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There is a hot debate in many countries over youth use of e-cigarettes, electronic devices that deliver nicotine to consumers without the deadly tar found in the smoke from traditional cigarettes. Although nicotine is not a carcinogen, it is still bad for developing brains and should not be used by young adults or pregnant women. At the same time, e-cigarettes offer real advantages over traditional tobacco products for smokers who are otherwise unable to quit.
Unfortunately, effective deterrence of youth use of e-cigarettes has proven difficult to achieve. Approaches include raising the legal age for purchasing tobacco products, running a public health education campaign like the one led by the US Food and Drug Administration (FDA), and prosecuting businesses that unlawfully market their products to teenagers.
A tempting, but clearly undesirable, approach is a ban on e-cigarette use by everyone, adults and minors alike. Such a ban is currently being formally considered in Hong Kong, and in India an executive order banning e-cigarettes is currently under consideration. Offenders in Hong Kong would be punishable by up to six months in jail and a fine of up to HK$50,000 (about US$6,400) and a leaked draft of the policy in India describes a maximum sentence of three years and fines up to 500,000 rupees (about US$7,000).
As I explained in a recent formal comment on the Hong Kong proposal:
The public health opportunity from e-cigarettes and heated tobacco products relate to reduced health risks both for smokers and for others who may otherwise be subject to secondhand smoke. The U.S. Surgeon General and numerous other public health researchers have documented the health risks of smoking, and cigarette use causes house fires and other avoidable accidents. Relative to traditional cigarettes, for which the public health risk is both large and certain, e-cigarettes and heated tobacco products offer a lower-risk alternative for nicotine delivery to smokers.
E-cigarettes do not contain tar, the known carcinogen that is responsible for the overwhelming majority of the health risk associated with traditional cigarettes. And the [FDA] recently deemed a heated tobacco product “appropriate for the protection of public health” and approved it for marketing in the United States.
While the smoking rate (current smoking prevalence) in Hong Kong has declined significantly over the last thirty years, from 19.7% to 10.8% of the adult population in 2018, the total number of smokers still exceeds 600,000. To improve the health of smokers and reduce the risk for those around them, reduced risk alternatives should be available.
Admittedly, it is difficult to craft an effective framework that allows smokers access to products that can dramatically reduce the health risks from smoking while ensuring that the products are kept out of the hands of youth. Nevertheless, Hong Kong, India, and other countries should reject the simple and easy route of banning those products. A ban would undermine a vital public health objective — saving lives by transitioning smokers to less harmful sources of nicotine.
It is difficult to craft an effective framework that allows smokers access to products that can dramatically reduce the health risks from smoking while ensuring that the products are kept out of the hands of youth.
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