Few topics in mental health create as much attention and misunderstanding as the rise of vaping. The mainstream media has painted a grim picture of these devices as a looming crisis, particularly for young folks, often referring to vaping products as “gateway devices”. While undoubtedly born of genuine concern, this narrative fails to acknowledge the reality of the role of vaping in tobacco harm reduction. This can unintentionally risk pushing smokers away from what can be a lifesaving alternative. When one directly examines the scientific literature on vaping, a completely different story emerges from the ones most public commentators speak of.
Several studies conducted by authoritative sources such as Public Health England suggest that e-cigarettes are about 95 per cent less harmful than ordinary cigarettes. The effectiveness of e-cigarettes as a smoking cessation tool is another area where public perception often trails behind scientific evidence. For instance, a study published in the New England Journal of Medicine found that e-cigarettes were twice as effective at aiding smokers to quit compared to traditional nicotine replacement therapies. This finding, backed up by real-world data from countries like the United Kingdom, emphasizes the strong potential of vaping as a formidable weapon in the battle against smoking and smokingrelated diseases. As such, policy approaches that incorrectly treat vaping as equivalent to smoking or, worse, seek to ban it entirely do more harm than good.
Once celebrated as visionary, Bhutan’s attempted comprehensive tobacco ban ultimately led to a sharp growth in smoking rates and fostered a thriving black market, forcing a repeal of the policy. Similarly, South Africa’s temporary ban during the Covid-19 pandemic barely made a dent in smoking, with analyses after the fact showing that 93 per cent of South African smokers continued to practice the habit despite the ban. Moreover, rates returned to their prior values once the policy was repealed, leaving no hint of any lingering benefit. At the same time, the ban significantly increased prices of cigarettes by 240 per cent, a burden that fell disproportionately on lower-income individuals.
The unintended consequences of overly rigid policies are, thus, not mere speculation. Flavour bans, often proposed to supposedly reduce youth appeal, represent another well-intentioned but counterproductive policy. Evidence suggests that curiosity, not flavours, is the primary driver of experimentation. Furthermore, vaping flavours are key players in assisting smokers to move away from cigarettes. Hence, eliminating this option could push former smokers back to more harmful tobacco products. But by far the most pernicious myth surrounding vaping, one that has captured the minds of many policymakers (here in India included), is the “gateway effect,” which fears that young people who take up vaping will eventually end up smoking cigarettes instead.
In reality, multiple studies, like a comprehensive review of fifteen articles, fail to demonstrate any causal link between vaping and subsequent smoking initiation. Indeed, the evidence is in population numbers. Until 2016, India was the second largest tobacco consumer in the world, second only to China. However, since the advent of vaping, youth smoking rates have been at an all-time low, with a substantial 6 per cent decline in smoking rates among teens in India when vaping rates have been going up. Far from a gateway effect, these figures indicate that vapes are used as a safer alternative for cigarettes. As we navigate the intricate landscape of tobacco control in the 21st century, it’s imperative to embrace a comprehensive harm reduction approach, one that recognizes the potential of e-cigarettes as a less harmful alternative to smoking.
Such an approach calls for nuanced policies that balance youth protection with the needs of adult smokers seeking to quit. The stakes measured in lives saved and improved are simply too high to let misinformation guide our approach to what could be one of the most significant public health innovations of our time.
Originally published here
