In the special session Issues Important to Tobacco Control, members of the AACR Tobacco Products and Cancer Subcommittee discussed tobacco control policy and regulation, the health impacts of e-cigarettes, flavored tobacco products, the emergence of synthetic nicotine, and the role tobacco plays in exploiting health disparities.

Benjamin A. Toll, PhD, Medical University of South Carolina, provided an overview of the committee’s efforts to foster scientific and policy initiatives to cut down on the incidence of disease and mortality caused by tobacco use.

“Since it was formed in 2009, our Subcommittee on Tobacco and Cancer has published multiple policy statements, sponsored a U.S. Surgeon General event, engaged in several congressional sessions, and written letters to the FDA and CMS on key policy issues,” Toll said.

Flavors and nicotine in tobacco products: Targets for regulation

“Flavors and nicotine have been identified by the FDA as two components of tobacco products that they are very interested in including in their comprehensive plan for tobacco and nicotine regulation,” said Suchitra Krishnan-Sarin, PhD, Yale University School of Medicine.

When it comes to flavors in cigarettes, Krishnan-Sarin said there has been some action from the FDA, which has banned all flavors in cigarettes, with the notable exception of menthol.

“Given the weight of all the evidence that exists on how menthol can alter the appeal and use of tobacco cigarette products, the WHO Framework Convention of Tobacco Control has made a recommendation that menthol in cigarettes should be banned, and many countries have followed this recommendation,” Krishnan-Sarin said.

Despite the fact that the FDA’s Tobacco Product Scientific Advisory Committee recommended in 2011 that “removal of menthol cigarettes from the marketplace would benefit public health in the U.S.,” there is still no ban in the U.S.

Another regulatory concern, Krishnan-Sarin said, is the emergence of tobacco-free or synthetic nicotine.

“This is a product that has recently appeared on the market and it is being used by many manufacturers in their tobacco products,” she said. “The Family Tobacco Control Act can only regulate nicotine that comes from tobacco products, so if the market were to contain a tobacco-free or synthetic nicotine, it is unclear as to whether the FDA would have any regulatory authority over these products.”

Health effects from e-cigarette use

“When we talk about health effects from e-cigarettes, we’re really talking about a scale weighing individual risk versus population risk,” said Peter G. Shields, MD, The Ohio State University Wexner Medical Center.

The biggest problem, he said, is the fact that e-cigarettes are so new with little data regarding their health risk, particularly long term.

“Evidence continues to emerge that e-cigarettes are helping smokers quit in randomized clinical trials. Population studies are not showing the same thing, but they can be easily confounded,” Shields said. “However, there is no evidence to date for health effects that are unique or exclusive to e-cigarette use, either from consistently altered biomarkers, symptoms, or diagnoses.”

Disparities in tobacco exposure and avoidance

“Disparities exist for prevalence, cessation, time trends, and other traits, and this is true for cigarette smoking and other tobacco exposures, as well as for e-cigarettes,” said Timothy R. Rebbeck, PhD, Dana Farber Cancer Institute. “Additionally, we know that disparities exist for many characteristics in addition to race or ethnicity.”

Factors such as education in adults is strongly associated with a gradient of smoking prevalence, Rebbeck said, noting that college graduates and those with graduate degrees have lower prevalences of smoking compared to those with lower educational levels.

“There is also a strong, clear gradient between household income and prevalence of smoking, with the highest household incomes being associated with the lowest smoking prevalences,” he said.

Rebbeck said that individuals who self-identify as lesbian, gay, or bisexual have higher rates of smoking than those who self-identify as heterosexual or straight.

“We need to think about disparity in smoking and in other tobacco related products as an intersectional problem that affects certain subgroups much more severely than others,” Rebbeck said. “And we need to think about all of these areas of disparity if we’re going to effectively intervene on those who have the highest rates and the highest risks of smoking and smoking related health conditions.”

In addition to the On Demand session, the presenters participated in a live Panel Discussion. Registrants can watch a replay of them through June 21, 2021.