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The Best Way to Capture Public-Health Benefits from Vaping? Make Cigarettes Harder to Get

Photo: Gabby Jones/Bloomberg via Getty Images

Kevin Drum at Mother Jones highlights new research from the University of Michigan Institute for Social Research which finds that “increases in adolescent vaping from 2017 to 2018 were the largest ever recorded in the past 43 years for any adolescent substance use outcome in the U.S.”

The Michigan survey found 27 percent of 12th-grade respondents had used any vape product in the prior month; 21 percent had used a nicotine vape. As Drum notes, this trend is consistent with explosive sales growth in the nicotine vape industry.

Not coincidentally, vaping market-leader Juul is selling a large investment stake to Altria, the multinational tobacco company. The Altria deal places Juul’s valuation at $35 billion, making the company about as valuable as Delta Air Lines or Target Corp. Juul has made a strong public commitment to focusing its marketing on adults, but one of the drivers of its strong sales and high valuation is its popularity across age categories, including underage users.

Should we care if teens are vaping, so long as they’re not smoking cigarettes? After all, nicotine is not the ingredient in cigarettes that causes lung cancer.

“It’s clearly safer than smoking a cigarette,” says Mark Kleiman, a professor of public policy at NYU and an expert on drug regulation. But Kleiman notes that the health risks of stand-alone vaping, while lower than combustible cigarettes, are real and unknown. We don’t have good research on the effects of stand-alone nicotine addiction. Kleiman is also concerned about the potential health effects of additives in inhaled vapor.

In a radio interview last month, Kleiman estimated nicotine vaping was “about five percent as dangerous as smoking.”

“The question is how much independent e-cigarette use you’ll get from people who would not have otherwise been smoking,” he told me. And the answer to that appears to be a lot, particularly among teens — prior to the introduction of Juul, policymakers had tremendous success in reducing teen smoking rates far into the single digits.

So, I tend to agree with Drum that the rise of Juul among teens is a worrying trend, and I think it validates the approach the Food and Drug Administration has taken this year toward vape regulation: Trying to harness the very real public-health benefits that come from smokers switching to less-dangerous nicotine vaping, while discouraging current nonsmokers from taking up vaping, especially if they are underage. Tighter restrictions on where flavored vapes and vape cartridges may be sold are a sensible move in this direction.

But there is another important policy tool that can limit the social cost of nicotine vape addiction, while also increasing the public-health benefits that can arise from a switch from smoking to vaping: placing further restrictions on traditional cigarettes.

Many adult smokers who take up vaping continue to use both cigarettes and vapes. Further increases in the taxes on traditional cigarettes, new restrictions on where they can be sold and smoked, bans on specific cigarette varieties and flavors, more aggressive public-health messages about the dangers of cigarettes, and the like could push more of these users to shift farther away from cigarettes and toward vapes, reducing their exposure to the carcinogens in cigarettes and improving life expectancy.

Some of the strongest arguments against higher cigarette-taxes are made weaker by the rise of vaping. One is that high taxes lead to black markets in untaxed cigarettes. Another is that cigarette taxes are highly regressive, with low-income households paying a higher fraction of their income in cigarette tax. Both of these concerns are eased by the availability of vapes, as smokers could avoid the higher taxes by switching, and the availability of lower-tax vape products would reduce black-market demand for cigarettes.

Making it harder to buy cigarettes would address one of the big concerns about teen vaping you see in the media: that teens will take up vaping and then proceed to cigarettes. That’s not showing up yet in the data. The Michigan survey shows a continued decline in teen smoking, although not a statistically significant one from last year, even as teen vaping has soared.

Kleiman is skeptical that we will see a “gateway drug” phenomenon with vapes and cigarettes. He notes that teens who initiate vaping are indeed more likely to take up smoking, but that is not necessarily causal. It is possible that the kinds of teens who are drawn to rebellious behaviors or to addictive substances are more likely to both vape and smoke; it doesn’t mean they wouldn’t have become smokers if vaping didn’t exist.

Still, teens are especially price-sensitive. Juul pods are already less expensive than the equivalent quantity of cigarettes in most states; fostering a greater cost differential between cigarettes and vapes is a good way to ensure teens don’t progress to the former.

And better enforcement of age restrictions on cigarette sales would help avoid a perverse outcome where underage teens, facing greater restrictions on retail sales of vapes, switch to easier-to-buy cigarettes. One way to do that would be to subject cigarettes to the same age-based retailing rules the FDA is imposing on flavored nicotine vape-pods: Only allow their sale in stores that are only open to adults. Raising the national minimum age for buying cigarettes to 21, as some jurisdictions have already done, is another good way to discourage teens who vape from progressing to smoking.

The FDA is also exploring a ban on menthol cigarettes and flavored cigars; banning popular flavored tobacco products could push their existing users toward flavored nicotine vapes, which would be a net improvement for public health.

All that said, in the long run, for better or for worse, I think it is inevitable that nicotine vaping will be widespread and popular, among adults and probably also among teens. Drum refers to Juul as a “fad” in his headline; I very much doubt that it is one.

Cigarettes have long had a strong appeal to consumers because they are enjoyable to smoke and highly addictive. That appeal has been mitigated, especially in recent decades, by accurate perceptions that smoking is a dirty and dangerous habit that will materially reduce your life expectancy. Nicotine vapes are also enjoyable and addictive, and they are not as dirty or as dangerous as cigarettes. In the long run, why would that not lead to higher demand for vapes than has been observed for cigarettes?

To Reduce Ill Effects of Vaping, Restrict Cigarettes