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Electronic Cigarettes: Q&A

FDA proposes to crack down on e-cigarettes, other tobacco products.

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Public health advocates worry that the sweet flavors of e-cigarettes will continue to attract teens, along with marketing.

But CDC Director Tom Frieden, MD, said in an interview with NPR that rules in those areas could be challenged in court.

"One of the challenges that the FDA has is the balance between stringent regulation and regulation that will stand up to a court challenge,” Frieden told NPR.  He noted that the e-cigarette industry has already won one court case against the FDA.

“It is a real balancing act between how effective regulation can be and how sustainable it will be in court.”

Q: What other products are included in the new rules?

A: Besides electronic cigarettes, the proposed rules also cover cigars, pipe tobacco, nicotine gels, water pipe tobacco, and hookah tobacco.

The FDA already regulates cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco.

Q: When do these rules take effect, if finalized?

A: The 75-day comment period on the rules began in April. It's tough to estimate how long it will take to review those comments and issue a final ruling, says FDA Commissioner Margaret Hamburg.

Once that happens, the ban on sales to minors and from vending machines goes into effect in 30 days. For the rest, companies will have 24 months to meet the new rules. They can continue marketing their products during that time.

Q: Who is using e-cigarettes?

A: "At this point we have far more questions than answers about who is using e-cigarettes and how they are being used," Zeller says. There is some evidence, he says, that hard-core cigarette smokers may turn to e-cigarettes when they can't light up.

In that case, he says, e-cigarettes are not helping them stop smoking, but merely serving as a bridge from the last regular cigarette to the next.

Some studies have suggested that the use of e-cigarettes to help smokers quit may be equal to or slightly better than nicotine patches, the AHA says. If repeated quit attempts using proven strategies fail, or if a person rejects those strategies and wants to use e-cigarettes to quit, doctors “should not discourage” e-cigarette use, the association says.

Still, the association says doctors should tell patients that e-cigarettes aren’t regulated or FDA-approved as a quit-smoking strategy, and they “may contain low levels of toxic chemicals.” Also, since long-term studies haven’t been done on the safety of e-cigarettes, doctors should suggest that patients set a quit date for use of e-cigarettes, the recommendations say.

Young people represent a growing group of e-cigarette users, and that concerns public health experts. Between 2011 and 2012, the number of middle and high school students who used e-cigarettes doubled, reaching 1.78 million, CDC statistics show.

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