E-cigarette bans highlight public health divide between US and UK researchers
New York is joining 10 other states banning indoor vaping, reflecting a US focus on the harm of e-cigs, rather than their ability to help people quit cigarettes
New York will become the 11th US state to ban e-cigarettes indoors next month, after Governor Andrew Cuomo signed a bill to prohibit vaping in workplaces, bars and restaurants.
The ban brings the state in line with World Health Organization guidance, which called for bans on indoor vaping, but highlights a major public health divide between researchers in the US and UK, who have respectively focused on the potential harms or benefits of vaping.
“There has been some backlash by people who said: ‘You’re trying to kill me, I quit using cigarettes by using vapers!’” said New York State assemblymember Linda Rosenthal, a former smoker who quit about 20 years ago and who sponsored the current legislation.
“Well, that’s great – congratulations – but a pregnant woman does not need to be exposed, a child does not need to be exposed, a former smoker does not need to be triggered.”
Anti-tobacco campaigner Matt Myers, executive director for the Washington DC-based Campaign for Tobacco-Free Kids, likewise called the ban, “not only appropriate but important”.
“New York is not first to do this,” said Myers. “What we have found is when protecting people against any toxins indoors, you set a clear standard that both protects non-smokers and further de-normalizes any tobacco use.”
While US research into the smoking substitutes – which do not burn tobacco – has focused on the potential for children to get hooked on fruity vaping flavors; the potential that children could move on to cigarettes; and the detrimental effects on the cardiovascular system, public health messages in England have focused on the potential for e-cigarettes and vaping products to be used to help people quit.
The US National Institute on Drug Abuse has warned that e-cigarettes could contain “potentially toxic metal nanoparticles”. Vaping “might be less harmful than cigarettes”, the agency said, but more research was needed on its long-term effects.
By contrast, the UK agency Public Health England announced that e-cigarettes could be “95% less harmful than tobacco” – although the British health journal the Lancet later criticized this stance as “the opinions of a small group of individuals with no pre-specified expertise in tobacco control … based on an almost total absence of evidence of harm”. The UK’s Royal College of Physicians found that e-cigarettes carried only about 5% of the risks of smoking. One recent study showed using e-cigarettes had become the most popular method of quitting in the UK, while another suggested young people who tried e-cigarettes were not more likely to take up smoking as a result.
“I think the Americans are much more scared of nicotine,” said Peter Hajek, a professor, psychologist and tobacco researcher at the Queen Mary University of London. Hajek said the decision to ban e-cigarette use indoors in New York state – it was banned in New York City in 2013 – was part of an American “war on drugs” mentality. “This is a very irrational decision to make,” Hajek said.
In addition, America’s lax smoking regulations may contribute to researchers’ estimation of potential harms. Tobacco taxes are much lower in the US; unlike in countries such as Australia and the UK, cigarette packs do not display graphic warnings; and some states still allow smoking in public bars and restaurants.
“There’s no consumer product that kills anywhere near as many people as cigarettes. I mean, not even guns,” said Stan Glantz, a tobacco control expert at the University of California San Francisco. In America, 480,000 people die each year from smoking-related illness. “I had been saying, well because they do deliver lower levels of toxins, I was saying maybe they were 20% as bad [as cigarettes],” said Glantz. “And then 50% or 60% as bad.
“To say something is only two-thirds as bad as cigarettes – it’s like saying jumping out of the 20th story isn’t as bad as jumping out of the 30th story.”
He added: “The number of people left in the world who think e-cigs are harmless is getting to be a very short list, and it happens there’s a bunch of them in England. The number of people going around who say we don’t think e-cigs pose any risk is diminishing.”
To some former smokers, though, their personal experience remains powerful. Puffing a cherry-flavored vape in midtown Manhattan, English tourist Jennifer Moreton took exception to the idea that New York state’s new law was protecting people.
“This is not harmful to anybody else,” said Moreton, 72, of Staffordshire. “It doesn’t smell, and it encourages people to give up smoking. I used to smoke, and now I don’t,” she said.
However, the experience of vapers in Britain and the US may not be as different as the divergence in researchers’ views suggests.
“Because the US Food and Drug Administration has been so slow to regulate these products in any meaningful way, the rhetorical differences between researchers hasn’t really played out in dramatic practical distinctions,” said Myers.
Big tobacco has already moved into the e-cigarette space, hoping to keep it deregulated. A deadline for vaping manufacturers to submit detailed information to the FDA was postponed after Donald Trump took office, reflecting the new agency head’s optimism that e-cigarettes could help smokers quit.
“All the lobbying behind the scenes and all the campaign contributions were coming from Philip Morris and RJ Reynolds,” said Glantz, about California’s recent experience banning e-cigarette use indoors. “The tobacco companies want to protect the gateway market … The tobacco companies are managing the overall nicotine market.”
For some, including Rosenthal, it was a far more American sentiment that guided the desire to ban indoor e-cig use: individual rights. The WHO’s 2014 report claimed “exhaled aerosol is likely to increase above background levels the risk of disease to bystanders, especially in the case of some [e-cigarettes] that produce toxicant levels in the range of that produced by some cigarettes”.
“People’s right to smoke stops when it infringes on my right to have clean air,” she said. https://www.theguardian.com/society/2017/oct/24/e-cigarette-bans-highlight-public-health-divide-between-us-and-uk-researchers