A Vision for Tobacco Policy; 2020 Edition

Published February 10, 2020

Smoking rates among adults and youth are plummeting. And while too many youth are vaping, legislators and regulators at the federal lave have recently made significant changes which are likely to improve the situation.

But state legislatures around the country are poised to do what some politicians do best: Overreact.

That’s what happened in New Jersey this month, where Governor Murphy signed a bill banning the sale of flavored e-cigarettes to everyone, including adult smokers. Many states are also considering disproportionate taxes on e-cigarettes, a move that has already backfired in Minnesota, where quitters are become smokers again.

Two factors are driving draconian proposals will be considered in more than half the states in coming months. And if New Jersey and Minnesota are any indicators, lots of relevant information is being ignored to the detriment of public health.

First, the last half of 2019 saw the outbreak of lung injuries mislabeled as “e-cigarette, or vaping, product use-associated lung injury,” or EVALI.

The U.S. Centers for Disease Control finally acknowledges what many of us knew in August, which was that the outbreak was caused by adulterated THC oil, not water-based nicotine e-cigarettes.

Boston University public health professor Dr. Michael Siegel has chronicled the many harms caused by improperly blaming nicotine e-cigarettes such as Juul for a disease outbreak caused by an entirely different class of product.

As a result, smokers now have another convenient (and incorrect) excuse not to quit smoking.  The CDC and other opponents of tobacco harm reduction manufactured and promoted the misperception that e-cigarettes are more dangerous than smoking.

The second rationale for banning the sale of flavored e-cigarettes (to adults) is that there’s an “epidemic” of vaping among youth. Certainly, we shouldn’t be complacent about teen vaping. But regulatory efforts should be informed by the data and considered with a dose of cool-headed context.

Recently survey data from the CDC reinforces what we’ve known for a long time. Kids are curious and experiment with risky products. Flavors do make e-cigarettes enjoyable — which is why they are critical to keep former smokers from relapsing. But it’s not the flavors that induce teens to vape.

So, it’s important that measures taken to prevent youth vaping are in accord with the data and the science.

Here’s what we do know: According to an analysis of survey data from the 2018 National Youth Tobacco Survey published this month in Nicotine & Tobacco Research, over 86 percent of youth don’t vape.

Among those who do, most don’t do it regularly. And of those who do, most of them already have had experience with cigarettes. That’s an important and relevant finding because it suggests that vaping isn’t the “on-ramp” to smoking, as former FDA Commissioner Dr. Scott Gottlieb and others have hypothesized. Instead, it suggests that e-cigarettes are largely being used as an alternative to — or a detour away from — the far more dangerous behavior.

The researchers from the NYU School of Global Public Health also analyzed federal survey data from 2013 through 2019 and found that cigarette smoking decreased at a more rapid rate —including to a record low— during the very same years vaping increased.

According to study co-author Dr. David Abrams, “the faster drop in smoking suggests vaping is helping displace youth use of much more deadly smoking— a net harm reduction benefit to the population as a whole.”

Banning the sale of flavored e-cigarettes to adults to prevent youth vaping would undermine real public health gains; especially since more narrowly tailored restrictions have just been instituted, but not yet captured by survey data.

For starters, the federal government has just raised the legal age to purchase tobacco (and e-cigarettes) from 18 to 21.

In a January op-ed in the Washington Post, Dr. Gottlieb wrote, “If the 2020 National Youth Tobacco Survey, which begins in March, is going to show a decline in minors’ use of e-cigs, the new age restriction is the best hope.”

That’s because kids “get their e-cigs through social sources: the 18-year-old high school senior, say, who legally purchases e-cigs and resells them to younger students,” writes Dr. Gottlieb.

Further, the FDA has, at least for now, banned the sale of flavored pod-based e-cigarettes as it begins to review applications to authorize the sale of e-cigarettes. Those applications, due in May, will have to persuade the FDA that the marketing of the product to adult smokers will benefit public health.

Instead of recklessly taxing, if not outright banning all flavored e-cigarettes, state lawmakers should take responsible steps to protect public health by strictly enforcing the ban of sales to those under 21. Currently, only 19 states and Washington, D.C. have such laws on the books, complicating enforcement of the new federal law.

Overzealous health authorities in the U.S. have a lot to learn from their lackluster performance in 2019. But there’s hope. Hindsight is so 2020.

[Originally Published at Real Clear Health]