A new paper describes how New Zealand vapers feel “shocked” that they have been “abandoned by the health sector.” Getting no support for their own smoking cessation efforts, let alone their attempts to help others, the vapers engaged in both political and grassroots public health actions. Vapers everywhere know how this experience creates both a sense of frustration and of well-deserved pride, as is described in the paper. While the results will come as no surprise to most socially-engaged vapers, there is value in them being reported as “official” research results. Indeed, it might already be influencing the government.
The study, “Government and public health responses to e-cigarettes in New Zealand: vapers’ perspectives,” by Trish Fraser, of Global Public Health, and Marewa Glover and Penelope Truman of Massey University School of Health Sciences, was based on in-depth telephone interviews of 29 demographically diverse vapers in 2016. The subjects were prompted to provide open-ended answers about various topics, including switching from smoking, their motivations and problems they encountered. The paper focuses on the actions that the subjects took, including lobbying the government and health system and active efforts to communicate the truth about vaping and help smokers switch.
This research took place in an environment where the Ministry of Health’s position was that selling or importing nicotine-containing vapor products or nicotine is illegal, though this was not backed by draconian enforcement and punishment as in nearby Australia. A recent court ruling about PMI’s iQOS interprets the relevant law differently, allowing iQOS to be sold in New Zealand. This may legalize the sale of nicotine-containing vapor products as a side effect, though the Ministry of Health might appeal the case. In addition, legislative changes to clarify the legality of vaping in New Zealand may be in the works.
Open-system hardware is available legally in New Zealand, so the barrier faced by the study subjects was getting nicotine. Actions taken by the subjects included a sort of underground railroad, connecting vapers and potential vapers with international vendors who would ship nicotine-containing e-liquid into the country.
Some of the reported experience parallels the situation in the US in 2009, when the FDA attempted to ban imports of vapor products. Glover described how the subjects in her study understandably exhibited “quite a bit of anger about the way vapers had been treated” and that they “had to quickly learn how to lobby local Councils and MPs.” What the paper describes as “reactionary strategies” included forming self-help groups to assist others with vaping-aided smoking cessation. As in other countries, the role of real public health advocacy was left to individual vapers. One important aspect of this experience was that unlike similar efforts in the US, the UK and elsewhere, this had to be done entirely in an environment where the national government considered products illegal. American vapers did face the prospect of a ban, but vapers were already established and networked when that happened.
The most interesting international contrast is the relationship with the government and other authorities. American vapers have certainly expressed frustration with the government and other influential tobacco controllers, that they just do not “get it.” But Americans are not exactly shocked to find government health policy leaves them to fend for themselves. New Zealand offers the interesting case of a government that is generally perceived to be strong, effective and working in the interest of the people, but that took a terribly wrong turn with respect to vaping. The observations in this paper offer a fascinating opportunity for cross-cultural political science, perhaps including a comparison of the well-regarded government of Denmark’s handling of snus (banned due to EU rules, but widely desired).
The authors discuss the reported experience of vapers, about the benefits of vaping in quitting smoking, as a case of “lay epidemiology.” This term implicitly captures the idea that individual observations about a topic they understand far better than anyone else have scientific value, and it refers to them as a proper science. Unfortunately, there is a risk that the phrase “lay epidemiology” can undersell the importance of this evidence since it is inherently pejorative (“lay” is not “professional”) and has historically been used to describe often incorrect beliefs about what evidence implies. Perhaps a better term for vapers to adopt would be “real-world epidemiology.”
Whatever the terminology, Glover believes that if New Zealand clinicians, politicians and academics had recognized this as legitimate evidence earlier, many more smokers would have switched by now. Unlike in the US, where the dominant perception is that the government has shady ulterior motives for its war on vaping, the perception in New Zealand seems to be that the government means well but is misguided. Glover argues that the most important result of the study was that “the vaping community, without funding or government sanction, were able to provide stop-smoking support that potentially could rival that of funded services.” She suggests that official stop-smoking programs need to embrace vaping or become irrelevant. To embrace vaping properly, she argues, they should collaborate with the vaping community and create peer-led programs.
Interview-based studies are often badly reported by researchers who attempt to pigeonhole the responses and analyze them quantitatively. The worst such studies (which are quite common) consist of the authors presenting a narrative of their preconceived views, using cherrypicked interview responses as mere ornamentation for their own story. By contrast, this study appears to have genuinely sought to represent what was learned from the interviews. (It is necessary to offer the caveat, “appears,” because the reader ultimately has to trust that what was presented properly represents the content of the interviews.) The authors were already familiar with vaping culture and made further efforts to include the insight of vapers in the design of the research projects this paper was part of.
The Daily Vaper caught up with Glover as she and Truman were leaving a meeting with the New Zealand’s new Associate Minister of Health, Jenny Salesa. Glover and Truman provided Salesa with the copy of the paper and report, and reported, “we are pleased to hear that the Minister is progressing drafting legislation regarding electronic cigarettes, and that the Ministry of Health is still considering how other harm reduced alternatives to smoking might be handled in the future. The status of the new products needs to be clarified.”
Despite the movement in the right direction, however, Glover remains concerned that too much credence is being given to gateway claims that would-be nonsmoking young people start vaping and transition to smoking. She fears that officials are believing the recent junk “evidence” that this could have a net negative effect on population health. She concludes, “I think vapers are going to have to keep talking to health workers and politicians for some time yet.”