The Volokh Conspiracy

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Tobacco Control Advocates Claim Vaping Policies Are Unbalanced, May Cause Harm

Undue emphasis on unproven risks to youth may have undermined efforts to control smoking, costing lives in the process.


A new article in the American Journal of Public Health signed by fifteen past presidents of the Society for Research on Nicotine & Tobacco calls for a recalibration of U.S. policy on e-cigarettes and other nicotine-containing vaping products. The article, "Balancing Consideration of the Risks and Benefits of E-Cigarettes," reviews the relevant scientific literature on the potential risks and benefits of e-cigarettes and concludes that U.S. policy is out of whack.

Here is the abstract:

The topic of e-cigarettes is controversial. Opponents focus on e-cigarettes' risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths. Because of their messaging, much of the public—including most smokers—now consider e-cigarette use as dangerous as or more dangerous than smoking. By contrast, the National Academies of Science, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. Policies intended to reduce adolescent vaping may also reduce adult smokers' use of e-cigarettes in quit attempts.

Because evidence indicates that e-cigarette use can increase the odds of quitting smoking, many scientists, including this essay's authors, encourage the health community, media, and policymakers to more carefully weigh vaping's potential to reduce adult smoking-attributable mortality.

We review the health risks of e-cigarette use, the likelihood that vaping increases smoking cessation, concerns about youth vaping, and the need to balance valid concerns about risks to youths with the potential benefits of increasing adult smoking cessation.

Among other things, the article summarizes evidence suggesting that the misplaced focus of U.S. health agencies (including the FDA and CDC), combined with slanted media reporting, has resulted in widespread public ignorance about the potential risks and benefits of vaping, particularly among those for who whom vaping would be beneficial: current smokers. Perversely, producers and retailers of vaping products cannot do their part to inform smokers that e-cigarettes pose fewer health risks and could help them quit smoking, as providing such information to consumers would violate federal law (as I discuss in this article). The paper also notes extensive research (about which I have blogged here before) finding that well-intentioned restrictions on e-cigarettes can increase smoking rates, including among youth.

Here is the paper's conclusion:

We share the very legitimate concerns about youth vaping with the entire field of public health. Our goal is to put those concerns in perspective. 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.

While evidence suggests that vaping is currently increasing smoking cessation, the impact could be much larger if the public health community paid serious attention to vaping's potential to help adult smokers, smokers received accurate information about the relative risks of vaping and smoking, and policies were designed with the potential effects on smokers in mind. That is not happening. The need to pay attention to adult smokers is particularly important from a social justice perspective. African Americans suffer disproportionately from smoking-related deaths, a disparity that, a new clinical trial shows, vaping could reduce. Today's smokers come disproportionately from lower education and income groups, the LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) community, and populations suffering from mental health conditions and from other drug addictions. Smoking accounts for a significant proportion of the large life expectancy difference between affluent and poorer Americans. For smokers with serious psychological  distress, two thirds of their 15-year loss of life expectancy compared with nonsmokers without serious psychological distress may be attributable to their smoking. Vaping might assist more of these smokers to quit.

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. Yet 1 of every 7 US adults remains a smoker today.

Smoking will claim the lives of 480 000 of our fellow citizens this year alone.