Local jurisdictions in Maine are moving quickly to restrict access to e-cigarettes. Portland and Bangor have approved bans on flavored tobacco products, with Brunswick poised to follow suit. Now the focus is shifting to the Maine Legislature, where policymakers have introduced a flurry of bills to prohibit the sale of flavored e-tobacco products or ban e-cigarettes outright. Reducing tobacco use is a laudable objective, but targeting vaping won’t deliver the public health benefits we all seek.
By lumping e-cigarettes in with combustible tobacco products, supporters of these policies have failed to acknowledge the varying levels of harm within the wide range of “tobacco products.” Though vaping is far from risk-free, a consensus has formed among public health bodies — including Johns Hopkins Medical School and the National Academies of Sciences, Engineering, and Medicine — that e-cigarettes carry far fewer health hazards than combustible cigarettes. Since e-cigarettes don’t burn tobacco, they don’t produce the dangerous tars and disease-causing gasses found in regular cigarettes.
The doses of toxins contained in e-cigarettes are typically hundreds or thousands of times lower than in regular cigarettes. In 2015, a review of the scientific literature by Public Health England stated that “e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether.” Randomized trials indicate e-cigarettes are effective smoking cessation aids, with success rates nearly double those of current FDA-approved nicotine-replacement products like gum and nicotine patches.
Despite the alarmist claims of vaping, the trend away from combustible cigarettes and toward safer e-cigarette products is a public health triumph. In 2016, for example, 2.6 million e-cigarette users in the U.S. were former smokers.
Many advocates have made the “epidemic of youth vaping” a central theme in their attempts to enact e-cigarette restrictions. But they often ignore the fact that the uptick in e-cigarette use among middle and high school students over the last decade coincides with a precipitous drop in cigarette smoking among youth. As a matter of fact, among adolescents who vape often, nearly all of them are or were smokers, which suggests that e-cigarettes might be effective replacements for combustible cigarettes among teens. For example, the 2015 National Youth Tobacco Survey revealed that just 0.3 percent of non-smoking teenagers regularly vaped.
Researchers estimate that if current trends continue, the transition from combustible tobacco products to e-cigarettes will result in “1.8 million premature smoking- and vaping-attributable deaths avoided and 38.9 million life-years gained between 2013 and 2060.”
So while e-cigarette bans would benefit those who fully abandon tobacco products as a result, the risk of e-cigarette users being driven back to the pack vastly outweighs any gains. When Minnesota enacted high taxes on e-cigarettes to try to deter their use, for example, smoking increased and smoking cessation nose-dived. One study estimates that 32,400 additional adult smokers would have quit smoking in Minnesota in the absence of the tax. Another study found that teens substantially increased their use of combustible cigarettes when vaping taxes rose. If combustible cigarettes and e-cigarettes were equally detrimental to health, then the tradeoff might be justified. But they simply aren’t.
Imposing restrictions on e-cigarette flavors is likely to produce the same outcome: steering Mainers away from low-risk e-cigarettes and toward lethal combustible cigarettes. Research led by Yale University in 2017 found that a ban on all flavored tobacco products would cause combustible cigarette use to increase by 2.7 percent, and another recent study found that a flavor ban would cause 17.1 percent of adult e-cigarette users to stop vaping and smoke instead. Based on Maine’s population and rate of e-cigarette use, these findings imply that a state-wide flavor ban would drive almost a thousand Mainers back to the pack. That’s a sobering thought.
Every year, approximately 2,400 Mainers die of diseases caused by combustible cigarettes. For the 1 in 15 high school students and 1 in 6 adults in Maine who currently smoke combustible cigarettes, cracking down on e-cigarettes will only make it harder to access a potentially life-saving alternative.