Moderator: Scott Leischow, PhD
Title: The Future of Nicotine
Summary: Nicotine is and has been at the heart of the global tobacco use epidemic because addiction to nicotine is the primary reason why millions of users continue to use smoke, which is inherently deadly. However, regulated therapeutic nicotine delivery systems like patch and gum have low addiction potential given their relatively slow and low (compared to tobacco) delivery of nicotine, and this has allowed them to be sold over-the-counter in the US and other countries. But now ENDS products are widely available and there are currently no U.S. federal regulations governing the level of nicotine they deliver. The emergence of ENDS has raised debate about their potential for delivering nicotine comparable to cigarettes to help smokers quit, balanced against the concerns prompted by their use by youth as well as concerns that youth use of ENDS will lead to tobacco use. The rapid increase in ENDS products and use has caused many stakeholders - public, corporate, scientific and regulatory - to review how they think about and act on products that deliver nicotine. The objective of this session is to discuss critical research needs, challenges to achieving public health goals in a complex and evolving environment, and critical research and regulatory questions that will help to determine the future of nicotine as a consumer and medicinal product.
Moderator: Bonnie Halpern-Felsher, PhD; Hyoshin Kim, PhD; Scott Weaver, PhD
Title: What do we need to develop better measures of e-cigarette use, dependence, perceptions and policy?
Summary: There is a need for well-developed and validated measures of e-cigarette use, dependence, and perceptions. Such measures would greatly enhance our ability to provide data that will inform the field as well as regulation of e-cigarettes. In particular, we need measures of e-cigarette use that consider different device types, users, and age groups; different use patterns including quantity or intensity of use; and validated and agreed-upon measures of nicotine dependence. Developing and testing these measures will allow for a more uniform set of measures that can be used across studies, yielding more consistent findings that can be applied to regulatory science and policy. This session will provide a forum to discuss the current state of knowledge regarding e-cigarette measurement and future directions for research.
Moderator: Adam O. Goldstein, MD, MPH; Edward Anselm, MD
Title: Should clinicians counsel tobacco users to reduce or quit through the use of Electronic Nicotine Delivery Systems (ENDS)?
Summary: The clinical utility of Electronic Nicotine Delivery Systems (ENDS), such as e-cigarettes, for smoking cessation is an area of intense controversy in the public health and medical literature. Many tobacco users use e-cigarettes in an attempt to cut down or quit combustible cigarettes. However, it appears that a majority of those attempting to quit smoking combustible cigarettes with e-cigarettes are not successful in completely weaning off combustible tobacco, resulting in the dual use of combustible tobacco and electronic cigarettes. Many dual users think that reduction is an acceptable outcome. Cigarette smokers, exclusive e-cigarette users and increasingly dual users show up at the clinician's office seeking help in quitting their nicotine habits. Some clinicians feel ENDS are effective cessation tools, with safety profiles as good as FDA approved cessation products like nicotine patches, making their utility for cessation high. Other clinicians and treatment specialist feel that data do not show effectiveness for cessation and have an unknown safety profile compared to approved FDA cessation therapies, making their use for smoking cessation questionable at best. Throughout all these clinical discussions, patients are left to wonder which view is correct. This session will encourage discussion of the evidence and the different perspectives, including a discussion of challenges from different ethical, medical and policy frameworks for integrating harm reduction counseling into clinical practice.
Moderators: Janet Hoek, PhD; Natalie Walker, PhD
Title: What Does the Endgame for Ending the Tobacco Epidemic Look Like?
Summary: Across the world, the strategies for moving beyond tobacco control, which assumes the presence of tobacco in society but with parameters, toward an “endgame” for ending the tobacco epidemic, have increasingly been discussed and debated. Some countries have already initiated endgame goals, such as New Zealand which has committed to becoming a smoke-free society by 2025, and others are still pondering this possibility. This session will encourage discussion of the range of policies and proposals for a tobacco endgame, including discussing what that could look like in the U.S.
Moderator: Stanton A. Glantz, PhD
Title: Ethical Implications of Factoring in Tobacco Use in Hiring and Insurance Policies?
Summary: Over the past several decades, insurance companies have increasingly charged higher premiums to smokers and encouraged cessation as a means to reducing the burden on the health care system and in order to offset the higher expenditures accrued by smokers and other tobacco product users. In a related recent policy trend, companies and academic institutions have incorporated tobacco use restrictions into their hiring practices, requiring their new hires to be non-smokers or non-tobacco users. There is significant debate about the ethical implications of such policies. Is this the prerogative of a company or academic institution to seek to eliminate tobacco use in their workforce as a source of decreased productivity and increased expense? Or do these policies constitute discrimination against a class of people for a personal behavior, particularly in light of socioeconomic disparities between smokers and non-smokers? This session will feature discussion of these and related issues.