Signs of sanity in US tobacco control?

The American Journal of Public Health has published an article by fifteen past presidents of the Society for Research on Nicotine and Tobacco. Not all of it is sensible - they support raising the age at which e-cigarettes can be bought to 21 and they support the idiotic policy of reducing nicotine in cigarettes - but it is a beacon of enlightenment compared to most of the commentary coming out of the USA these days.

The key points:

Vaping reduces the smoking rate

For years, US cigarette sales declined 2% to 3% annually. More recently, as vaping product sales increased, cigarette sales decreased much more rapidly. Con- versely, following the EVALI outbreak and e-cigarette sales restrictions, sales of e-cigarettes fell and sales of cigarettes resumed their prevaping pattern. Studies finding a positive cross-price elasticity of demand between cigarettes and e-cigarettes support the conclusion that the products are substitutes. 

Although not the final word, the totality of the evidence indicates that frequent vaping increases adult smoking cessation. Smokers unable to quit smoking with evidence-based cessation methods should be well informed about the relative risks of vaping and smoking and vaping’s potential to help them quit smoking.

Flavour bans are stupid an counterproductive

Recent policy attention has focused on restricting the availability of e-cigarettes with flavors, a principal attraction for youths. While flavor bans could reduce youth interest in e-cigarettes, they could also reduce adult smokers’ vaping to quit smoking. Like youths, adults prefer nontobacco flavors, both groups favoring fruit and sweet flavors. Policies regarding flavors reflect the more general issue considered in this article: the need to create a balance between the sometimes-conflicting goals of preventing youth vaping and supporting adults’ smoking cessation attempts 

The gateway effect is trivial, if it exists at all

Prospective studies have found that young people who had vaped but never smoked cigarettes were more likely to have tried cigarettes several months to 2 years later than contemporaries who had neither smoked nor vaped. Some commentators thus consider vaping a “gateway” into smoking. Other observers believe the relationship reflects a “common liability”: young people who vape are generally more prone to risky behavior; hence, they might be more likely to try smoking even without vaping. Three recent studies have concluded that vaping likely diverts more young people from smoking than encourages them to smoke.

.. If vaping causes some young people to try cigarettes, the aggregate impact must be small. 

..Vaping may addict some youths to nicotine, but many fewer than popularly believed. 

Anti-vaping policies are effectively pro-smoking policies

To date, the singular focus of US policies on decreasing youth vaping may well have reduced vaping’s potential contribution to reducing adult smoking. Those policies include taxing e-cigarettes at rates comparable to cigarette taxes, decreasing adult access to flavored e-cigarettes that may facilitate smoking cessation, and convincing the public—including smokers—that vaping is as dangerous as smoking.

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 dem- onstrate 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.

Do read it all.