“A study found a “high rate of substitution” between vapes and cigarettes, suggesting that policies aimed at preventing underage use are undermining public health.”
““It’s really a product that’s good for some people and bad for other people, which doesn’t feel like too complex of a statement, but actually feels like something that is difficult for many to grapple with,” said Hartmann-Boyce, who is an associate professor of evidence-based policy and practice at the University of Oxford.
She led a 2022 Cochrane review — considered the best type of analysis of the available evidence — which looked at studies of e-cigarettes for smoking cessation. It found the strongest evidence yet that vaping works better than traditional nicotine replacement tools such as patches or gum to help people stop smoking. For those advocating that vaping is an effective harm-reduction mechanism, it was a significant win.
But it’s also more complicated than that.
Hartmann-Boyce said that since Cochrane first started looking at the evidence nearly 10 years ago, things have changed dramatically. The devices themselves are different now and are much better at delivering nicotine. That’s good for people trying to give up smoking but creates a problem with non-smokers like kids who are trying these for the first time.
But not everyone is even convinced it’s good for most smokers in the long term.
Jørgen Vestbo, a clinician and emeritus professor of respiratory medicine at the University Hospital of South Manchester, who recently returned to his native Denmark, agrees that the randomized controlled trials show e-cigarettes can help people quit.
But he also points to data from clinical trials that show people given e-cigarettes were more likely to use them for longer than those using aids such as nicotine gum. Vestbo said population-level evidence shows that as long as you are addicted to nicotine you are more likely to start smoking again.”
“After nearly two years of review, the Food and Drug Administration (FDA) is preparing to deny Juul’s application to keep its tobacco- and menthol-flavored vaping products on the market, according to reporting from The Wall Street Journal. The news is surprising; when compared to competitors’ applications, Juul’s was one of the most detailed and data-heavy, showing just how effective it was at transitioning smokers away from cigarettes, toward a safer alternative.”
“But what appeared to be a classic Silicon Valley success story soon became a victim of an intensely ideological war on nicotine. Unfortunately, Juul also for a time became the most popular product among minors who were experimenting with vaping. Youth vaping rates rose substantially. Current e-cigarette use, defined as taking a puff or more in the past 30 days, jumped from 11.7 percent in 2017 to 27.5 percent in 2019.
Juul was squarely blamed for the rise of youth vaping, with critics pointing to its initial marketing campaigns showing people in their early twenties enjoying the product. Critics alleged that flavors like mango and cucumber were especially appealing to the younger demographic. But what they forget is that in late 2016, the company switched to exclusively using models who are 35 or older in their advertising campaigns, as well as only using real customers who have switched from smoking to vaping. What anti-vaping campaigners also ignore is that the vast majority of adult vapers quit smoking using sweet or fruity flavors; such products are not just desired by teens.
The claim that Juul’s flavors were the underlying cause for the rise in youth vaping is highly dubious, considering there were thousands of different flavors for other e-cigarettes on the market years before Juul took off. Surveys of teenagers by the Centers for Disease Control and Prevention show that just 13.2 percent of young people who use e-cigarettes say they do so for the flavors. Experimentation with e-cigarettes mimics other behaviors like alcohol and illicit drug use, often with the same populations engaging in these types of activities. But to appease critics, Juul voluntarily removed all flavors other than tobacco and menthol from the market in 2019.”
“In 2020, the Cochrane Review, widely considered the gold standard for evaluating evidence-based medicine, concluded that e-cigarettes are more effective than traditional nicotine replacement therapies for helping smokers quit. By banning the most effective and popular e-cigarette on the market, there is no doubt that the FDA’s choice will force a portion of current Juul users to go back to smoking, and an unknown number of smokers to never make the healthier switch to vaping. What economist Alex Tabarrok calls the FDA’s “invisible graveyard” just got a whole lot bigger.”
“Electronic cigarettes, which deliver nicotine without tobacco or combustion, are the most important harm-reducing alternative to smoking ever developed, one that could prevent millions of premature deaths in the U.S. alone. Yet bureaucrats and politicians seem determined to negate that historic opportunity through regulations and taxes that threaten to cripple the industry.”
“Survey data indicate that the vast majority of teenagers who vape regularly are current or former smokers. That means the FDA’s fear that ENDS are causing an “epidemic” of adolescent nicotine addiction is overblown—especially since vaping by teenagers dropped substantially in 2019 and 2020, a development the agency prefers to ignore.”
” In an August American Journal of Public Health article, 15 prominent tobacco researchers warned that “policies intended to reduce adolescent vaping,” including flavor bans, “may also reduce adult smokers’ use of e-cigarettes in quit attempts.” They emphasized that “the potential lifesaving benefits of e-cigarettes for adult smokers deserve attention equal to the risks to youths.”
That article summarized “a growing body of evidence” that “vaping can foster smoking cessation.” Yet Rep. Raja Krishnamoorthi (D–Ill.), who wrote a bill he called the END ENDS Act, insists “there’s simply no evidence that vapes help [smokers] quit.” He also claims to believe “adults can do what they want,” which is likewise demonstrably false given the severe restrictions he favors.”
“A 2020 meta-analysis of 26 randomized controlled trials concluded “there is moderate-certainty evidence that [e-cigarettes] with nicotine increase quit rates compared to [e-cigarettes] without nicotine and compared to nicotine replacement therapy.” The results of population studies, Balfour et al. say, “are consistent with a near doubling of quit attempt success, found in the randomized controlled trials, and the fact that e-cigarettes are smokers’ most used aid in quit attempts.” They also note that declines in U.S. cigarette sales accelerated sharply as sales of vaping products took off, which reinforces the impression that more vaping means less smoking.”