In an unfortunate trend across the country, cities and towns have raced to institute new regulations and update existing laws that deal with e-cigarettes and vapor products, often with little consideration of the potential these products have to improve public health.
In Massachusetts, recent actions by local boards of health to label e-cigarettes as “tobacco products” are misleading, at best, and at worst, a move that limits access to far less-harmful alternatives to cigarettes. Many local policies aimed at protecting teens from smoking myopically disregard the effects on the adult smoking population.
Tobacco harm reduction is an approach to public health that seeks to reduce the incidence of cigarette use and smoking-related diseases by encouraging smokers to switch to less-harmful alternatives. These include e-cigarettes, vapor products and certain smokeless tobacco products that, while not completely without risk, are orders of magnitude less harmful to a person’s health than their combustible cousins.
Historically, American tobacco control policy has been based on the premise that all tobacco products are hazardous and that none can offer personal or public health benefits. However, peer-reviewed research by the United Kingdom’s Royal College of Physicians has demonstrated that e-cigarettes are a significantly safer than cigarettes, which continue to be both the most widely used and the most harmful tobacco products on the market.
That work by the Royal College of Physicians is particularly notable in light of the fact that it was they, decades ago, who presented the first comprehensive study on the negative health impact of cigarette use.
More recently, in the United States, Food and Drug Administration Commissioner Scott Gottlieb echoed similar sentiments in a recent Washington Post interview. Gottlieb noted that most e-cigarettes contain nicotine, a known addictive substance, but the real threat to humans are the carcinogens produced when tobacco is combusted. Electronic nicotine delivery systems, or “ENDS,” provide a safer alternative for adults who still want access to nicotine but avoid that mass of carcinogens.
While the relative safety of noncombustible products is not in doubt, many local boards of health continues to resist their use out of fear that they may lead to heightened incidence of tobacco use among teens. In particular, there are concerns that “flavored products” attract teens to smoking. In response, localities have issued broad prohibitions on the sale of such products, without differentiating between cigarettes and less-harmful alternatives. Recently in Massachusetts, the towns of Canton and Marion and the city of Gloucester all have considered regulations that, if approved, will greatly reduce access to a host of less-harmful, non-combustible alternatives.
The unintended consequence of such rules is that they could make those who already smoke less likely to transition away from cigarettes. Furthermore, a recent study by Saul Shiffman and colleagues that examined flavor preferences among adolescent nonsmokers found they had less interest in supposedly youth-targeted e-cigarette flavors than adult smokers. In fact, the study concluded that teens preferred flavors that seemed more “adult-like.” Thus, not only do flavor bans not have their desired effect of preventing teens from smoking, they actually make it more difficult for adult smokers to improve their health. That’s bad policy.
A holistic approach to harm reduction demands that, in addition to discouraging adolescents from nicotine and cigarette use, a significant goal of any tobacco regulation should be to encourage adult smokers to switch to safer alternatives. Greater flavor options provide smokers with more paths away from the most harmful and widely used tobacco products – cigarettes. Taking steps to make e-cigarettes less accessible to current and future smokers means failing to make progress on reducing future rates of smoking-related diseases, which collectively kill 480,000 people in the United States each year.
By focusing solely on minors, many of these local regulations disregard and discount cigarette use among adults. The measure of a successful public health policy should be the impact it has on the whole population, not just certain segments. While cigarette use in the United States is at an all-time low, the significant drop-off in smoking rates is due, at least in part, to the development of attractive (and much safer) alternatives.