APHA Committee Adopts Policy Statement on ENDS

The Governing Council of the American Public Health Association (APHA) adopted a policy supporting the regulation of electronic nicotine delivery systems (ENDS) prepared and submitted by Dr. Hadii Mamudu and members of the Policy Committee of the section on Alcohol, Tobacco, and Other Drugs (ATOD), Ginny Chadwick of University of Missouri, Dr. Page Dobbs of the University of Oklahoma, and Dr. Timothy Sanborn of the Medial College of Wisconsin.  Dr. Mamudu, Associate Professor in East Tennessee State University College of Public Health’s Department of Health Services Management and Policy and the Chair of the ATOD Policy Committee, led his team to navigate the APHA policymaking structure that culminated in the adoption of this ENDS policy. 

ENDS products, commonly known as e-cigarettes, are battery-powered devices that deliver aerosol vapor, known to include propylene glycol, which decomposes into formaldehyde and other carcinogens. The safety of these products and their efficacy in smoking cessation programs have not been demonstrated, and scientific evidence exists to the contrary. In the United States (U.S.), their use has increased among all demographic groups, including youth, vulnerable populations, and minorities. Some studies suggest ENDS use increases the use of combustible tobacco, and chemicals are harmful to both users and those exposed to secondhand vapor.

In August 2016, the U.S. Food and Drug Administration “Deeming Regulations” established that ENDS products could not be sold to anyone under 18 years of age or via vending machines (unless sold within an adult-only facility). On September 12, 2018, the FDA announced it had issued more than 1,300 warnings and civil penalties to tobacco retailers that illegally sold these products to minors. This was the strongest policy enforcement by FDA since the Deeming Act was enacted.  As of July 2018, 13 states, Puerto Rico, Washington, D.C., and over 100 cities included ENDS in their smoke-free air policies, and several corporations prohibited their use in workplaces.

The APHA identified a policy gap related to the regulation of ENDS in 2018.  The new policy amended the original policy that was adopted in 2014; it established APHA’s support to regulate ENDS products via restrictions of advertisements and promotion and prohibition of use in public and at workplaces. Moreover, it called for evidence-based research regarding efficacy in smoking cessation and recommended prohibiting flavoring and sales to people aged 21 years and younger.