Every so often, a burst of technology can change society’s trajectory in major ways. Airplanes have shrunk world travel to less than 24 hours. Cellphones have freed us from landlines. We are now faced with a disruption that could dramatically change the way we use nicotine and improve the country’s health, except many lawmakers won’t let us.
Without the deadly tar and other products of combustion found in tobacco cigarettes, e-cigarettes are growing in popularity as a way to transition off combustible cigarettes. While e-cigarettes are not totally safe or healthful, they are far less harmful than cigarettes. Public Health England estimates that electronic cigarettes are no less than 95 percent safer than combustible cigarettes and both Public Health England and the Office of the Surgeon General report that e-cigarettes have a similar risk profile to other nicotine replacements, such as the patch and nicotine gum.
Much like the difference between the first cellphones that were about the size of a loaf of bread and cost nearly $4,000, current ones that you can lose in your pocket and are more affordable than landlines, e-cigarettes have gone through a similar evolution. When they were introduced in 2007, they were more of a novelty without any real potential to help people quit. Those original e-cigarettes had only about half the nicotine of combustible cigarettes and cost about as much. They also didn’t offer much in the way of customization, including a fairly limited palate of potential flavors.
In recent years, however, the quality and availability both have improved to the point that e-cigarettes are now attractive substitutes and often a first option for people looking to quit smoking. Because of this paradigm shift, e-cigarettes have potential to displace combustible cigarettes from the marketplace. In fact, in 2016, André Calantzopoulos, CEO of the international tobacco company PMI, stated publicly that he envisions a future without combustible cigarettes.
Those old, clunky cellphones, now a telltale sign of a movie made in the 1990s, were toys for people who had too much money – accouterments of the good life. Like those first generation cellphones, early e-cigarettes were designed to meet a recreational desire and not to fulfill some larger quest to save the 5.4 million people who die from cigarettes every year. But it’s hard to deny that, with improvements in subsequent generations, e-cigarettes are now widely used as a quitting tool for smokers.
Flavor options play an important part in that. A recent report in The International Journal of Environmental Research and Public Health showed that limits on vapers’ flavor choices negatively impact e-cigarette use. About 40 percent of former and current adult smokers predict that removing their ability to choose flavors would make them less likely to remain abstinent or even attempt to quit in the first place. In fact, data in this report define a flavor pattern that is common in transitioning off cigarettes – current smokers are partial to the flavor of traditional tobacco, while fruit and sweet flavors are preferred by former smokers.
That finding would conceivably be a reason to enact flavor prohibitions to deter people from starting smoking, but the evidence does not support the idea that e-cigarettes are a gateway to smoking. The Centers for Disease Control and Prevention recently released their 2016 National Youth Tobacco Surveys data and there is good news all-around. Cigarette smoking among high school adolescents is at an all-time low of 13 percent, down from 17 percent in previous years. E-cigarette use is also down, falling to 11 percent from 16 percent in previous years. This cannot be emphasized enough – current policies to keep young people from smoking are working, at no time in history has youth tobacco use been this low.
When lawmakers propose flavor bans or include e-cigarettes in the definition of “tobacco products,” they are doing so out of concern for the risk of youth initiation to smoking. However, the reality is that the primary effect of limiting flavor options is that people who would use e-cigarettes to quit are left behind.
Technology has improved to the point that people are turning to these safer products and ditching the landline version of tobacco. Considering the relative safety of e-cigarettes compared to combustibles, we ought to encourage this switch, rather than impede further progress.
Dr. Carrie Wade is the harm reduction policy manager for the R Street Institute.