E-Cigarettes AHA Statement

• AHA Policy Statement

Electronic Cigarettes

A Policy Statement From the American Heart Association

1. Aruni Bhatnagar, PhD, FAHA, Chair; 
2. Laurie P. Whitsel, PhD; 
3. Kurt M. Ribisl, PhD;
4. Chris Bullen, MBChB, PhD; 
5. Frank Chaloupka, PhD; 
6. Mariann R. Piano, PhD;
7. Rose Marie Robertson, MD, FAHA; 
8. Timothy McAuley, PhD; 
9. David Goff, MD, PhD, FAHA; 
10. Neal Benowitz, MD; 
11. on behalf of the American Heart Association Advocacy Coordinating Committee, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research

Key Words:

• AHA Scientific Statements
• cardiovascular disease
• e-cigarettes
• nicotine
• public health
• smoking
• tobacco
• tobacco smoke pollution

For decades, advocacy for tobacco control has been a priority of the American Heart Association (AHA). In partnership with major public health organizations, the association has made major strides in tobacco use prevention and cessation by prioritizing evidence-based strategies such as increasing excise taxes; passing comprehensive smoke-free air laws; facilitating US Food and Drug Administration (FDA) authority to regulate tobacco, including comprehensive tobacco cessation treatment within healthcare plans; and supporting adequate funding of comprehensive tobacco control programs in different states. These tobacco control efforts have cut in half the youth smoking rate from 1997 to 2007 and have saved >8 million lives in the past 50 years.¹ However, the work is far from done and has stalled, especially for people living below the poverty line, those with mental illnesses,² and those with low educational attainment.³ Unless current trends reverse, ≈5.6 million children alive today in the United States will die prematurely of smoking-related diseases.¹ Even now, cigarette smoking kills nearly half a million Americans each year, and an additional 16 million individuals suffer from smoking-related illness, which costs the United States $289 billion dollars annually in direct medical care and other economic costs.¹

This statement reviews the latest science concerning one of the newest classes of products to enter the tobacco product landscape—electronic cigarettes (e-cigarettes), also called electronic nicotine delivery systems (ENDS)—and provides an overview on design, operations, constituents, toxicology, safety, user profiles, public health, youth access, impact as a cessation aid, and secondhand exposure. On the basis of the current evidence, we provide policy recommendations in key areas of tobacco control such as clean indoor air laws, taxation, regulation, preventing youth access, marketing and advertising to youth, counseling for cessation, surveillance, and defining e-cigarettes in state laws. The statement concludes by outlining a future research agenda to further our understanding of this emerging area of tobacco control and the impact of e-cigarettes on public health./.../