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Research & Evidence
Dual use of ENDS and other tobacco products is common and generates little to none of the positive health impacts of quitting combustible tobacco products altogether.
Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine
CA: A Cancer Journal for Clinicians
Wang, Teresa W., PhD; Michael A. Tynan; Cynthia Hallett, MPH; Laura Walpert, JD; Maggie Hopkins; Darryl Konter; Brian A. King, PhD. "Smoke-Free and Tobacco-Free Policies in Colleges and Universities ― United States and Territories, 2017." Morbidity and Mortality Weekly Report (MMWR), June 22, 2018.
Each year in the United States, cigarette smoking causes an estimated 480,000 deaths, including approximately 41,000 deaths from secondhand smoke exposure among nonsmoking adults. Smoke-free policies protect nonsmokers from secondhand smoke exposure, reduce the social acceptability of smoking, help in preventing youth and young adult smoking initiation, and increase smokers’ efforts to quit smoking. Given that 99% of adult cigarette smokers first start smoking before age 26 years and many smokers transition to regular, daily use during young adulthood, colleges and universities represent an important venue for protecting students, faculty, staff members, and guests from secondhand smoke exposure through tobacco control policies
National Academies of Sciences, Engineering, and Medicine.. "Incorporating weight management and physical activity throughout the cancer care continuum: Proceedings of a workshop.." Washington, DC: The National Academies Press., 2018.
The National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a public workshop, Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum, on February 13 and 14, 2017, in Washington, DC. The purpose of this workshop was to highlight the current evidence base, gaps in knowledge, and research needs on the associations among obesity, physical activity, weight management, and health outcomes for cancer survivors, as well as to examine the effectiveness of interventions for promoting physical activity and weight management among people living with or beyond cancer. Workshop sessions also reviewed the opportunities and challenges for providing weight management and physical activity interventions to cancer survivors. This publication summarizes the presentations and discussions from the workshop.
Marian Freedman and Michael G Burke, MD. "High-nicotine e-cigarettes lead to more smoking and vaping." Contemporary Pediatrics, February 1, 2018.
Compared with adolescents who use e-cigarettes with relatively low or no nicotine concentrations, those who use e-cigarettes with higher nicotine concentrations are more likely to progress to more frequent and intense combustible cigarette smoking and vaping.
National Academies of Sciences, Engineering, and Medicine. "Public Health Consequences of E-Cigarettes." Washington, DC: The National Academies Press, 2018.
Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes.
Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research.
Ahmed Jamal, MBBS; Elyse Phillips, MPH; Andrea S. Gentzke, PhD; David M. Homa, PhD; Stephen D. Babb, MPH; Brian A. King, PhD; Linda J. Neff, PhD. "Current Cigarette Smoking Among Adults — United States, 2016." CDC Morbidity and Mortality Weekly Report, January 19, 2018.
The U.S. Surgeon General has concluded that the burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reduce cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the highest prevalences.
Farhad Islami, MD, PhD; Ann Goding Sauer, MSPH; Kimberly D. Miller, MPH; Rebecca L. Siegel, MPH; Stacey A. Fedewa, PhD, MPH; Eric J. Jacobs, PhD; Marjorie L. McCullough, ScD, RD; Alpa V. Patel, PhD; Jiemin Ma, PhD, MHS; Isabelle Soerjomataram, MD, PhD, MS. "Proportion and Number of Cancer Cases and Deaths Attributable to Potentially Modifiable Risk Factors in the United States." CA: A Cancer Journal for Clinicians, November 21, 2017.
Contemporary information on the fraction of cancers that potentially could be prevented is useful for priority setting in cancer prevention and control. Herein, the authors estimate the proportion and number of invasive cancer cases and deaths, overall (excluding nonmelanoma skin cancers) and for 26 cancer types, in adults aged 30 years and older in the United States in 2014, that were attributable to major, potentially modifiable exposures (cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and 6 cancer-associated infections).
Elyse Phillips, MPH; Teresa W. Wang, PhD; Corinne G. Husten, MD; Catherine G. Corey, MSPH; Benjamin J. Apelberg, PhD; Ahmed Jamal, MBBS; David M. Homa, PhD; Brian A. King, PhD . "Tobacco Product Use Among Adults — United States, 2015." Centers for Disease Control and Prevention, November 10, 2017.
In 2015, approximately one in five U.S. adults (48.7 million) currently used any tobacco product, with most using combustible tobacco products. Any tobacco product use was significantly higher among males; adults aged <65 years; non-Hispanic AI/AN, whites, blacks, and persons of multiple races; persons living in the Midwest; persons with a GED; persons with annual household income <$35,000; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons who were uninsured or insured through Medicaid; persons with a disability; and persons who identified as LGB. Adults with serious psychological distress had the highest prevalence of any tobacco product use of any subpopulation.
Girija Syamlal, MBBS; Brian A. King, PhD; Jacek M. Mazurek, MD. "Tobacco Use Among Working Adults — United States, 2014–2016." Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, October 27, 2017.
Cigarette smoking has declined considerably among U.S. adults over several decades; however, increases have occurred in the use of noncigarette tobacco products in recent years, and the use of multiple tobacco products has become common among current users of noncigarette tobacco products.
Babb, Stephen MPH, Benmei Liu PhD, Brandon Kenemer MPH, Carissa Baker Holmes MPH, Anne M. Hartman MS, MA, James T. Gibson BS, Brian A. King PhD, MPH. "Changes in Self-Reported Smokefree Workplace Policy Coverage Among Employed Adults— United States, 2003 and 2010–2011." Oxford University Press on behalf of Society for Research on Nicotine & Tobacco Research, October 12, 2017.
The workplace is a major source of exposure to secondhand smoke from combustible tobacco products. Smokefree workplace policies protect nonsmoking workers from secondhand smoke and help workers who smoke quit. This study examined changes in self-reported smokefree workplace policy coverage among U.S. workers from 2003 to 2010–2011.
Greta M. Massetti, PhD; William H. Dietz, MD, PhD; Lisa C. Richardson, MD, MPH. "Excessive Weight Gain, Obesity, and Cancer." JAMA, October 3, 2017.
Even though the effects of overweight and obesity on diabetes, cardiovascular disease, all-cause mortality, and other health outcomes are widely known, there is less awareness that overweight, obesity, and weight gain are associated with an increased risk of certain cancers. A recent review of more than 1000 studies concluded that sufficient evidence existed to link weight gain, overweight, and obesity with 13 cancers, including adenocarcinoma of the esophagus; cancers of the gastric cardia, colon and rectum, liver, gallbladder, pancreas, corpus uteri, ovary, kidney, and thyroid; postmenopausal female breast cancer; meningioma; and multiple myeloma.
Drope, J., Cahn, Z., Kennedy, R., Liber, A. C., Stoklosa, M., Henson, R., Douglas, C. E. and Drope, J. "Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine." CA: A Cancer Journal for Clinicians, September 29, 2017.
Over the last decade, the use of electronic nicotine delivery systems (ENDS), including the electronic cigarette or e-cigarette, has grown rapidly. More youth now use ENDS than any tobacco product. This extensive research review shows that there are scientifically sound, sometimes competing arguments about ENDS that are not immediately and/or completely resolvable. However, the preponderance of the scientific evidence to date suggests that current-generation ENDS products are demonstrably less harmful than combustible tobacco products such as conventional cigarettes in several key ways, including by generating far lower levels of carcinogens and other toxic compounds than combustible products or those that contain tobacco. To place ENDS in context, the authors begin by reviewing the trends in use of major nicotine-containing products. Because nicotine is the common core—and highly addictive—constituent across all tobacco products, its toxicology is examined. With its long history as the only nicotine product widely accepted as being relatively safe, nicotine-replacement therapy (NRT) is also examined. A section is also included that examines snus, the most debated potential harm-reduction product before ENDS. Between discussions of NRT and snus, ENDS are extensively examined: what they are, knowledge about their level of “harm,” their relationship to smoking cessation, the so-called gateway effect, and dual use/poly-use.
"AACR Cancer Progress Report." Philadelphia: American Association for Cancer Research, September 13, 2017.
With the number of cancer cases diagnosed in the United States rising every year, it is vital that the AACR increases public awareness about cancer and the importance of research for improving health and saving lives from cancer. The annual AACR Cancer Progress Report is a cornerstone of these educational efforts and the AACR’s work to advocate for increased funding for the federal agencies that are vital for fueling progress against cancer— in particular, the National Institutes of Health (NIH), the National Cancer Institute (NCI), and the Food and Drug Administration (FDA).
The Report is released in September of each year and highlights advances over the past 12 months in the prevention, detection, diagnosis, and treatment of cancer. It also includes the personal experiences of cancer survivors who have benefited from these advances. Together with the developments described in the report, these survivor stories provide hope for a much brighter future for cancer patients and their loved ones.
Scott Gottlieb, M.D., and Mitchell Zeller, J.D. "A Nicotine-Focused Framework for Public Health." New England Journal of Medicine, August 6, 2017.
Despite extraordinary progress in tobacco control and prevention, tobacco use remains the leading cause of preventable disease and death in the United States. Combustible cigarettes cause the overwhelming majority of tobacco-related disease and are responsible for more than 480,000 U.S. deaths each year. Indeed, when used as intended, combustible cigarettes kill half of all long-term users.
Hines, Jonas Z. MD ; Steven C. Fiala, MPH ; Katrina Hedberg, MD. "Electronic Cigarettes as an Introductory Tobacco Product Among Eighth and 11th Grade Tobacco Users — Oregon, 2015." CDC Morbidity and Mortality Weekly Report (MMWR), June 16, 2017.
During 2011–2015, increased electronic cigarette (e-cigarette) and hookah use offset declines in cigarette and other tobacco product use among youths (persons aged <18 years)
Maura L. Gillison, Tatevik Broutian, Barry Graubard, Robert Pickard, Zhen-Yue Tong, Weihong Xiao, Lisa Kahle, Anil Chaturvedi; Ohio State University, Columbus, OH; National Cancer Institute, Rockville, MD; The Ohio State University, Columbus, OH; Informat. "Impact of HPV vaccination on oral HPV infections among young adults in the U.S.." Meeting Library, ASCO University, June 5, 2017.
The incidence of HPV-positive oropharyngeal cancers has risen in recent decades among US men. The potential impact of HPV vaccines on oral HPV infections has yet to be evaluated in efficacy-trials or surveillance studies.
HPV vaccination substantially reduced vaccine-type oral HPV infection prevalence among young adults (ages 18-33 years) in the US population during 2011-2014. However, due to low vaccine uptake, population-level effectiveness was modest overall and particularly low in men.