It’s not smoke, and there’s no fire, but is ‘safer’ safe enough?

Los Angeles, California Jun 4, 2024 (Issuewire.com) – What role could e-cigarettes play in reducing smoking? That is the central question of a new book by Samuel Hampsher-Monk, James Prieger, and Sudhanshu Patwardhan exploring the challenges and opportunities of e-cigarette regulation.

Somewhere in the world, every four seconds a person dies from disease caused by smoking. More than 1 billion people use tobacco, mostly from disadvantaged communities and mostly by smoking cigarettes. New strategies are needed to improve public health and health equity. Non-combustible nicotine products, including e-cigarettes (vapes), decouple nicotine consumption from the harmful effects of inhaled cigarette smoke. Research published by the Cochrane Library finds them to be more effective than traditional supports like nicotine patches and gum. But their broad appeal is a double-edged sword: e-cigarettes can also be popular among young people including those who did not previously smoke.

There is fierce disagreement about how e-cigarettes should be regulated. The controversy is fueled, in part, by the fact that the product category is diverse and consumption patterns are dynamic, complicating efforts to evaluate safety and efficacy in generalizable terms. As Hampsher-Monk notes, “the available evidence is often interpreted through the lens of subjective values. Different stakeholders prioritize the wellbeing of different groups; exhibit different levels of risk aversion; and disagree about what qualifies as risk and what kinds of precautionary measures are justified. Even the best empirical data does not, by itself, resolve those differences.”

By shaping public attitudes and, by extension, demand- and supply-side behavior, regulatory decisions are hugely influential in deciding how good – or bad – e-cigarettes are for public health. But as Professor Donald Kenkel, of Cornell Brooks School of Public Policy, writes in the foreword, “the issues raised by e-cigarette regulation are complex, including interactions between health and regulatory science, economics, policy, law, and marketing.” Public decisions that ignore those interactions may inadvertently incentivize riskier consumption patterns. Drawing on economics, policy analysis, and other disciplines, the authors suggest that targeted and risk-proportionate interventions could better balance risks and benefits; helping divert current and future generations from smoking-related harms while also discouraging vaping by nonsmokers.

“This book is a valuable resource for policymakers and others wrestling with . . . e-cigarette regulation in the real world… [It] provides a careful review of the evidence and thoughtful analysis of the policy trade-offs.”

– Donald Kenkel, Cornell Brooks School of Public Policy

Tobacco Regulation, Economics and Public Health: Clearing the Air on E-cigarettes and Harm Reduction is published by Palgrave MacMillan; part of Springer Nature, and is available in print and e-book formats from June 4, 2024.