A group of prominent public-health experts on the vape crisis in the United States had a message to share in one of the country's leading academic journals this week: Don't panic.
The op-ed published Thursday in Science, perhaps the most substantial and forceful academic memo on the matter to date, is an attempt to address and reframe a narrative that has spun out of control. Alarm morphed to panic this summer following a spike of vaping-related illnesses (now largely linked to illicit THC carts) and an ongoing "epidemic" of teenage e-cigarette use, the blame for which has constantly fallen on the powerhouse JUUL, despite its denials of targeting teens. (The piece was co-authored by some of the leading scholars in tobacco control—Amy Fairchild of Ohio State; Ronald Bayer of Columbia; Cheryl Healton and David Abrams of New York University; and James Curran of Emory. Three of them are the deans of some of the most prestigious public-health schools in the country.)
Bayer and his colleagues write that allowing combustible cigarettes to stay on the market, but "restricting access and appeal among less harmful vaping products out of an abundance of caution," would be a massive setback for public health globally—not a benefit. Instead they advocate a harm-reduction approach, which has been embraced in the United Kingdom and found success there, in part because the nation enforces nicotine caps and advertising restrictions. This kind of tactic rests heavily on the assumption that nicotine itself will not be eradicated from the world anytime soon.
"In public health, there are always trade-offs," Bayer said. "You have to weigh both the risks and benefits."
The authors call for careful policy and regulation, such as some sort of "product monitoring system" and add that, "if the [U.S. is] going to take policy action on flavors, menthol in combustible products must be the first target." But, as Bayer emphasized, the crucial conclusions and recommendations they make are for taxing vaping products—enough to keep them out of the hands of teenagers, but lower than those on combustible cigarettes so as not to discourage current smokers to switch. They also suggest federally raising the legal age to purchase nicotine products to 21.
Bayer and his co-writers don't harp much on what attracts minors to experimenting with vaping, but more and more evidence has suggested it has much less to do with flavors than kids being kids. Just last week, the Centers for Disease Control and Prevention (CDC) released some data from its annual National Youth Tobacco Survey (NYTS), which noted that a majority of kids who tried e-cigs cited mere "curiosity" as their motivation. (Flavors themselves came in a distant third.) In general, critics slammed the NYTS for being both imprecise and incomplete: The student respondents didn't have an option to choose "wanting nicotine" as a primary reason for experimenting with e-cigarettes, and, as some harm-reduction opponents have already pointed out, e-cigarettes are not even tobacco products, since there is no tobacco in them.
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But even if Bayer and his colleagues can assertively present clear evidence and refute already-established preconceptions, that doesn't mean people are going to listen. Particularly if the misinformation has solidified into a firmly held belief. Because the vaping crisis has now become politicized in the most modern way possible, a criss-crossing of elements that have come to define our era. Notably, there's our distrust of longstanding, corrupt institutions: A contingent of bipartisan elected officials have insisted vaping is essentially just another ploy by Big Tobacco, a claim that has become difficult to refute since Altria, a Big Tobacco producer, purchased a 35 percent stake in JUUL at the end of 2018. And then there's a relatively niche-yet-energized bloc of voters—enough vapers, reportedly, that could swing elections in 2020 and beyond.
The battle for public opinion on e-cigarettes, then, has mainly fallen into two distinct camps: those who recognize that the rapid increase in teenage vaping is a serious problem that must be dealt with but also see e-cigarettes as a harm-reduction tool to help smokers ditch cigarettes, and those who believe that this problem can be eradicated through prohibition-esque tactics, like adopting flavor bans that many states and large cities have already done. (The Trump administration has still not landed on a strategy.)
Bayer admitted that the entire situation is "politically delicate." He does not necessarily think that the "fog" will lift—that those who have been weary or antagonistic to vaping will ever change their minds.
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