San Francisco E-Cig Ban Punishes Marginalized

San Francisco will be the first American city to ban e-cigs. The board of supervisors unanimously approved the measure, and final approval should occur as soon as next week.

When passed, the ordinance will halt the sales of e-cigarettes in San Francisco. It will also block the delivery of e-cigarettes to San Francisco addresses until the FDA completes their safety review of electronic cigarettes. This blow to choice and freedom is not a distant threat. E-Cig prohibition in San Francisco is fast approaching, and would be implemented seven months after approval.

According to the San Francisco Chronicle, Juul hopes to strike back by taking the issue to voters with a ballot measure this November which would override a ban on vaping that would fall hardest on those without the mobility or financial wherewithal to seek their e-cigarettes outside of city limits.

The San Francisco board of supervisors also expressed interest in passing a separate measure which would prohibit the distribution, manufacture and sale of e-cigarettes on city property. Juul’s San Francisco headquarters is located on the city owned Pier 70 property.  Juul has over 1,200 employees based out of their San Francisco offices, and recently purchased additional real estate for their growing business.

In response to the ban, Juul spokesman Ted Kwong said:

“The prohibition of vapor products for all adults in San Francisco will not effectively address underage use and will leave cigarettes on shelves as the only choice for adult smokers, even though they kill 40,000 Californians every year.”

Harm Reduction in San Francisco

In related news, California Assembly Bill 362, legislation that would provide safe injection sites for IV drug users in San Francisco is slowly making its way through the California State Senate. This bill would provide hygienic areas where pre-purchased drugs could be consumed under the watchful eye of health care professionals.

San Francisco hands out 4.5 million syringes annually, and has been pushing for safe injection sites for the better part of the decade. San Francisco also has a reputation for offering superior social services for the homeless.

This tradition of humane treatment is about to be betrayed in a big way. The board of supervisors have shown that they are willing to stamp out the lives of smokers and vapers in order to address an uptick in teen vaping and score political points by blasting local vape giant Juul.

Apparently, smokers are not worthy of the humane treatment extended to IV drug users. San Francisco has long promoted harm reduction policies and purports to be a standard bearer of liberal values. If they were consistent, they would establish something like the “Using E-Cigs to Stop Smoking” resource page hosted by the UK’s National Health Service.  

Yet they ignore the UK model of promoting e-cigarettes, and that country’s correspondingly lower levels of both smoking and teen vaping. The teen vaping epidemic is the catalyst for these laws, or at least a way to drum up support for them. This begs the question, why do fewer teenagers vape in the UK where vaping is promoted?

Public Health England Promotes Vaping

Drumming up hysteria to solidify their political base is certainly well within the rights of any politician. It is up to voters to deal with the officials they have elected. But the San Francisco e-cig ban seems extremely reactionary and oppressive, hardly a vision of inclusivity and compassion.

Compare the total ban proposed in San Francisco and various laws that have appeared across the US with the official stance of the UK’s National Health Service (NHS):

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 (PHE), is an executive agency in the UK’s Department of Health and Social Care, has determined that vaping is 95 percent less harmful than cigarettes. They reject the conspiracy theory that vaping is just a gateway to smoking.

The London Fire Brigade promotes e-cigs as an alternative to combustible cigarettes, and has the numbers that prove vaping prevents house fires.

The UK has outperformed EU countries in smoking cessation. They credit a humane and science based approach to e-cigarettes. They argue that countless lives could be saved if other countries were willing to follow their lead.

It does not appear that politicians in the US share their zeal for protecting the lives of smokers and former smokers. And the numbers suggest that marginalized smokers would benefit the most from an about-face.

Keep in mind that the NHS and PHE have no special agenda. As part of a publicly funded, single payer system, they rely on tax dollars to stay afloat and can be ruthless about cutting costs. In 2017, the NHS pulled the plug on homeopathic and herbal treatments. Whatever your thoughts are on alternative medicine, this move makes it clear that the UK is not afraid to act if it means saving money.

New England Journal of Medicine E-Cig Study

So why is progressive San Francisco so eager to enforce a puritanical law that demands either smoking or total nicotine abstinence? A New England Journal of Medicine study found that vaping crushes nicotine replacement therapy for smoking cessation. The vaping device that fared so well against nicotine replacement therapy was a classic cartomizer. It would be interesting to see if a modern pod system or box mod is even more effective.

Critics of vaping were not appeased by the study, and they decided to shift the goal posts. The old myth was that vaping is a mere supplement for cigarettes, and does not reduce use. This concern was shown to be groundless by the study, and has since morphed into concerns about vapers continuing to consume nicotine after they had stopped smoking.

Looking at this situation logically, vaping was shown to be more effective than nicotine replacement therapy. If the issue was continued use, why not invest money and time into developing officially sanctioned and codified titration and cessation strategies? This makes more sense than prohibition, and is the exact strategy embraced in the UK.

E-Cigs and the LGBTQ+ Community

San Francisco is turning a blind eye to the fact that strict e-cig laws harm marginalized groups. Smoking and vaping are most prevalent in the LGBTQ+ community. A CDC study found that 20.3 percent of adults who identify as gay, lesbian, or bi-sexual smoke cigarettes. The overall rate is 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 LGBTQ+ community kills over 30,000 annually and leads significant health disparities.

Taken as a whole, the LGBTQ+ 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.

Strict E-Cig Laws Harm Marginalized Groups and Minorities

The CDC’s study, “Cigarette Smoking and Tobacco Use Among People of Low Socioeconomic Status” demonstrates 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. 

African Americans and E-Cig Bans

The International Journal of Environmental Research and Public Health conducted a study into racial and ethnic differences among e-cigarette users. They discovered 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.

Not surprisingly, this study was study was operating under the premise that “evidence based” methods such as nicotine replacement therapy were more effective than e-cigarettes. A notion that has since been debunked. The study authors made it clear that transitioning to e-cigarettes was not a worthwhile end goal, all that mattered was the gold-standard of total nicotine abstinence.

Their efforts attempts to explain away the general skepticism about nicotine replacement therapy in African American community distracted them from the salient issue, the widespread embrace of e-cigarettes in place of combustible cigarettes by this same population cohort.

In light of the 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, it starkly outlined the negative impact that e-cig bans may have on the African American community that has largely rejected nicotine replacement therapy.

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.

Why is Vaping the Target?

Why are cities like San Francisco, and progressive politicians across the US, willing to harm marginalized groups in their crusade to promote total nicotine abstinence? The uptick in teenage vaping is the major issue, and it poses an existential threat to the vaping industry. Strict national e-cig laws are in the works and an FDA crackdown are on the horizon.

Marijuana seems to be on the opposite course, with Illinois being the most recent state to legalize use. Illinois punished marginalized smokers with an ecig sin tax earlier this year, so consistency is apparently not a virtue when vaping is involved.

Interestingly, marijuana use is actually more common than vaping among youth according to the CDC. The American Academy of Child and Adolescent Psychology claims youth marijuana use is at its highest level in 30 years. So why is one teetering on the brink of illegality while the other is being championed? If prohibition didn’t work for liquor, weed, cigarettes and gambling, why will it work for vaping?

Other high risk teen behaviors are even more prevalent, and deadly than vaping. Alcohol is a scourge that kills 4,300 minors annually, and sends another 119,000 to the emergency room, according to the CDC.

These aren’t hypothetical concerns, like Juul naming a flavor Crème Brulee after a French inspired dessert that peaked in popularity 25 years ago. Or banning the sale of retro ejuice flavors marketed to adults because they seem like something a child might like. Newsflash: the most popular Juul flavor is Mint and their packaging does not resemble a cereal box.

Moreover, millennial does not equal minor. The massive declines in smoking among younger Americans does not cover much of that age group. Are they not to be afforded ash and smoke free alternatives to conventional cigarettes?

The Wealthy Don’t Smoke

It is no coincidence that e-cig bans harm marginalized groups, and additional restrictions on the sale of alcohol are not on the radar. These two issues are intertwined. As expertly outlined in the Washington Post, the wealthy have largely given up smoking. But drinking rates are highest among the highest educated, and most wealthy adults.

It is easy to pursue vaping with a prohibitionist zeal when you do not know any vapers. It is a habit seems that seems foreign and disreputable to a vocal minority that is hell-bent on a complete ban.

It is unclear why education, age verification and lowered nicotine levels aren’t being proposed. These are the methods that were used to reduce the rate of actual cigarette smoking.

Instead, we face draconian laws that will drive the voiceless minority of vapers back into the arms of big tobacco. Perhaps lawmakers think this serves us right.  The “problem” of vaping is easily solved with total abstinence. Is this what passes for “progressivism” in 2019?