In my last post I discussed the good news about falling rates of smoking, particularly among teenagers. In the U.S. those rates are now down to single digits. These shrinking levels among young people are especially positive because if a person doesn't smoke before their 20s they are unlikely to ever be a regular smoker.
But something else is happening with the young ones: they are vaping in rapidly increasing numbers. Depending on how you look at kids and their taking to e-cigarettes, two very different views emerge.
The first is feeling alarmed. Kids are staying away from one deadly habit only to be ensnared by another. Vaping may not be as poisonous as conventional smoking (because no tar is delivered to the lungs) but there are still lots of (known and unknown) dangers. Vaping is a gateway: once people start it's only a matter of time before they want the "real" thing. And e-cigarettes also do not work the other way: they don't help individuals quit conventional ones.
The second is feeling (somewhat) reassured. Sure we don't want people vaping; the health impacts are not clearly established. But conventional cigarettes are so toxic that almost anything that keeps someone from smoking is a godsend. What's more the falling rates of cigarette consumption in the face of an uptick in vaping demonstrates that e-cigarettes are not a gateway to conventional smoking. The opposite is the case: they attract kids away from starting that toxic habit. They may also help individuals, already smoking, to stop.
Which view is right? No one seems to know for sure. So the debate is going to continue. And it should until the relevant science is clarified. Meanwhile respected voices are calling for regulatory action even in the face of scientific uncertainty. Much of the urging is on behalf of kids and against e-cigarette suppliers that use flavoring, celebrity endorsements, Internet sales, and other manipulative techniques to entice the young ones into the world of vaping. So advocates push for the exercise of the "precautionary principle": a lack of definitive evidence of danger should not foreclose legal action aimed at preventing harm from occurring, especially in terms of kids.
There's much to be said for those wanting more extensive regulation. In any event when it comes to teenagers we're still left with two big issues. First, will legal strategies aimed at closing down vaping push adolescents back to conventional cigarettes? That would be an unintended but decidedly negative consequence. Apparently, as of now, we have no way of knowing.
Second, almost everyone who has looked at these issues agrees that, to the extent that sales to kids of e-cigarettes are not already illegal, they should be. But the reality is that most kids who want them are going to get them. Sales of conventional cigarettes to teenagers have been banned for years. But that hasn't stopped minors who want to smoke from lighting up.
The combination of these two issues leaves us with a big, complicated task. And invoking law to prohibit sales to minors is not enough, in itself, to get the job done. So how do we craft persuasive messages to kids that get them to see that both smoking and vaping are dumb ideas? We'll probably need to try several tactics. But a useful one may be similar to the one I suggested in my last post.
A well-designed message that companies seek to manipulate them and to turn them into pawns may get to youths inclined to smoke and vape in ways that conventional warnings do not. Such information about attempts to exploit may prompt teens with a recalcitrant streak to decide that such rebelliousness is best turned on corporations that peddle any toxins as "cool." Can we get them to see that an ultimate act of defiance is to both butt out and blow out in the face of tobacco companies and others as they connive to addict? A tall order -- but a crucial goal for public health.
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