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Bans aren’t the only step needed to reduce youth vaping, say experts. Getty Images
  • Several states and cities have moved forward with bans on e-cigarettes, but a group of public health experts say this could do more harm than good.
  • E-cigarettes have been connected to more than 2,000 hospitalizations and 50 deaths in recent months.
  • But experts say vaping may help some adults stop using combustible cigarettes.

With thousands of Americans hospitalized this year for vaping-related injuries, and e-cigarette use among youth continuing to rise, several states and cities are cracking down on vaping.

Many applaud these efforts to protect public health, especially that of youth.

But a group of public health, tobacco policy and ethics experts warn that such restrictive policies on e-cigarettes “may do more harm than good” by slowing the fight against combustible cigarettes.

“Restricting access and appeal among less harmful vaping products out of an abundance of caution while leaving deadly combustible products on the market does not protect public health,” the authors write Dec. 13 in the journal Science.

The paper comes amid two concerning trends.

Recent data shows that vaping among youth continues to rise. In 2019, 27.5 percent of high school students used e-cigarettes in the past 30 days, reports the Centers for Disease Control and Prevention (CDC).

As of Dec. 10, 2019, the CDC has also reported 2,409 hospitalizations linked to vaping-related lung injuries, with 52 confirmed deaths.

The agency found that 82 percent of vaping-related lung injury cases involved THC-containing products. It has also identified vitamin E acetate, an additive in certain products, as a “chemical of concern.”

Some of these products may have been obtained online or from friends rather than through licensed retailers.

“Public health measures must not neglect distinctions between nicotine and THC as well as between products obtained through the retail and black markets,” write the authors of the new paper.

The CDC cautions, though, that there may be more than one cause behind the lung injuries. Also, some cases involved only nicotine-containing products.

Research also shows that even non-THC vape products — including those purchased at licensed retailers — may harm the lungs, heart, blood vessels, and immune system.

It could be years before we fully understand the long-term risks of vaping nicotine.

However, while e-cigarettes do carry some health risks, the authors of the new paper point out that “there is solid scientific evidence that vaping nicotine is much safer than smoking.”

David Ashley, PhD, a professor in the Tobacco Center of Regulatory Science and School of Public Health at Georgia State University in Atlanta, says e-cigarettes can also help some smokers who haven’t been able to quit by other means give up combustible cigarettes.

He adds the downside, though, is that many smokers who start vaping don’t give up cigarettes completely.

“The science around dual use suggests that if you’re a dual user, you may get very little benefit from starting to use e-cigarettes,” said Ashley, who wasn’t an author on the new paper.

While some states — and even President Trump — have talked about banning e-cigarettes or just certain flavored products, the Food and Drug Administration (FDA) and Department of Health and Human Services haven’t used the word “ban.”

“When they talk about their actions, what they’re talking about is requiring products to go through what is a statutorily defined process for allowing products to come onto the market,” Ashley said.

That means e-cigarette manufacturers will need to show that their products are safe — or as safe as possible — before they can sell them in the United States.

Although the FDA announced in September that it would develop rules for this process, the Trump administration has since showed signs of wavering on that decision.

Ashley thinks certain kinds of e-cigarette regulations can help keep youth from vaping.

One is restricting flavored e-cigarettes. A recent study found that flavors like mint, mango, and fruit are popular among high school and middle school students.

“States are talking about banning flavors,” Ashley said, “and I think that would have a big impact on kids.”

But he adds this may work against adult smokers trying to quit.

“Adults who use non-tobacco flavor — fruit flavors, etc. — are more likely to be able to switch completely from cigarettes,” Ashley said.

Taking that away from them could make it harder to give up smoking.

Taxation is another step that could slow the rise in youth vaping.

“Taxation has also proved an effective means of pricing products out of the hands of youth,” write the authors of the new paper.

They also propose keeping taxes on e-cigarettes lower than those on combustible cigarettes to encourage smokers to switch to vaping.

Bans — or FDA market reviews — aren’t the only steps needed to reduce youth vaping.

Earlier this year, Massachusetts Gov. Charlie Baker passed an emergency ban on all nicotine and marijuana vape sales. It expired this week.

Going forward, sales of nicotine vaping products and flavored vapes will be heavily restricted. It’s not known whether cannabis vape sales will resume.

On top of this, the state also offers various vaping education resources and tools — with one clear message.

“Our messaging has always been that the problem with switching from combustibles to e-cigarettes is that you’re still addicted to nicotine,” said Tina Grosowsky, MA, project coordinator for the Central Massachusetts Tobacco-Free Community Partnership.

This is a program of the department of psychiatry at UMass Medical School and a clinical partner with UMass Memorial Health Care.

“For people who are addicted to nicotine,” Grosowsky said, “we recommend that they use an FDA-approved nicotine replacement product and get counseling or coaching from a trained tobacco treatment coach.”

This includes both vapers and smokers.

Organizations like the This is Quitting – Truth Initiative and Make Smoking History may help people stop smoking traditional cigarettes or e-cigarettes.