The potential of electronic cigarettes to save millions of lives is being lost because of the media, public health groups, and politicians' near singular focus on youth vaping to the detriment of adult smokers. That's according to a new paper written by 15 past presidents of the Society for Research on Nicotine and Tobacco (SRNT).
SRNT is the world's largest professional organization dedicated to studying tobacco, nicotine, and their effects on public health. For decades, SRNT has been instrumental in advancing anti-tobacco policies.
Published August 19 in the American Journal of Public Health (AJPH), the paper represents one of the most dramatic interventions by tobacco control experts in favor of a harm reduction rather than a prohibitionist approach to vaping, highlighting a significant split in the public health community.
"In my 45 years in the field of tobacco control research, I've never seen an issue that is as divisive as this one; and maybe none that is as important to public health," said Kenneth Warner, the article's lead author. Warner urges policy makers, the medical community, and broader society to rebalance their attitudes toward vaping.
Reviewing the scientific literature on e-cigarettes, the authors make clear vaping is dramatically safer than smoking. Yet, the majority of Americans incorrectly believe vaping is just as or more dangerous than regular cigarettes.
E-cigarettes are a consistent target for prohibitions, taxes, and product limitations. A leading cause of this hostility is that most media attention paid to e-cigarettes focuses on how many youths are vaping and how frequently. While a valid concern, the authors of the AJPH piece argue this often ignores the adult smokers who quit thanks to vaping and can exaggerate the threat e-cigarettes present to teens and how many are addicted.
A study of U.S. news articles on e-cigarettes cited in the piece showed from 2015 to 2018, 70 percent mentioned vaping's risks to youths, while only 37.3 percent acknowledged potential benefits for adult smokers who switch. Even celebrities are getting in on the action. Oscar-winning actress Laura Dern is partnering with the American Lung Association to warn about the dangers of e-cigarettes, claiming
The AJPH article doesn't doubt youths can become addicted to vaping, but "…the evidence does not suggest it is addicting very large numbers." The piece cites evidence showing the data don't support claims that e-cigarettes are fueling an epidemic of teen nicotine addiction. What the evidence does show is that most kids who frequently vape are either former or current smokers. Of those who have never smoked, just 2.3 percent vape regularly, and few show signs of dependence.
Fears that vaping could be a "gateway" for kids to pick up smoking are also misplaced, with the youth smoking rate having "declined at its fastest rate ever during vaping's ascendancy." Another frequently voiced concern regarding teen vaping is the potential for long-term cognitive damage. But research to date has not shown nicotine itself can harm youth by causing long-term brain changes with negative impacts on impulse control. The authors are eager for more study in this area to understand the risks of youth vaping properly.
One reason vaping is frequently maligned as a vice of high schoolers rather than a public health benefit is that smokers are no longer represented among the upper echelons of our culture: "To the more privileged members of society, today's smokers may be nearly invisible. Indeed, many affluent, educated US persons may believe the problem of smoking has been largely 'solved.' They do not smoke. Their friends and colleagues do not smoke. There is no smoking in their workplaces, nor in the restaurants and bars they frequent." About 14 percent of Americans smoke. However, smoking is heavily concentrated among those in the LGBTQ community and those with lower incomes, with mental health problems, or without a college degree.
To maximize the benefits of vaping, the authors recommend, among other things, higher taxes on regular cigarettes. Still, e-cigarette taxes should be "more modest" and far lower than cigarettes, encouraging smokers to switch. Instead of banning all e-cigarette flavors other than tobacco, which could hinder many adult smokers from switching, the authors suggest they could be restricted to adult-only stores. Government agencies and health bodies could highlight concerns about youth vaping but communicate the benefits of switching to adult smokers to counter misinformation about vaping. The document is a far cry from a free market manifesto but is a welcome challenge to the prevailing orthodoxy among many public health groups that the policy response to vaping should be one of draconian restriction.
"We agree with former Surgeon General C. Everett Koop who, in 1998, urged that '[A]s we take every action to save our children from the ravages of tobacco, we should demonstrate that our commitment to those who are already addicted . . . will never expire.' The latter appears at risk today," the paper warns.