinion on Electronic Cigarettes,” the European Union’s Scientific Committee on Health, Environmental, and Emerging Risks (SCHEER) highlights concerns about e-cigarettes and finds insufficient, or “weak,” evidence that they help smokers quit tobacco. Adopted by written procedure on 16 April, the opinion runs over 120 pages; it will be used to inform the review of the European Union’s 2014 Tobacco Products Directive, which limits the ways in which tobacco and tobacco-related products (including e-cigarettes) can be manufactured, presented, and sold in EU member states.
The committee began its investigation more than two years ago, in February 2019, when it was officially mandated to assess e-cigarette risks and benefits. Relying primarily on literature published between January 2015 and April 2019, the reviewed studies were diverse in their methodology—longitudinal data analysis, randomized control trials, meta-analysis of e-cigarettes as consumer products—but consistent in finding that there was high risk of dual use of products, a high risk of continuing use of e-cigarettes, and a high risk of use by never smokers.
Reiterating a key concern in The Union’s May 2020 position paper on novel products—“Where Bans Are Best,”— the EU’s Scientific Committee also notes that e-cigarettes are particularly appealing to young people, including those who have never smoked combustible cigarettes. The number of adolescent users in the EU doubled between 2012 and 2017, according to the opinion, from 7.2% to 14.6%.
“Young non-users perceive the electronic cigarette as a cool and fashionable product that mimics the smoking routine and is judged to be rather safe to use,” write the authors, who note that flavors entice both youth and adults. “Flavours decrease harm perceptions and increase willingness to try and initiate use of electronic cigarettes. Adolescents consider flavour the most important attribute in these products and were more likely to initiate using through flavoured electronic cigarettes.”
The committee found that e-cigarettes might be used in cessation efforts, but only in carefully prescribed circumstances—for a short-term, under clinical supervision. Its primary conclusion—“There is a lack of robust longitudinal data on the effect of electronic cigarettes on smoking cessation"—is aligned with The Union’s position that these products are not an effective, real world, population-level intervention. (Other recent studies—Richard Wang et al; a January 2021 metanalysis; a study using PATH data; and a study from McDermott and colleagues also caution against e-cigarettes as cessation aids outside clinical settings).
“The Final Opinion paints a picture of a product class that is extremely worrisome,” said Gan Quan, Director of The Union’s Tobacco Control Department. “It would be an egregious mistake to ignore this advice, and we certainly hope it informs the next EU Tobacco Products Directive. Millions of lives are at stake.”