AHA Invests Big in 'End the Lies' Research to Thwart Youth Vaping

PHILADELPHIA — The American Heart Association (AHA) has announced a "bold" three-pronged program — a big investment in research, an awareness campaign on social media, and continued government lobbying — to stop the increase in the number of young people who are harming their health by vaping.

"We are concerned about the vaping epidemic in youth spiraling out of control," AHA CEO Nancy Brown said in a media briefing on Friday before the start of the association's Scientific Sessions 2019 here.

A decade ago, 1 in 100 high school students was vaping, she noted, and today that number has risen to 1 in 4.

Young people are hiding their vaping by using devices that look like USB drives or pens, and the e-cigarette manufacturers are lying to young people and other consumers when they promote e-cigarettes as being less harmful than smoking tobacco, she noted. "The industry's lies don't just sound like Big Tobacco — the industry is Big Tobacco," she said.

JUUL reps are telling students that vaping is "totally safe," Brown said, and this misinformation "must stop."

In fact, she stressed, one pod contains as much nicotine as a pack of cigarettes — which many parents, physicians, and young people may not realize.

To combat such misinformation, the AHA is first investing up to $20 million to fund two or three "bold research projects" as part of its "End the Lies Youth Vaping and Nicotine Research Initiative," AHA President Robert Harrington, MD, said during a press conference here.

The grant approval process is being fast-tracked, he told theheart.org | Medscape Cardiology.

The AHA will "announce it Sunday, call for proposals right after this meeting, and the applications are going to be due in January," Harrington said. "By March, April, we're going to make those awards. That's really rapid."

Second, the AHA is launching an awareness campaign, dubbed #QuitLying, (www.QuitLying.org), to provide students, parents, and educators with a forum and information tools to counter misinformation from the tobacco industry.

Third, the organization is continuing its lobbying efforts to get multiple levels of government to enact policies to thwart youth vaping and, importantly, to get the US Food and Drug Administration (FDA) to ban the sale of flavored e-cigarettes that are attractive to young people.

To help these efforts, the AHA has received a commitment from Kaiser Permanente for multiyear funding for a new "Preventing Youth Nicotine Addiction" policy fund.

What Do Cardiologists Need to Know?

When these e-cigarettes came on the market, cardiologists wondered if they would be effective and safe to help patients quit smoking, Harrington told theheart.org | Medscape Cardiology.

Now it's known that "it's not safe. That's pretty clear," he said. Second, "there's still no definitive good information that these are effective smoking cessation products."

In talks with the FDA, the AHA has pointed out that JUUL claims e-cigarettes are smoking cessation devices for adults, he noted, but "they've not done the studies to show us that."

People need to understand that e-cigarettes "are not safe; they may well be associated with an increased risk of heart disease and stroke; and there is insufficient data to say that they're efficient smoking cessation devices."

"We don't know whether the long-term trade-off from going from combustible cigarettes to continuing to use e-cigarettes is a good trade-off," he added, since it's unclear if people can go from smoking cigarettes to vaping to stopping vaping.

There was a great series of articles in the Wall Street Journal over the last few weeks, Harrington noted, that explained how JUUL used publicly available research and marketing data from tobacco companies to figure out the best way to deliver nicotine.

And recently, vaping shops are contesting local legislation, arguing that they are small businesses that drive the local economy in small communities.

"How do you balance the public health against that?" Harrington asked rhetorically. "You really have to be forceful in your protection of the public health."

Big Research Commitment to Counter "Big Lies"

To overcome "Big Tobacco" — or, as an AHA press release refers to it, "Big Vape" — there's a need for "a big unparalleled commitment," Harrington told the media here.

This funding is 40 times bigger than the typical AHA research grant of $7 million to $10 million dollars.

Some of the research priorities that the AHA has identified include studying:

The impact of nicotine on teen brain development, intelligence, and learning
The role of e-cigarette device type, flavors, chemicals, and byproducts on addiction
How to reverse nicotine addiction in youth using behavioral, pharmacologic, and/or technologic (mobile app) solutions
Transitions from e-cigarettes to tobacco (and vice versa) and smoking and vaping cessation effectiveness in different populations
The impact of policies such as eliminating flavors and restricting sales and/or marketing to youth

Researchers are invited to submit grant applications until January 14, 2020.

Multiple Stakeholders Band Together

At the media briefing, multiple stakeholders shared reasons for the urgent need to address the vaping epidemic in youth — leading up to the announcement of the new AHA initiative.

Mariel Jessup, MD, chief science and medical officer of the AHA, noted that 60 years ago, the population was "bombarded by ads" claiming cigarettes were soothing for the throat, could improve indigestion, and promoted a slender figure.

Today, companies have "beguiling ads" to promote vaping that are designed to appeal to young people.

But research has shown that teen brains are more susceptible to nicotine addiction.

Moreover, the "recent spate of lung disease and death" traced to heating the non-nicotine components of e-cigarettes, and possible contamination from tetrahydrocannabinol, have raised alarms that these products are not benign, she added.

Research has shown that the compounds formed from the heated flavorings may be toxic to the endothelium, which, in addition to immediate threat to lungs and even life, could be an "early warning of future heart disease."

"There is still so much we don't know," but "time is running out," Jessup cautioned.

Vaping will be the focus of a "Hot Topics" session here on Saturday, November 16, moderated by Rose Marie Robertson, MD, deputy chief science and medical officer at the AHA.

Potential Stop-Smoking Benefit?

In a separate analysis, the Vascular Effects of Regular Cigarettes Versus Electronic Cigarette Use (VESUVIUS) trial published online the same day in the Journal of the American College of Cardiology, found evidence of vascular health benefit in long-time heavy smokers who switched from tobacco cigarettes to e-cigarettes — but they, too, caution that this does not make them safe for children and nonsmokers.

The researchers, with first author Jacob George, MD, professor of cardiovascular medicine and therapeutics at the University of Dundee, United Kingdom, recruited 114 cigarette smokers who had smoked about 18 cigarettes a day for approximately 32 years and allocated participants to one of three groups for 1 month: continue smoking tobacco cigarettes, switch to e-cigarettes with nicotine, or switch to e-cigarettes without nicotine.

Tobacco smokers, particularly women, had significant improvements in vascular health within 1 month of switching from tobacco to e-cigarettes, and people who had smoked less than 20 years benefitted more.

Therefore, switching from tobacco to e-cigarettes "may be considered a harms reduction measure," the researchers conclude.

In a statement released by the university, George explained that to put this into context, "each percentage point improvement in vascular function results in a 13% reduction in cardiovascular event rates such as heart attack, and smokers who switched to e-cigarettes had an average 1.5% improvement in vascular health within just a month, whether or not the e-cigarette contained nicotine."

He is, however, on the same page as the AHA when it comes to stressing that vaping is still harmful and youth should not start.

"It is crucial to emphasize that e-cigarettes are not safe, just less harmful than tobacco cigarettes when it comes to vascular health," he stressed.

"Smoking of any kind is a preventable risk factor for heart disease," he added, and e-cigarettes "should not be seen as harmless devices for nonsmokers or young people to try."

The AHA receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers, and other companies) also make donations and fund specific association programs and events. The AHA has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information

American Heart Association (AHA) Scientific Sessions 2019. Presented November 15, 16, 2019.

J Am Coll Cardiol. Published online November 15, 2019. Full text

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