Monday, June 17, 2024

Tobacco Research Leaders Call for a Reset of the Vaping Debate


With less than a month before the FDA is expected to make decisions on authorizing vaping products, a new paper from a group of respected longtime tobacco control leaders could fundamentally change the conversation around vaping. It’s intended to do just that.

The paper argues that public understanding of vaping has been poisoned by powerful interests that have exaggerated the risks of e-cigarettes to youth and largely ignored the potential benefits of vaping for adults who smoke. The authors say that adult smokers as a group have become invisible to the tobacco control groups and media that control the one-sided conversation.

The paper, published today in the American Journal of Public Health, was co-authored by 15 past presidents of the Society for Research on Nicotine and Tobacco (SRNT), led by University of Michigan School of Public Health emeritus professor and dean Kenneth Warner. Warner presented a summary of the findings earlier this year at the U.S. E-Cigarette Summit.

The authors are among the most respected in the tobacco control field. In addition to Warner, they include Neal Benowitz, Dorothy Hatsukami, Nancy Rigotti and Robert West—all household names in the tobacco control world. None of them can be accused of being tobacco or vaping shills, and none can be dismissed as non-experts.

While the primary value of the paper is in the reputations of the people who wrote it, it also serves as a wonderfully concise literature review, presenting both-sides evidence on most of the major vaping issues of the day in a format easy to read for deadline-bound reporters.

The authors cite the growing evidence in both clinical and population studies that vaping helps smokers quit cigarettes; they describe recent drops in cigarette sales that correspond with increases in vaping adoption; and they note that policies (like taxes) that reduce the appeal of vaping increase smoking, making the two practices economic substitutes.

They dispute the evidence that vaping is causing an “epidemic” of youth nicotine addiction, citing studies that show no population-level increase in nicotine dependence, and very little frequent vaping among tobacco-naive youth. And they cite studies showing that “vaping likely diverts more young people from smoking than encourages them to smoke.”

The authors are cautious regarding the flavor debate, but they acknowledge that flavors are important to the former smokers who quit with vaping. “While flavor bans could reduce youth interest in e-cigarettes,” they write, “they could also reduce adult smokers’ vaping to quit smoking.” They suggest limiting flavored vaping products to adult-only retail outlets like vape shops.

While no one is called out by name, Warner and his colleagues are genuinely bothered by the tactics of the Bloomberg-funded Campaign for Tobacco-Free Kids and their allies that have excluded any consideration for the lives of adults who smoke from their political crusade. Public health agencies like the FDA and CDC haven’t been much better.

“While evidence suggests that vaping is currently increasing smoking cessation,” they write, “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.”

Many of the 34 million adults who smoke are from low-income or low-education populations, and from at-risk groups like LGBTQ citizens and people with mental health conditions. The authors say vaping could help those groups achieve life-expectancy parity with the rest of the adult population. That makes vaping a social justice issue—as many vaping advocates have pointed out before.

The public health agencies and anti-tobacco organizations that control the vaping discourse simply don’t consider the lives of adults who smoke as part of the discussion. It’s as though they don’t exist.

“To the more privileged members of society, today’s smokers may be nearly invisible,” write Warner and his colleagues. “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.”

The Warner paper is unlikely to teach politically active vapers anything new about the issues, but that’s beside the point. It’s a paper that needs to be shared with local and state politicians, quoted in letters to the editor, linked in responses to anti-vaping social media posts, and (metaphorically) scrawled on the walls of public health agencies.

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