Strict E-Cig Laws Punish Marginalized Groups
There are plenty of hobbyists who enjoy zero nicotine e-juice, but the vast majority of e-cig users are former smokers. For those of us in this group, access to a nicotine delivery platform that is free of smoke and ash has been a game changer.
Society as a whole is gradually moving away puritanical strictures regarding marijuana use. Alcohol prohibition was discredited nearly a century ago. Why does vaping alone face ramped up legal pressure and ever more stringent FDA regulations?
The Wealthy Don’t Vape
The answer can be found in smoking trends. A Washington Post report in 2015 outlined in detail how the wealthy have almost entirely stopped smoking cigarettes. It is among marginalized groups that cigarettes remain most prevalent. The same trends hold true among adult vapers. Only a small minority of e-cig users were non-smokers and smokers over the age of 45 are less likely to use have tried e-cigarettes.
The well-being of smokers is clearly of no concern to the California politicians who are fighting for e-cig prohibition. A short term spike in vaping among minors has prompted moves to bar access to e-cigarettes. A long-time foe of Big Tobacco, Iowa AG Thomas Miller outlined the cruelty and shortsightedness of this approach in his letter to the FDA.
Going after e-cigarettes is easy because the adults being denied access are not well-represented in the social circles where most politicians and anti-vaping activists reside. Like any new technology, vaping has always faced more than its share of pressure. The real crackdown only started when Juul devices began to appear in middle class and affluent high schools. This led to new FDA regulations on e-cigs.
Ignoring Minorities and the Marginalized
The CDC’s study, “Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status” starkly outlines the disproportionate impact that smoking has on the less affluent. Adults with less than a high school education succeed in quitting cigarettes only 43.5 percent of the time versus 73.9 percent for college graduates. Adults earning more than twice the poverty line are only half as likely to smoke as adults living below the poverty line.
The CDC’s own numbers show that African American smokers generally smoke fewer cigarettes, report more quit attempts and less success at quitting than their White and Hispanic counterparts. International Journal of Environmental Research and Public Health conducted a study into racial and ethnic differences among e-cigarette users. They found that African Americans were more likely to embrace e-cigarettes as a cessation aid than Whites and Hispanics. They were also statistically more inclined to avoid dual use of cigarettes and e-cigarettes.
This study was operating under the premise that “evidence based” methods such as nicotine replacement therapy were more effective than e-cigarettes, and that transitioning to e-cigarettes was not a worthwhile end goal. In pursuit of their gold-standard of total nicotine abstinence, the study’s authors engaged in some serious mental gymnastics. Their attempts to explain away the general skepticism about nicotine replacement and the widespread embrace of e-cigarettes by the African Americans surveyed was particularly flimsy.
In light of the New England Journal of Medicine (NEJM) study that found e-cigarettes were nearly twice as effective as nicotine replacement, it is time to revisit how these results were interpreted. Although it was not the purpose of either study, they illustrate the negative impact that e-cig bans may have on the African American community.
Grim trends are also prevalent in rural and poor areas. Lung cancer rates are far higher and a lack of access to health care is blamed. Banning e-cigarettes from gas stations will heavily impact availability in rural areas. There is no reason to compound smoking health disparities by denying ash and smoke free alternatives.
Vaping and the LGBT Community
Vaping is most prevalent in the LGBT community. The CDC found that 20.3 percent of adults that identify as lesbian, gay or bisexual smoke cigarettes, versus an overall rate of 14 percent. Bisexual women are over twice as likely to smoke as heterosexual women. As a whole, the LGBT population in the US is three times more likely to use electronic cigarettes: 7.5 percent versus 2.6 percent. This is the highest rate for any group surveyed.
Smoking rates among the transgendered have been estimated at over 80 percent and studies have tied this to structural discrimination. As a whole, the smoking rate in the LGBT community kills over 30,000 annually and leads significant health disparities.
Vaping Crushes Nicotine Replacement Therapy
It is cruel and unconscionable to impose policies that incentivize cigarette smoking over vaping. Vaping crushed nicotine replacement as a smoking cessation tool in the NEJM study. The logical response is to determine if e-cigarettes can be incorporated into a comprehensive harm reduction program. At the very least, the findings should prompt additional research.
Instead, states like New York and California are restricting access and promoting total abstinence. This approach punishes anyone with the temerity to seek nicotine, which is legal. It also funnels vapers back onto the cigarette track.
The NEJM smoking cessation study was met with pearl clutching and excuse making. Concerns about former smokers continuing to vape were presented as proof that e-cigarettes have no value. This marks a major shift of the goalposts. The old vaping myth was that that e-cigarettes merely supplemented cigarettes.
Why Is Vaping the Target?
Vaping is low-hanging fruit for regulators and politicians looking to score easy points. Smokers are not heavily represented in middle and upper income brackets, whereas drinking rates are highest among educated, high-income adults.
It is more politically fraught to purse underage drinking with the same prohibitionist zeal. It would require restricting the freedom and condemning the personal habits of family members, neighbors, colleagues and peers. Alcohol abuse by minors is a scourge. It kills more than 4,300 underage drinkers each year and results in 119,000 ER visits annual among people aged 12 to 20, according to the CDC.
These aren’t hypothetical concerns about Crème Brule flavor appealing to tweens or concerns about vaping being a gateway to cigarettes. The ghastly toll inflicted by underage drinking is actual, unmitigated carnage.
High risk behaviors in high school students have declined remarkably over the last several decades. It is unfortunate that vaping is now on this list of behaviors and the industry will remain imperiled until this trend is reversed. We are opposed to underage e-cig use at Vapor4Life and go beyond the industry standard with age verification.
E-cigarettes are also an easy target because they are a relatively new technology. A huge number of preposterous zombie vaping myths are still spread by anti-vaping extremists. You would be branded a buffoon if you spouted long debunked talking points from Reefer Madness or quoted liberally about the evil temptations of the “Devil’s Agent” from an early 20th century temperance pamphlet.
A Patchwork Approach
If promoting health was really the goal of lawmakers and anti-vapers, the rational response would be to determine if there is a best method to taper nicotine levels to zero. Compare the CDC’s skepticism of e-cigarettes to their long-standing love affair with nicotine replacement therapy. The transdermal nicotine patch first appeared 34 years ago. There are also lozenges, gums, sprays, tabs, and pills.
An incredible amount of time, resources and money has been dumped into streamlining the use of nicotine replacement products. This investment gap could explain why a high percentage of nicotine replacement users were totally nicotine free after one year. Yet taken as a smoking cessation tool, the drug industry backed and CDC approved nicotine replacement therapy was easily outperformed by a 650 mAh cartomizer starter kit in the NEJM study.
Creating guidelines to help vapers reduce their nicotine levels is something worth investing in. This would not require any reclassification of e-cigs or promotion into the cessation tool category. But for this to happen, the CDC would need relax their hardline stance.
The UK Is a Beacon of Hope
It is a different story on the other side of the pond. The UK is light-years ahead of the US when it comes to promoting harm reduction. The official NHS stance on e-cigarettes is humane and rational:
An estimated 2.9 million adults in Great Britain currently use e-cigarettes and of these, 1.5 million people have completely stopped smoking cigarettes. They carry a fraction of the risk of cigarettes and can be particularly effective when combined with extra quitting support.
Public Health England, an executive agency in the UK’s Department of Health and Social Care, views vaping as being 95 percent less harmful than cigarettes. The London Fire Brigade endorsed e-cigs as an alternative to combustible cigarettes after confirming that vaping prevents house fires.
The UK has outperformed EU countries in smoking cessation. They credit their scientific based approach to e-cigarettes and argue that countless lives could be saved if other countries were willing to follow their lead. It remains to be seen if the US will ever follow suit. But the numbers suggest that marginalized smokers would benefit the most from an about-face.