The Volokh Conspiracy

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Volokh Conspiracy

Is the surgeon general endangering America's youth?


Last week, the U.S. surgeon general released an extensive report on the use of electronic cigarettes and other vaping products by youth and young adults. The report urges greater restrictions on youth access to vaping products and received substantial media attention, which largely focused on the report's central message of discouraging e-cig use among youth. Unfortunately, the report is misleading in key respects—indeed, "scientifically dishonest," according to one public health researcher—and could actually do more harm than good.

The new report,"E-Cigarette Use Among Youth and Young Adults," is intended to sound the alarm about e-cigarettes. According to the surgeon general, e-cigarette use is "a growing public health threat to our nation's young people." Although teen smoking rates have declined—which is incredibly good news—teen use of vaping products has increased, at least as measured by the National Youth Tobacco Survey. (The NYTS data has limits because it adopts an extremely broad definition of e-cigarette "use.") This is a potential concern, but it should not be overstated, nor should it distract from efforts to continue to reduce teen smoking.

E-cigarettes are not risk-free. Most contain nicotine, which is highly addictive. Vaping aerosol also contains potentially harmful constituents (albeit at far lower levels than are found in cigarette smoke). While I would recommend vaping as an alternative to smoking, it's not a habit I would otherwise encourage.

Whatever the risks of vaping, it is well-established that e-cigarettes pose much lower risks than actual tobacco products. Insofar as vaping products serve as a substitute for tobacco products, their use can actually help improve public health through harm reduction. Yet the report repeatedly treats vaping products as just another form of tobacco—calling them a tobacco product—even though they do not contain tobacco and do not pose the same risks.

Although the surgeon general's report acknowledges some of the evidence showing e-cigarettes to be less harmful than tobacco cigarettes—and that smokers would reduce their health risks "substantially" were they to switch to vaping products—the report largely glosses over evidence that vaping products often serve as a substitute for tobacco products, such that restrictions on vaping products can increase smoking, including among young people.

Although one would not realize this from reading the surgeon general's report, there are now several studies that look at the effect of restricting teen access to vaping products showing that such measures increase teen smoking (including among pregnant women). I'll say that again: Reducing youth access to e-cigarettes appears to increase youth smoking rates. (I blogged about some of these studies here and here.) Despite their relevance, these studies are completely ignored by the surgeon general. They're not even listed in the report's references.

Why aren't these studies cited? It's not because they lack relevance, as they address the central issue of the report. It's not because they aren't reputable. They are authored by researchers at Yale and Cornell and published in such journals as Preventive Medicine and the Journal of Health Economics. It's not because they are too recent, as the report cites more recently published studies.

Whatever the reason, the surgeon general's report ignores relevant research on the effect of e-cig regulations on teen smoking rates, and the result is a report that does not grapple with real public health questions and has the potential to do more harm than good. Indeed, if policymakers follow the surgeon general's recommendations, they may actually make public health worse by increasing smoking rates among children.

The potential harm of misguided e-cigarette regulation is magnified by the fact that powerful special interests seek to manipulate such regulation for their benefit. As my co-authors and I discuss in this new article from the Yale Journal on Regulation, current e-cigarette regulation is a product of a "Baptist & Bootlegger" coalition of well-intentioned health activists and tobacco companies. E-cigarette policy is also shaped by pharmaceutical companies, which see vaping products as a source of competition for their (largely ineffective) tobacco cessation products. I discuss these dynamics further here.

Let me close on a personal note. I have two daughters. I hope that neither of them chooses to smoke or vape. But if they were going to do one or the other, there is no question which I would choose. Indeed, if I had a choice between one of them smoking and both of them vaping, the latter is still an easy call. And precisely because I care about my children's health, I would not mislead them about what we know about the relative risks between e-cigs and actual tobacco products.

The Office of the Surgeon General is supposed to "provide[] Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury." With its latest report on e-cigarettes and youth, the surgeon general has failed to fulfill this purpose.