Anti-e-cigarette alarmism reached fever pitch recently, with the release of the surgeon general’s first-ever report on youth e-cigarette use.
Purporting to be the country’s most scientifically-sound report into the threats e-cigarettes pose to young people, it comes up woefully short and gives a fundamentally dishonest impression of the state of use and risks of vaping.
“These products are now the most commonly used form of tobacco among youth in the United States,” Surgeon General Vivek Murthy warns ominously. This language appears designed to sow maximum possible confusion about what e-cigarettes are and their dangers relative to tobacco cigarettes.
It is flat out wrong to describe vaping as a “form of tobacco use.” E-cigarettes contain zero tobacco and are up to 95 percent safer than regular cigarettes, according to the United Kingdom’s Royal College of Physicians. To imply the risks of vaping are in any way equivalent to the risks of smoking is a severe misrepresentation of the truth.
The report makes great play of the surge in e-cigarette use among high school students. While the data cited are accurate, its presentation gives a highly misleading picture of teen e-cigarette use.
Murthy highlights data on middle and high school students who have ever used e-cigarettes or have used e-cigarettes in the past 30 days, showing dramatic increases since 2011. What Murthy doesn’t make clear is that the vast majority of teens using e-cigarettes do so only occasionally or experimentally.
Only around 1 percent of high schoolers vape daily. Many of them use vaping products with zero nicotine, which is the principal focus of the report’s health concerns.
The report also takes great pains to stress the strong association between youth vaping and youth smoking. But this association should come as a surprise to no one, as a high proportion of those young people vaping are also smokers or are among those most likely to smoke. The way the report presents this association, one would think vaping is very likely a gateway to smoking.
But we only have to look at the data to quickly dispose of this notion. The United States’ teen smoking rate has been in free fall for the last three years, at the same time that vaping prevalence has been rising. In 2015, the cigarette smoking rate among U.S. high school students fell to the lowest level since the National Youth Risk Behavior Survey began in 1991.
If vaping was a gateway to smoking, we should be seeing a dramatic increase in the teen smoking rate, not the reverse. Far from being a gateway to smoking, e-cigarettes are a gateway to quitting or even a barrier to teens taking up smoking in the first place.
While Murthy is correct to point out that vaping is not entirely safe, the report totally evades how much safer it is than smoking. This omission fails the most elementary rule of analysis whenever one is discussing the risks of e-cigarettes: Risky compared to what?
If young people, or anybody else for that matter, are quitting combustible cigarettes for e-cigarettes it is a net health benefit. While the ideal scenario is that all minors abstain from both tobacco and vapor products, vaping appears to be displacing smoking, showing that teens are taking a step in the right direction.
By only highlighting the risks associated with vaping, Murthy’s report offers a salad of confused and highly counterproductive policy recommendations.
Higher taxes on vaping, marketing restrictions and application of smoke-free policies to e-cigarettes are all justified on the grounds of limiting access to minors. They will, however, likely harm adult smokers trying to quit or cut down.
But as the Royal College of Physicians pointed out in a groundbreaking report earlier this year, making e-cigarettes more expensive, less accessible and less acceptable could push people toward smoking and away from less harmful products.
Murthy views e-cigarettes through the lens of abstinence at any price rather than tobacco harm reduction. This leads to poor evidence and even poorer policy recommendations, with Murthy’s report now being a leading example.
This column first appeared in The Washington Examiner.