Debate Over Vaping At U.S. E-Cigarette Summit
The debate between anti-vaping advocates and supporters of vaping heated up last week, with each side representing their view in a public forum.
MedPage Today reported late last week that a new annual event, the United States E-Cigarette Summit, was the center stage for a debate between Kenneth E. Warner, Ph.D., and Samir Soneji, Ph.D. The gentlemen were not the only voices in the debate, but they were the most reported experts who spoke at the summit.
Mr. Warner is the Avedis Donabedian Distinguished University Professor of Public Health at the University of Michigan. He has presented work in over 200 professional publications, most often with a focus on tobacco and public health. He also worked as the World Bank’s personal representative during talks to secure a global treaty on tobacco control, known as the Framework Convention on Tobacco Control. Warner has testified before both houses of Congress on matters relating to public health in the past. He argued a centrist view on vaping that leaned towards supporting it as a smoking cessation method.
Mr. Soneji is the Assistant Professor at the Dartmouth Institute for Health Policy and Clinical Practice. He is also a researcher with an emphasis on tobacco regulatory control and has been presented in two dozen papers that were delivered to professional and academic journals. He argued for stricter regulations on vaping based on the belief that the habit might renormalize smoking for young adults and teens.
The U.S. E-Cigarette Summit was convened to discuss matters relating to vaping; it was attended by anti-smoking advocates, tobacco researchers and experts, representatives from the cigarette, vaping, and public health industries. Issues discussed are reported to include the advantages and disadvantages of current vaping technology, youth and children vaping reports, FDA regulations that cover vaping, and recent developments in Congress that are aimed at curtailing the laws that are threatening to eradicate the entire industry.
Warner began the discussion by drawing a comparison between vaping and anti-vaping advocates, stating that while the former chooses to focus on how vaping could be an asset to smokers who are trying to quit, the later is fixated on the potential risks to children and how vaping could cause the idea of smoking to be normalized again.
He went on to note the often-cited studies that are optimistic about vaping coming from the United Kingdom and how the public health community and even legislators in the country have taken on a pro-vaping stance. This is in contrast to the United States, where the majority of legislators, other policymakers, and public health agencies continue to hold the view that vaping is harmful and could have negative effects on teens and young adults.
“The issues that divide the skeptics and enthusiasts are numerous and often very profound,” Warner continued.
The principal concern for anti-vaping advocates, in Warner’s view, continues to be the baffling idea that vaping couldead to renormalization of tobacco products for teens and young adults. To this end, he acknowledged that all but one recent study recently done that measured vaping use among kids and teens seemed to suggest that the products could act as a gateway to smoking.
While Warner elaborated that the studies were small, with most studies only surveying less than 2,500 students and few had long-term follow-up programs, and that the studies also did not control for other smoking factors that are commonly thought to be associated with the beginnings of a habit, there is one other thing he left out.
Many of the studies, including the US Surgeon General’s Office report that was released late last year, were incomplete and bordered on unconscious bias. Because the studies rarely report how many students are frequent vape users, or even those who vaped using liquids with nicotine, a complete picture of how the vaping industry has affected the young adult and teen population in the country is impossible.
In fact, some recent studies, including one from the National Institute on Drug Abuse’s Monitoring the Future survey, have shown that even vape use among teens is falling in the US, calling into question the validity of the opposing argument.
“The decrease in cigarette smoking (among young people) in recent years has been unprecedented. We have never seen declines so large,” Warner commented.
In the NIDA survey, the conclusion showed that vaping surpasses traditional smoking among teens, but that use declined by 23 percent in 2016 from 2015, when the usage was reported to be flat. The decline could be linked to many things, including the fact that young adults and teens are more educated on tobacco and nicotine and have no desire to try vaping. It could also be due to vaping being a somewhat expensive habit; vape devices often cost around $40 while vape liquids start around $25 per bottle, with prices expected to increase as more of the FDA regulations take hold.
But the decline could also be due to something else entirely: young adults go through phases with novelty items.
“I wondered early on whether vaping was essentially going to be a fad for kids,” Warner said when discussing this very idea. “While we don’t know that yet, the fact that usage dropped last year and leveled out in the previous year suggests [it is].”
Arguing for the view of anti-vaping advocates, Soneji argued that vaping might, if left unregulated and easily accessible to minors, reverse the stigma of smoking for teens and young adults; that stigma surrounding smoking has led to a dramatic decline in cigarette use in those demographic over the past few years.
“The concern that I and others have is that e-cigarettes may re-normalize smoking and reduce the stigma of smoking in public,” Soneji is reported to have said.
He also stated that while smoking rates continues to fall among teens and young adults, it is likely that those rates would have fallen further if vaping had not been introduced into the market. He also made note of the highly criticized teen vaping initiation “gateway” studies to suggest that it is possible that a large group of young vapers could become smokers because they tried vaping first.
This notion that vapers turn into smokers is not supported by any study; in fact, the opposite is true. In the US Surgeon General’s report, there are parallels between students who reported smoking before trying vaping and then stopping the traditional habit after using a vape device.
With the summit concluded for this year, advocates on both sides of the vaping issue will continue to pressure Congress and states into taking action on the industry. While anti-vaping advocates are pushing for stricter regulations and higher taxes, vaping advocates are asking for a chance to prove that vaping can be an effective smoking cessation method. Only when both sides sit down together and look at all the facts can consensus be reached and a new path forward for the vaping industry can be designed.