With youth vaping hitting a 10-year low, policymakers should focus on harm-reduction
Photo 91235473 © Ruslan Gilmanshin | Dreamstime.com


With youth vaping hitting a 10-year low, policymakers should focus on harm-reduction

Nations that have embraced noncombustible nicotine products and tobacco harm reduction are reaping the public health benefits.

Youth vaping in the United States has hit a 10-year low, according to new data from the Centers for Disease Control and Prevention (CDC). The so-called youth vaping epidemic appears to be a thing of the past, with historical lows in youth smoking dispelling fears of a gateway effect. The focus of anti-tobacco advocates and policymakers, however, remains disproportionately fixated on youth vaping, diverting attention and resources away from those at the greatest and most immediate risk of tobacco-related disease and death: adult smokers. 

From a public health perspective, the news is good. The latest National Youth Tobacco Survey (NYTS), an annual CDC-administered survey of middle and high school students, reveals that only 10 percent of high schoolers and just 4.6 percent of middle schoolers reported any e-cigarette use in the previous month. It signifies a 20 percent decline in youth vaping from the previous year and an impressive 60 percent drop since its peak in 2019. The survey also highlights a broader positive trend, with diminished youth interest in all forms of tobacco, particularly traditional cigarettes, as a mere 1.6 percent of youth reported current smoking. 

The youth vaping epidemic, declared by the Food and Drug Administration (FDA) in 2018, appears now to have been more of a teenage fad—one possibly partially fueled by media attention on the issue. But, while the vaping fad may be subsiding, the hysteria surrounding it continues unabated. Anti-vaping campaigns and legislation continue to sweep across the country, often swaying towards outright bans, leaving little room for a nuanced discussion of the varying risk profiles of noncombustible nicotine products, the benefits lower-risk nicotine products may provide adult smokers, or the potential unintended consequences of youth-centric policy proposals. 

Even nations with minimal youth vaping rates but high smoking prevalence began to criminalize e-cigarettes. In the U.S., lawmakers implemented a barrage of regulations, from online sales bans, restrictions on shipping, exorbitant taxes, bans on flavors, and prohibition of all sales. Regrettably, these policies meant to make e-cigarettes and other noncombustible sources of nicotine less attractive to youth have a similar effect on adults, discouraging adult smokers from potentially life-saving alternatives to cigarettes.

The reality obscured throughout the panic over youth vaping is that nicotine without combustion poses minimal risk of harm. While nicotine use carries a risk of dependency, dependency itself is not necessarily harmful. Dependency can quickly lead to harm, however, when public policy prioritizes abstinence above all other considerations, including the well-being of those who continue to use that substance. Take caffeine, for example, a different habit-forming substance that over 80 percent of Americans use daily. Caffeine addiction, though not completely without risk, is a relatively widespread dependency with few individual or social harms. Were caffeine treated like nicotine and caffeine abstinence the main focus of public policy, harms would almost certainly emerge as caffeine consumers turn—as e-cigarette consumers have done—to illicit alternatives, products of questionable quality, and non-legal sources to feed their habit, raising a host of additional risks beyond those inherent to caffeine use.

Increasingly, policymakers have embraced this reality when it comes to illicit drug use, ditching punitive anti-drug initiatives in favor of harm reduction, which prioritizes minimizing the hazards of drug use rather than seeking total abstinence. Initiatives like supervised injection sites, clean needle exchange programs, opioid replacement therapy, and overdose reversal medications are effective ways to reduce the risks drugs pose both to users and communities while maintaining respect for the autonomy and dignity of those who use drugs. Yet, when it comes to nicotine, the approach is turned on its head, embracing bans that push those who wish to use nicotine toward the most hazardous forms of nicotine use. 

Traditional combustible cigarettes are the most dangerous way to consume nicotine. Around half of all smokers are expected to die as a result of their habit. Evidence suggests that smokers who quit by the age of 40 practically eliminate their risk of future smoking-related diseases, most of which typically manifest after middle age. However, not all smokers can quit, even with the aid of smoking cessation therapies. Luckily, more than 15 years of research have demonstrated that smokers who cannot or will not quit can greatly reduce exposure to harmful toxins and significantly lower their risk of disease by switching to noncombustible sources of nicotine, like e-cigarettes, snus, or heated tobacco. E-cigarettes, in particular, have proved effective at helping smokers make this transition, more so even than traditional nicotine replacement therapies.

Nations that have embraced noncombustible nicotine products and tobacco harm reduction are already reaping the public health benefits, such as the United Kingdom, which provides no-cost e-cigarettes as part of their quit-smoking initiative that has led to 50,000 smokers quitting in a single year. Similarly, Japan, which legalized the sale of heated tobacco in 2014, has seen a 50 percent decline in cigarette sales since. Sweden, where snus—a moist tobacco snuff—is the preferred nicotine source, has virtually no smokers and enjoys the lowest rates of lung cancer in the European Union. 

Meanwhile, governments that continue to focus on youth prevention, no matter the cost, are suffering predictable consequences. Australia, which outlawed the importation of nicotine e-cigarettes in 2021 due to youth vaping hysteria, is now struggling to contain the explosion in crime and even greater access to these outlawed products Australian youth now appear to have. To a lesser degree, this is what we’re beginning to see in the U.S. as cities and states adopt increasingly restrictive laws, leaving those adults who wish to use nicotine with cigarettes as their only feasible option. 

The uncomfortable truth is that neither smoking nor any other potentially risky behavior can be eliminated through force. Attempting to do so is not only deeply inhumane but also entirely unnecessary. As the national youth tobacco survey indicates, tobacco no longer poses a major health threat to youth, and the risk of dependency posed by youth use of noncombustible nicotine is declining. The nearly 30 million American adults who continue to smoke, however, are in immediate and lethal danger and their lives should not be sacrificed to marginally reduce already low risks to youth. 

Our tobacco policies must align with the evidence and embrace harm reduction. If the goal is to save lives, some of the energy and resources spent shielding youth from the relatively minor risks of nicotine must be reallocated toward preventing death in adult smokers. If policymakers can balance the needs of both youth and adults when it comes to cannabis, alcohol, opioids, and other adult behaviors, there is no reason they cannot do the same when it comes to nicotine.