Jeremy Wong smokes an e-cigarette at The Vaping Buddha on January 23, 2018 in South San Francisco, California GETTY IMAGES NORTH AMERICA/AFP/File |
Washington (AFP) - San Francisco has decided to ban the sale of e-cigarettes in 2020, hoping to curb a surge in vaping among adolescents. But is the policy backed up by the available evidence?
How
harmful is vaping?
Unlike
tobacco cigarettes, e-cigarettes do not "burn." The devices, which
have been available in the US since 2006, work instead by heating up a liquid
that then turns into vapor and is inhaled.
Because of
this, e-cigarette users don't get exposed to the estimated 7,0000 chemical
constituents present in combustible cigarettes, and vaping is generally
believed to be safer than smoking.
The liquids
do, however, contain nicotine, which has been studied for decades and is known
to be highly addictive.
They also
contain a variety of other constituents classed as "potentially
harmful" according to a 2018 study compiled by the US National Academy of
Sciences requested by Congress.
Though many
of the flavorings in e-liquids are recognized as safe, their toxicity was
studied for oral consumption in food and not inhalation, it said.
There is
also "substantial evidence" that the vapor contains traces of metals,
either from the coil used to heat the liquid, or other parts of the device.
Another
potential red flag, according to the Centers for Disease Control and Prevention
is the presence of diacetyl, which is used to add a butter flavoring to
microwave popcorn but has been linked to a serious but relatively rare lung
disease.
For the
time being, there is "no available evidence" to show whether or not
e-cigarettes use is associated with cancer, said the NAS report.
But there's
a caveat. While experts generally believe vaping is a less toxic alternative to
smoking, "the implications for long-term effects on morbidity and
mortality are not yet clear," and would require decades of more data and
studies to know for certain.
Can it
help smokers quit?
Market
leading maker Juul's response to the San Francisco ban was that it would
"drive former adult smokers who successfully switched to vapor products
back to deadly cigarettes."
Are they
right about that?
A study
published in February in the New England Journal of Medicine on a group of 886
patients in Britain's National Health Service found the claim to be true.
The
one-year abstinence rate among e-cigarette users was 18 percent, compared to
9.9 percent among a group who used other nicotine replacement products like gum
or patches.
The
conversions are not, however, all in one direction.
A slew of
recent studies have found that, among adolescents, e-cigarettes effectively
provide a gateway toward full-fledged smoking.
Authorities
are worried that decades of declining smoking rates among this demographic
could go up in smoke as a result of these devices.
Regulation
versus prohibition
The vaping
industry is adamant it doesn't want to see underage people using its products
and more must be done to prevent their sale. E-cigarettes are already illegal
to sell in the US to people under 18 or 21, depending on the state.
But, the
sector argues, bans are a poor policy choice because they deprive adults
addicted to smoking of a valuable tool.
"To
deprive those smokers from access to e-cigarettes, which we know are
substantially less harmful, I think is a terrible decision, " Neil
McKeganey, of the UK-based Center for Substance Use Research based, which is
partly funded by the industry, told AFP.
The irony
is that the sale of alcohol, cigarettes and cannabis will remain legal in San
Francisco for those over 21.
The risks
associated with all three are well studied. For alcohol, these include liver
disease, high blood pressure and heart disease, numerous cancers. For
cigarettes, heart disease, stroke, lung and various other cancers.
Numerous
papers meanwhile have explored the risks of cannabis particularly on the
juvenile brain.
In place of
bans, makers want to see tighter regulation.
There is a
lot of work to be done: an analysis of Californian vendors published Monday in
the medical journal JAMA found that almost half of tobacco and vape shops did
not ID young customers looking to buy vape products.
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