We Need Sensible Vaping Regulation, And T21 Laws Work

The recent outbreak of vaping-related lung injuries and even deaths is no different from other tragic but limited episodes. So why are federal and state officials’ reactions so out of line?

Certainly, the nearly 1,500 cases of lung injuries – and 33 deaths – across the country is alarming. But a closer look at the problem reveals that most of the injuries are the result of vaping illegal, marijuana-based liquids – not legal, nicotine products.

Still, federal and state officials have issued public warnings against using e-cigarettes, and 7 states have implemented bans on sales of them. But these kinds of sweeping measures are misleading the public and likely to create more serious public health consequences.

To put this into context, a more familiar public health scenario is food poisoning at a community picnic caused by a contaminated batch of potato salad. In that case, public health professionals may recall the contaminated product, but they don’t blame the spoons. And they certainly don’t tell people to stop eating. The same should be the case here.

Broad vaping bans make it harder for adult smokers to access vastly safer nicotine vapor products. And by failing to tell Americans the truth, marijuana users are in the dark about dangerous illegal products. Lawmakers need to slow down, recognize and acknowledge the black-market culprit, and introduce long-term, sensible regulations. 

It’s true teen vaping has increased in recent years.  But federal surveys show that underage teens only make up 8 percent of the nearly 9 million current vapers. The recent deaths from this outbreak are tragic, but it’s important to remember that this year there have already been nearly 400,000 smoking-related deaths in the U.S. The vast majority of vapers are adult smokers who understand e-cigarettes are 95 percent safer than smoking. They’ve helped millions of Americans walk away from the fire. And a study in the New England Journal of Medicine confirmed that they are twice as effective as medicinal nicotine in quitting.

Teen vaping has been exacerbated, however, by older students who can legally buy tobacco products and provide them to their younger classmates. The Food and Drug Administration’s (FDA) Population Assessment of Tobacco and Health (PATH) survey shows that more than 90 percent of teens who use tobacco products gain access to them from social sources, namely friends or family; fewer than 10 percent of current teen e-cigarettes users “bought them myself.”

To try to stem the flow of underage vaping, 475 cities and counties – and 18 states – have passed “Tobacco 21 laws,” (T21) which raise the minimum legal age for purchasing all nicotine and tobacco products, including e-cigarettes. While eighteen-year-olds only make up 14 percent of American high school students, they account for one-quarter of high school smokers and vapers. Many tobacco harm-reduction advocates hope that raising the age from 18 to 21 will remove legal purchasers from the nation’s high schools and potentially disrupt the teen “black markets.”

A new study published in the journal Addiction finds that these laws may be working.  Dr. Abigail Friedman and colleagues at the Yale School of Public Health analyzed a 2016-17 online survey involving young adults (18-22 years old) across the United States who reported ever smoking or ever vaping. The researchers compared rates of current smoking (in teens that smoked any day in the past 30) and established smoking (100 cigarettes lifetime and past 30 days) among participants according to whether they were in states or localities with or without T21 laws. 

And the results are encouraging. When the team compared young adults 18-20 years of age, who would have been affected by T21 laws, with counterparts 21-22 years who were not affected, they found that T21 exposure was associated with a 39 percent drop in recent smoking. In short, teens living in T21 areas are far less likely to be smoking. And the impact on established smoking is even greater.

But there’s more. A key predictor of whether or not a teen starts smoking is if they have friends or family members who smoke. While the Yale research saw no effect from parental smoking habits, it did find that there is a “social multiplier effect” from T21. That is, there is a “spillover” effect that comes from limiting access to teens. T21 laws affect teens both “directly and indirectly, via peer responses to the policy.” When T21 is in effect, fewer teens smoke, because they don’t see other teens smoking.

Vaping bans harm smokers, so they represent public health inaction. Let’s ban the bans and turn to sensible regulations instead. T21 laws balance adult smokers’ access to safer cigarette substitutes with policies that prevent youth initiation. That’s good public health, in action.

Brad Rodu is a professor of medicine and holds an endowed chair in Tobacco Harm Reduction Research at the University of Louisville.

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