Public Health is in Dangerous Denial on Vaping
Most people, especially in lower socioeconomic areas where smoking has historically been most prevalent, will know someone who has replaced their previous smoking habit by exclusively vaping. Yet, it is still the Food and Drug Administration’s (FDA) misguided view that vaping is not helping people quit smoking traditional cigarettes. The agency’s published guide to e-cigarettes still claims that “there is not yet enough evidence to support claims that e-cigarettes and other [electronic nicotine delivery devices] are effective tools for quitting smoking.”
Likewise, materials for the American Cancer Society’s (ACS) Great American Smoke Out actively discourages use of vaping and claim that “there’s just not enough research or evidence yet” for their efficacy in helping people quit smoking. This is in direct contrast to the UK’s annual stop smoking campaign, Stoptober, which includes vaping products as a prime stop smoking option recognized by the National Health Service.
However, new research has shown that the increased use of reduced risk products such as e-cigarettes and vapes is, indeed, leading to a consequential reduction in cigarette sales across the United States. In a preprint published in October, researchers analyzed cigarette sales before and after widespread take-up of vaping in the U.S. and found that vaping has significantly displaced smoking at the population level.
Trends in cigarette sales were modelled in the period from 2014 to 2016 before vapes had achieved a substantial market share and the data into the period from 2017 to 2019 when vaping had gained a foothold amongst the smoking population.
The outstanding analysis was careful to control for macroeconomic factors and concluded that cigarette sales were lower across the period that followed substantial market share for e-cigarettes, resulting in a “cigarette shortfall” of up to 16 percent. It was clearly vaping products which led to this. The researchers studied per-capita sales volumes and identified that cigarette sales were 1.4 packs-per-capita lower than expected.
This strongly suggests that if the U.S. government and health agencies wish to see a significant reduction in use of combustible tobacco, simply giving clear messages directing smokers towards far safer vaping products would deliver highly positive results. By not doing so or remaining in denial about the potential benefits of vaping for public health, the FDA, ACS, and other public health organizations are merely protecting the cigarette trade from competition.
Current data on smoking and vaping in America tend to bear out what the study researchers found, with the latest Behavioral Risk Factor Surveillance System (BRFSS) survey estimating that 34 million people smoke across the country and 17 million vape. It is inconceivable that the U.S. is somehow different to other countries where data routinely finds the vaping population to be almost exclusively drawn from those who formerly smoked.
Too many in American public health circles are wedded to an abstinence-only approach to smoking and refuse to give weight to the benefits that reduced risk nicotine products can play to rapidly reduce the prevalence of adult smoking.
The FDA and others in the science and health community should be resetting ideological objections to the use of vaping products and should immediately cease pretending that there is no smoking cessation potential for e-cigarettes and vapes.
The evidence is clear that vaping is a direct substitute for smoking for many adults and acts as a diversion from combustible tobacco for millions of people. Comparisons between countries which have liberal policies towards vaping and those who do not show that the former experience declines in smoking far greater than the latter.
This latest research proves that the direction of travel in recent years among American nicotine users has been from smoking to vaping, which increases as vaping products become more available. To deny this – as the FDA, ACS and others continue to do - in the face of overwhelming real-life experiences and what regular citizens can see with their own eyes is not only laughable, but acts as an obstruction to improved public health by deterring more people from making healthier choices.
Martin Cullip is International Fellow at The Taxpayers Protection Alliance's Consumer Center and is based in South London, UK.
