Sunday, May 28, 2023

The FDA and Juul are fighting over a vape ban, but the role of e-cigarettes in the world of tobacco abuse is not clear

On June 23, 2022, the U.S. Food and Drug Administration announced that all Juul products should be removed from U.S. markets. This decision essentially broadened an existing ban on teen use of the company’s nicotine e-cigarettes to include adults as well. The next day, Juul asked a federal appeals court to temporarily reverse the ban while Juul challenged the decision. The court agreed to the break, and for now, Juul products are still on sale in the US

Lynn Kozlowski of the University of Buffalo has been studying nicotine and cigarette addiction for decades. He explains how the recent battle over Juul products fits into the larger discussion of e-cigarettes, tobacco use and public health among adults and teens.

Why does the FDA want to stop selling Juul products?

According to the FDA, the decision was a preventative response due to a lack of “sufficient evidence regarding the toxicological profile of the products” to ensure the protection of public health. The FDA also noted that it had not received any information indicating that Juul products were an “immediate hazard”.

In the announcement, FDA commissioner Robert M. Califf commented on the effect Juul products had on youths. And this decision comes at a time when some have hoped that a new ban on Juul products and other e-cigarettes for adults will help reduce damping by teens.

A woman exhaling a cloud of steam while holding a juul e-cigarette.
E-cigarettes are not without health care, but evidence suggests that they are far less harmful to health than tobacco cigarettes.
Associated Press Photo / Craig Mitchelldyer

How do the health risks of vaping compare to smoking?

Cigarettes kill at least 1-in-2 smokers prematurely and shorten smokers’ lives by an average of 10 years due to cancer, obstructive pulmonary disease and cardiovascular disease.

There are no long-term epidemiological data available on e-cigarettes yet. But US and UK evaluations have concluded that while vaping is likely to be significantly less harmful than cigarettes, it is not risk-free. Potential harm includes nicotine addiction as well as some cardiovascular risks, although it is estimated to be lower than risks of cigarettes.

Can e-cigarettes reduce damage from normal smoking?

I do not encourage anyone to steam when it is not necessary. But if someone else were to smoke cigarettes, and vaping helps them to quit smoking completely, e-cigarettes can be a useful tool in reducing the smoking and health problem. Quitting cigarettes is unequivocally good for your health. Research shows that if a person stops using cigarettes by the age of 40, they avoid on average 90% of the increased risk of death compared to if they continue to smoke. If a person at the age of 30 stops smoking cigarettes, their health risks are almost the same as a person who has never smoked.

The CDC says there is limited evidence that vaping helps people quit smoking cigarettes. The FDA, in approving some e-cigarettes for sale, expresses the view that e-cigarettes can be a beneficial tool for smokers who significantly reduce their cigarette use or quit smoking by switching to e-cigarettes.

Recent studies have also shown that e-cigarettes are more effective than nicotine replacement medicine in helping people who want to quit smoking. The UK National Health Service includes vaping as an approved way to quit smoking.

Numerous types of vapes on a desk.
Vaping is popular among high school students – as shown in this photo of vapes confiscated at a high school in New York – but it is declining.
Associated Press Photo / Steven Senne,

Is vaping among teens as popular as it once was?

Teen vaping is on a downward trend. Data from the CDC showed that 27.5% of high school students in 2019 had steamed at least once in the previous month. That number has dropped to 19.6% in 2020 and to 11.3% in 2022. Just over a quarter of monthly users – or about 3% of high school students in 2022 – report vaping daily.

Some of these declines were likely due to COVID-19, enforcement of youth access restrictions, and government anti-vaping campaigns.

Widespread publicity about a serious lung disease caused by vaping, called EVALI, has most likely turned away from vaping. This was despite the fact that research eventually showed that the disease is mostly caused by black market cannabis evaporation products.

Increases the use of teen tobacco?

Despite the encouraging decline in teen vaping, an important question to ask is whether vaping directly leads to later cigarette smoking.

Parents are rightly concerned that vaping could be a gateway to smoking. But research does not appear to support a strong causal link. While vaping has risen nationally over the past few years, smoking rates have dropped.

Using several years of U.S. data from the National Youth Tobacco Survey on nearly 40,000 participants, researchers found that less than 1% of those who first used e-cigarettes continued to become established cigarette smokers. People who smoked first were also less likely to become smokers than those who tried cigarettes or other tobacco products first.

Another large study of American youth found that a history of e-cigarette use is associated with only modest or non-significant increases in cigarette smoking once the researchers took control of general risk-taking behaviors.

How do you balance adult use with teen safety?

Even though vaping is not a big factor in getting teens to smoke, teenage use of vaping products is a concern despite a ban on the sale of e-cigarettes to people under 21 in 2019.

Banning a product that is useful for adult smokers who want to quit completely is not the only way to reduce youth access. For example, one proposal proposes to move sales of all nicotine and tobacco products to stores that are only accessible to those 21 or older.

While products like Juul deserve study and regulation, it is important to keep in mind the proven lethality and easy availability of cigarettes – both for adults today and for the many teens who start smoking each year and will become adult smokers. Getting as many smokers out of tobacco cigarettes as possible will save lives.

Nation World News Desk
Nation World News Desk
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