Commentary by Dr. James E. K. Hildreth

Black America is worried about addictive nicotine products. This is the crucial insight Meharry Medical College has gained since founding the Center for the Study of Social Determinants of Health and launching our first research initiative into the health effects of e-cigarettes just a few months ago.

With $7.5 million in funding from JUUL Laboratories and a guarantee of complete research autonomy to investigate what we want and publish what we find, we at Meharry have initiated our work by doing what we have done for 140 years as a research institution committed to the underserved:

We are opening our doors, and we are listening. Before launching any research, before racing forward with opinions, we are making sure that we know what is top of mind among the people who matter most to us.

What we are hearing – in both focus groups and surveys – is that our community wants answers to questions about the long- term health benefits or drawbacks of e-cigarettes.

The industry claims e-cigarettes help smokers avoid the carcinogens in tobacco. But fully 80 percent of those we have surveyed want to know if the additive chemicals in e-cigarettes contribute to other harmful diseases. Fifty percent are either concerned or very concerned about e-cigarette second-hand smoke. And all are very worried about e-cigarettes’ potential impact on the health of our children.

Black people are well aware that tobacco’s scourge has hit African American communities harder than most and left us reeling from health problems down through the generations. As an expert on disparities of care between white and minority communities during the AIDS crisis, I strongly suspect that our survey respondents’ extreme concern reflects, in part, the reality that health issues that first hit white communities invariably trickle down to black communities – but the solutions to those health issues don’t tend to trickle down.

This is why Meharry created the Center and why we are taking the helm in investigating this emerging national health issue. Because whatever the ramifications of e-cigarettes on the health and well-being of this country, Black America will feel them – and Black Americans know it.

This is a difficult topic. Right now, in the absence of hard facts, many people are responding with fear and envisioning worst case scenarios. We have heard from black academics, medical professionals, employees, students, and average citizens who are anxious for Meharry as we embark on our investigation, fearing our institution is going to be used by JUUL to produce the research findings it needs to sell more product. Yet we also have heard from these same sectors that they want answers. As one nurse practitioner told us, “I am concerned e-cigarettes just trade one form of nicotine addiction for another one.” In fact, 85 percent of Meharry alumni surveyed – doctors, dentists and health policy experts – view e-cigarettes as a major health issue that must be studied.

This is why we are embracing this work: to dispense with the emotion and find the facts. And we will answer only to the people who count on us for healthy lives and healthy communities.

Later this month, the Meharry Center for the Social Determinants of Health will host a panel at the annual meeting of the Congressional Black Caucus in Washington, DC, to address not only the impact of electronic nicotine devices, but the continued smoking epidemic in low income and communities of color. One of the high profile issues certain to arise during our national nicotine conversation is the recent spate of nearly 200 cases of severe lung illness possibly linked to vaping. JUUL CEO Kevin Burns has stated JUUL will not pull its products unless and until a clear connection has been made between vaping and lung disease. The challenge to find answers – and break out of this limbo – could not be greater, and Meharry is moving forward with our research quickly, without fear or favor.

There are other issues that could emerge during our CBC conversation that are less high-profile but no less important to the African American medical community. For example, black dentists participating in our recent focus groups wondered if the unknown additives in e-cigarettes could interact poorly with the less expensive sedatives they must use for their uninsured or under insured patients during dental procedures.

In fact, everyone we have contacted is either wondering or worried or both – even those who are urging caution in our relationship with JUUL or encouraging us to postpone until we find non corporate research dollars elsewhere. That’s exactly why we cannot and will not postpone. We do not intend to let others who are not invested in our community take control of either the conversation or the research context. In the months and years ahead and with the betterment of our community’s health as our north star – we will lead this fight, not be its cannon fodder.