E-CIGARETTE POLICY BRIEF:  Seven Things Policy Makers Need to Know

All references are hyperlinked to official WHO and government reports, and peer-reviewed studies

The death toll from smoking is enormous

• 8 million people die every year from smoking-related diseases (WHO), including 480,000 in the USA (CDC)
• 1.1 billion people smoke worldwide (WHO), including 34 million in the USA (CDC)
• In the USA, smoking is now concentrated among low-income and LGBTQ people, people living with mental

illnesses, and indigenous peoples (American Lung Association)

→ Tobacco smoking is, by far, the world’s leading cause of preventable cancer, heart and lung disease

Harm reduction can reduce that death toll

• There is growing independent consensus that e-cigarettes are safer than smoking (35+ official public statements)
• There is strong evidence that smokers who switch to e-cigarettes have lower risk of cancer, heart & lung disease
• When not in tobacco smoke, nicotine itself does not cause cancer, heart or lung disease (CDC and IARC/WHO)

→ Other examples of harm reduction include seat belts, bicycle helmets, parachutes, methadone and condoms

Safer nicotine alternatives help smokers quit

• Big pharma nicotine patches & gum (NRTs) cause neither addiction nor cancer, heart or lung disease (FDA; CDC)
• NRTs increase quit success from 5% (cold turkey) to 9% (on average, smokers try and fail 30 times before quitting)
• E-cigarettes are two times more effective than NRTs (Cochrane review of 50 peer-reviewed studies worldwide)
• Many adult vapers “quit by accident” with e-cigarettes (online survey); NRTs only benefit those who want to quit
• 92% of US all vapers are ADULTS; 4.3 million US adults have quit smoking completely with nicotine vapes (CDC)
• The adult cessation total may be 5.4 million because 26% of those who quit with e-cigarettes later quit vaping
• 2.1 million UK smokers (UK government) and 7.5 million EU smokers (Eurobarometer) have quit with e-cigarettes
• ‘Flavors’ are up to 2.3 times more effective for smoking cessation than tobacco flavor (Yale study) (UK study)
• 80% of US adult vapers prefer fruit, dessert or candy flavors that don’t remind them of smoking (FDA submission)

→ Forcing ex-smokers to vape tobacco flavor is like forcing recovering alcoholics to drink rum-flavored club soda

Teen vaping is undesirable, but not a crisis

• In the UK, which promotes nicotine vaping for adult smokers, teen “current use” by never-smokers is just 1%
• US high school “current use” of vaping products dropped 29% between 2019 and March 2020 (CDC/NYTS)
• By March 2020, only 1 in 20 US high school students vaped daily (4.4%, but 53% of that may be THC not nicotine)
• US youth & young adult vaping dropped another 32% during the pandemic (JAMA survey up to November 2020)
• If both surveys are combined, just 1 in 10 US high school-age teens are now “current users” (13%)

→ If this assumption is correct, then US teen past 30-day ever-use is now lower than it was in 2015 (6 years ago)

Proposed policy “cures” are worse than the “disease”

• Proposed policies to reduce teen vaping include higher taxes, ‘flavor’ bans, online sales bans and shipping bans  
• E-cigarette taxes have caused cigarette sales to increase in 8 US states (National Bureau of Economic Research)
• E-cigarette taxes “increase prenatal smoking and lower smoking cessation during pregnancy” in female smokers
• Ecig flavor bans increased cigarette sales in San Francisco; Washington; Rhode Island; New York; and Nova Scotia
• Online sales and mail shipment bans reduce adult access, so are also very likely to strengthen cigarette sales

→ Higher taxes, ‘flavor’ bans, and online/mail bans protect big tobacco’s main cash cow:  deadly cigarettes

Unintended consequences and logical inconsistencies

• Probable outcome of ‘flavor’ bans:  Teen vapers will switch to THC vaping or to cigarette smoking; many adult

vapers will relapse to smoking; fewer smokers will quit; an illicit market (with no age-checks) will arise

• The same organizations that claim teen vaping is a gateway to tobacco smoking, also claim tobacco-flavored

e-cigarettes repel teens (i.e., banning ‘flavored’ nicotine vapes will reduce teen vaping)

→ Definitions differ:  adult current use = daily or regular use; teen current use = past 30-day ever-use

Full context of adult products that teens use, but should not use

• US teens are more likely to smoke pot or use illegal drugs than to be “current users” of e-cigarettes (NIDA MTF)
• US teens are 2X more likely to binge drink than vape “frequently”; 3X more likely to binge drink than vape daily
• US teen binge drinking causes 3,500 deaths and 119,000 ER visits/year (CDC); US policy response?  Age-checks
• US teen “current smoking” rates dropped 3X faster than historical trends after 2012 (NIDA MTF)

→ Teens should not vape, smoke, drink or use cannabis (and adults should try to avoid irrational moral panics)

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