Policy Studies Harm Reduction

Analyzing Medical Advocacy Organizations’ Positions on E-cigarettes

by Chelsea Boyd

May 16, 2023

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Author

Chelsea Boyd

Resident Research Fellow, Harm Reduction

Key Points

Advocacy organizations should promote the need for high-quality research that considers and attempts to mitigate the challenges of studying e-cigarette use.

Public education campaigns should be targeted to appropriate audiences and should evolve as scientific evidence evolves.

Because medical advocacy organizations play a key role in the discourse about e-cigarettes, they should educate policy makers about the nuances of the issue, encourage policymakers to consider the net public health impact of their recommendations, and encourage governmental organizations to correct misperceptions and clearly communicate relative risk.

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Medical advocacy organizations influence professional practice and legislative priorities, both of which eventually impact the perspective of the general public.

Executive Summary

Medical advocacy organizations often promote policy change. Their advocacy work can also influence public perception of health conditions and behaviors. With this in mind, we conducted a study to analyze these organizations’ publicly available policy or position statements related to e-cigarette use. We describe the content of the statements, explore the nuances of the science underpinning the statements, and discuss how the statements may contribute to the social and policy environment.

Fourteen policy/position statements met our study inclusion criteria. After reviewing the statements, we conducted a qualitative discourse analysis by thematically coding the content of each and tabulating the frequency with which identified themes appear. We identified 12 themes and 18 subthemes, which we condensed into six broad categories that provided a loose structure for reporting the results of the discourse analysis: youth use; nicotine addiction; health impacts and e-cigarette or vaping use-associated lung injury; chemical exposure; accidental injuries and poisonings; and calls to action.

Our study found that, overall, the medical advocacy organizations’ statements were grounded in scientific evidence, but they often failed to convey important subtleties. This is noteworthy because the discourse produced by medical advocacy organizations has social and political implications. Although the statements often offered a balanced assessment of e-cigarettes’ potential harms, the message that has been reaching and resonating with policymakers and the public is that e-cigarettes are more harmful than combustible cigarettes, which is the opposite of the general scientific consensus. This misalignment is problematic, as the message of increased harm—in addition to other misperceptions about relative risk, nicotine and net effect on public health—has led to misguided proposed and implemented policies that include bans on all non-tobacco-flavored e-cigarettes and limits on nicotine concentration.