The fight over what to do with e-cigarettes is continuing to heat up, and New York is the latest state to err on the side of caution.
On Monday, New York Governor Andrew Cuomo signed a law that will ban the use of e-cigarettes in places where smoking is already prohibited, including in public indoor spaces like restaurants, bars, and workplaces. Many of the state's local counties had already passed restrictions on e-cigarette use, but the new legislation creates an universal standard throughout the state. The ban, which will go into effect in 30 days, is an extension of the state's existing Clean Indoor Air Act implemented in 2004, which outlawed the use of tobacco cigarettes in most public spaces.
"Closing the e-cigarette loophole by including it in the Clean Indoor Air Act is a long-overdue step that will help protect every New Yorker's right to enjoy indoor public spaces free from the intrusion of e-cigarette vapor," said Assemblymember Linda B. Rosenthal, one of the bill's cosponsors, in a statement.
New York is the 11th state to create an e-cigarette ban as harsh as the nationwide ban imposed on tobacco. The other states with similar laws are: California, Connecticut, Delaware, Hawaii, Maine, New Jersey, North Dakota, Oregon, Utah, and Vermont. Many cities across the country also have bans—New York City has had a ban in place since 2013. Only a few states like Nevada have held off entirely on imposing restrictions on where you can vape, with many cities banning it in schools and government-owned buildings. And New York almost certainly won't be the last place to shut the door on indoor vaping; cities in Minnesota and Colorado are already weighing similar bans.
Though the Associated Press reports that organizations like the American Lung Association and the American Cancer Society endorsed the ban, vaping enthusiasts aren't too pleased about the trend of treating e-cigarettes the same way as their tobacco version.
Some vaping advocates say these restrictions and regulations are both ignoring the science and dooming smokers to a cruel fate. While both products provide users with nicotine, vaping is absolutely safer than smoking, they argue, thanks to the relatively fewer number of toxins users are exposed to. Because of that, the effects of nudging cigarette smokers into vaping would be dramatic and life-saving. One recent study published earlier this August, for instance, estimated that 6.6 million early deaths would be prevented over a 10 year-old period if a majority of smokers switched to vaping full time.
Vaping critics in the public health world, however, are less convinced by these claims, arguing that we know little about how e-cigarettes can affect us, especially over a long period. Some research, as recently reported by Tonic, has suggested vaping can cause harm to our lungs that's both similar to and different from smoking tobacco; other research has found that certain popular vaping fluids that add flavor could also be hazardous when inhaled. For these scientists, New York's indoor ban is an unequivocal public health win.
"Until we know exactly the health effects [of e-cigarettes], through both short- and long-term studies, these products should absolutely be regulated like tobacco cigarettes," Emanuela Taioli, director of the Institute for Translational Epidemiology at Mount Sinai's Icahn School of Medicine in New York, tells Tonic. "Because they do contain carcinogenic and addictive products; the main two reasons why tobacco is banned."
Taioli believes that current research suggesting e-cigarettes are relatively harmless is woefully underwhelming. For example, few studies have looked at how vaping could affect the heart and cardiovascular system, she says. Nicotine is already known to increase the risk of cardiovascular disease when inhaled through cigarette smoke. And while other nicotine replacement therapies like the gum or patch largely avoid that added risk, vaped nicotine seemingly doesn't.
"It's a complicated issue," Vaughan Rees, director of the Center for Global Tobacco Control at Harvard University, tells Tonic. Though there's still a lot we don't know about vaping's health effects, it has the potential to be a substantial harm reduction method for current smokers, Rees explains. While public health experts have rightfully trumpeted the declining smoking rate in America recently, much of this victory has come from preventing new smokers; quitting tobacco for good remains a difficult feat for the majority of users. Vaping, then, might be the first tobacco replacement that can really keep smokers on the wagon, and there's already some early evidence showing just that.
"We're dealing with an epidemic that kills, in the United States alone, half a million people annually," Rees says. "If that's not a public health emergency, I don't know what is."
But even among experts like Rees who are legitimately hopeful that vaping could prevent smoking deaths, New York's indoor ban isn't necessarily unpopular.
"I'm arguing that we should embrace e-cigarettes as a less risky alternative to tobacco use. But it makes good sense to not renormalize the use of nicotine products by using them indoors," Rees says. "That's not inconsistent with saying we want to ensure e-cigarettes are available to smokers if and when they need them."
On both sides of the scientific debate at least, those like Rees and Taioli agree that e-cigarettes shouldn't be being marketed and sold to people who definitely stand to gain nothing from using them, like young teens who've never smoked. To that end, they say it's just common sense to socially stigmatize e-cigarettes every bit as much as their combustible counterparts through bans and regulations (like those that ban fruity, kid-appealing flavors). Despite a decrease from 2015, it's estimated that more than 2 million middle and high schoolers were considered current e-cig users in 2016 (meaning they had used an e-cig within the last month at the time of a Centers for Disease Control and Prevention survey).
"There's a legitimate role for e-cigarettes in reducing tobacco harm, but only when done in concert with appropriate regulations to reduce demand for e-cigarettes, particularly among youth," Rees says.