Thursday, 5 May 2016

Time to end the e-cigarette ban paradox

New Zealand and Australia both prohibit the sale of e-cigarette products containing nicotine. This creates a weird paradox where cigarettes containing nicotine are legal, but e-cigarettes containing nicotine are not. The argument from some public health advocates is that e-cigarettes may be a gateway to smoking, they increase social acceptability of smoking, and the long-term health impacts of e-cigarettes are unknown so it is better to be safe than sorry. An interesting piece in The Conversation this week by Colin Mendelsohn (University of Sydney) takes up the issue:
A new report by the Royal College of Physicians in the United Kingdom says electronic cigarettes (e-cigarettes) are much safer than smoking and encourages their widespread use by smokers. It concludes that e-cigarettes have huge potential to prevent death and disease from tobacco use.
The review identifies e-cigarettes as a valuable tool to help smokers quit. For those who are unable to quit with currently available methods, e-cigarettes can substitute for smoking by providing the nicotine to which smokers are addicted without the smoke that causes almost all of the harm. This approach is supported by the scientific and public health community in the UK and is consistent with a previous review by Public Health England, the government health agency...
In the UK, there is no evidence e-cigarettes are a gateway to smoking. E-cigarette use is almost entirely restricted to current or past smokers. Use by children who would not otherwise have smoked appears to be minimal.
The report found no evidence to suspect the use of e-cigarettes renormalises smoking. On the contrary, smoking rates in the UK have been falling as e-cigarette use rises.
E-cigarette vapour contains some toxins and the report acknowledges some harm from long-term use cannot be dismissed. However, it supports the widely held view that the hazard to health is unlikely to exceed 5% of the risk of smoking, and may well be substantially lower.
The irony here is that a ban on e-cigarettes, which as noted above are substantially lower risk than cigarettes, probably leads at least some people who would have quit smoking if e-cigarettes were available, to continue smoking. Cigarettes and e-cigarettes are substitutes - the unavailability of one (e-cigarettes) makes consumers more likely to consume the other (cigarettes).

Not only that, the unavailability of e-cigarettes may lead to more new smokers taking up the habit. Recent research by Abigail Friedman (Yale School of Public Health), reported here (but with the original paper here, and ungated earlier version here), shows that:
...state bans on e-cigarette sales to minors find that such bans yield a positive and statistically significant 0.7 percentage point increase in recent smoking rates among 12 to 17 year olds, relative to the rate in states that had not implemented such bans.
Of course, that doesn't answer the question about the effect of a ban on e-cigarette sales on smoking rates for the population as a whole. However, it is probably not a stretch to believe that similar effects would be apparent for New Zealand teens, and so a relaxation of the ban on e-cigarette sales is likely to reduce smoking among the older population, and reduce rates of smoking uptake among the younger population.

Clearly, having more smokers as a result of banning e-cigarettes is an unintended consequence of the policy, since it leads to greater harm. As many others have argued, it is time to relax the ban on e-cigarettes containing nicotine, to reduce this unintended consequence.

[HT for the Yale research: Marginal Revolution]

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