New CHEST Research Statement Identifies Critical Gaps in the Science Guiding E-Cigarette Regulation
May 8, 2026
Glenview, Illinois – A new research statement published in the May 2026 issue of the journal CHEST®, the flagship journal of the American College of Chest Physicians (CHEST), highlights significant gaps in the scientific evidence needed to effectively regulate electronic cigarettes (ECs) and protect public health. The article, “Critical Gaps in the Scientific Basis for Electronic Cigarette Regulation,” was developed by the CHEST Tobacco and Vaping Workgroup to inform future regulatory and research priorities.
Drawing on a comprehensive review of the literature, the multidisciplinary panel identified four prioritized research questions that warrant focused and urgent consideration by the research community and regulators. They are:
- What is the anticipated population health impact of various accessibility limitations?
- What would the anticipated effect be of limiting the amount of nicotine deliverable through electronic devices like ECs?
- What is the mechanistic contribution of ECs to noncardiac and nonmalignant health risks?
- What is the specific impact of flavorant classes on airway biology?
In response to these questions, the panel reviewed the literature and provided 13 recommendations to better characterize the anticipated impact on population health. Of the 13 recommendations, highlights include:
- Pragmatic trials evaluating the feasibility and impact of systematic restrictions such as prescription-only access, pharmacy-only access, retailer licensing, and more should be conducted to ascertain their potential to improve population health.
- Estimating the impact of nicotine delivery limitations should be expansive, and include characterizations of propylene glycol, carbonyl, and other toxicant exposure.
- Because variations in nicotine delivery may influence the amount of aerosol consumed by the user, population health impact studies of reduced nicotine products should include known markers of cardiovascular stress, systemic inflammation, and carcinogenesis.
- The regulatory research agenda should prioritize the precise quantification of potential toxicity among the individual components of EC aerosol, the potential synergistic effects of toxicant mixtures, and the interaction between toxicant delivery and the physical characteristics of the aerosol (eg, concentration, temperature, particle size, etc.).
“Effective regulation depends on strong, targeted scientific evidence, and right now, that evidence base is incomplete,” said lead author Frank T. Leone, MD, FCCP. “Our findings highlight the urgent need for research that reflects real-world use patterns and directly informs policies designed to protect population health.”
This research statement reflects CHEST’s ongoing commitment to reducing the burden of tobacco-related disease and advancing evidence-based policy. CHEST continues to advocate for stronger tobacco control measures, increased research funding, and expanded access to cessation services.
Through its advocacy efforts, CHEST works with policymakers and stakeholders to promote science-driven regulation, address emerging nicotine products such as e-cigarettes, and protect vulnerable populations from tobacco-related harm.
To learn more about CHEST’s advocacy initiatives in tobacco control, visit https://www.chestnet.org/membership-and-community/advocacy
About the American College of Chest Physicians
The American College of Chest Physicians® (CHEST) is the global leader in the prevention, diagnosis, and treatment of chest diseases. Its mission is to champion advanced clinical practice, education, communication, and research in chest medicine. It serves as an essential connection to clinical knowledge and resources for its 18,000+ members from around the world who provide patient care in pulmonary, critical care, and sleep medicine. For information about the American College of Chest Physicians and its family of journals, including the flagship journal CHEST®, visit chestnet.org.