EDITORIALS

who might be at risk from the potential

Tobacco Control Leaders harms of nicotine addiction is far smaller
than the number of smokers in the
Call for a Balanced United States (1 in 7 of the population) at
real and evident risk of serious harm

Assessment of the Risks from their smoking who could benefit

from increased smoking cessation. To

and Benefits of be clear, they are not arguing that vaping

should be promoted as overall benefi-

Nicotine Vaping cial, just that a more appropriate balance

should be struck between the likely
potential harms and benefits.
Martin Dockrell, PGDip, BA, and John N. Newton, MSc The problem with the current focus in
ABOUT THE AUTHORS the United States on youth vaping is that
many measures to discourage vaping,
Martin Dockrell and John N. Newton are with Public Health England, London, England.
such as flavoring bans, taxes, and
e-cigarette sales restrictions, may

T he role of e-cigarettes, or nicotine

vaping products, in tobacco control
has been controversial from the outset.
nicotine products, mainly e-cigarettes.
They briefly cover the health risks of
vaping, the potential for e-cigarettes to
reduce smoking cessation and effec-
tively protect smoking.3,4
There is another risk in antivaping

AJPH
Early divisions among public health increase smoking cessation, and con- policies intended to protect youths. In

Published online ahead of print August 26, 2021

experts led to polarized coverage in the cerns about youth nicotine vaping. The seeking to tell a strong story, we are in
media, confused messages to the public, context is staggering success in reducing danger of misleading the public. The
and inconsistent policymaking between smoking rates to historic lows, especially authors contrast public perception with
jurisdictions. For many authorities in the among US youths, and the announce- the conclusions of the US National
United States, the potential health ment of the aim to reduce tobacco use Academy of Sciences and the Royal Col-
harms of e-cigarettes and youth-vaping prevalence to less than 5% by 2030.2 lege of Physicians. Nearly half of Ameri-
concerns were overriding considera- These eminent authors conclude that cans incorrectly believe e-cigarettes to
tions. For others (most notably in the the “singular focus of US policies on be at least as harmful as smoked
United Kingdom), those risks have been decreasing youth vaping” (Balfour et al. tobacco. The effect has been worsened
balanced more explicitly against the [https://bit.ly/2WiEPA1]) has been a dis- by the EVALI (e-cigarette or vaping use-
potential benefits for smokers of easy traction from the larger goal of tobacco associated lung injury) outbreak caused
access to nicotine vaping products. As control, namely reducing smoking and its by adulterated marijuana products and
more and better evidence becomes harms. They point out that despite wide- wrongly ascribed to nicotine vaping
available and continues to accrue, some spread experimentation, frequent use devices. The harm to health from this
consensus should be possible on the remains much more common among misattribution has had effects far
individual elements of this complex pol- youths who smoke, and if vaping were to beyond the United States and continues
icy question. It remains, however, a sig- lead to more youth smoking then we to this day.5,6 The price is a high one, as
nificant challenge to integrate that evi- would see some evidence of it by now. smokers, doctors, and governments are
dence into a holistic view of the major Population surveillance data show the put off supporting an approach to quit-
risks and benefits associated with nico- reverse: youth smoking continues to fall ting that can be twice as effective as
1
tine vaping products. and at a faster rate than before. It seems licensed medicines.7 Overemphasis of
In this issue of AJPH, 15 past presidents at least plausible that vaping has contrib- the risks of vaping leads to cognitive
of the Society for Research on Nicotine & uted to this decline, with vaping replacing bias that means we are inclined to reject
Tobacco—the world’s leading scientific smoking among US youths. the benefits highlighted, for example, in
society for the study of smoking—review The authors also point out that the the recent Cochrane review.8 Public
the evidence underpinning US policy on number of nonsmoking young people health risks stealing the industry’s

Editorial Dockrell and Newton e1

 EDITORIALS

clothes, becoming the new merchants of when they find their adolescent sons REFERENCES
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Kingdom, and elsewhere has been to Correspondence should be sent to Martin Dock- CD010216. https://doi.org/10.1002/14651858.
rell, PHE, Wellington House, 133-155 Waterloo Rd., CD010216.pub4
increase inequalities. As Balfour et al. London SE1 8UG, England (e-mail: martin. 9. Quit Strong. 2021. Available at: https://quitstrong.
AJPH

point out: [email protected]). Reprints can be ordered at nz/?gclid=EAIaIQobChMI47yn2aPb8AIVkAWiAx2g

http://www.ajph.org by clicking the “Reprints” link. 4QgYEAAYASAAEgLZSvD_BwE. Accessed June 4,
2021.
African Americans suffer dispropor- 10. New Zealand Ministry of Health—Manatu Hauora.
PUBLICATION INFORMATION
tionately from smoking-related deaths. Vaping facts. 2021. Available at: https://
Full Citation: Dockrell M, Newton JN. Tobacco con- vapingfacts.health.nz. Accessed June 4, 2021.
. . . Today’s smokers come dispropor- trol leaders call for a balanced assessment of the
tionately from lower education and risks and benefits of nicotine vaping. Am J Public
Health. Published online ahead of print August 26,
income groups, the LGBTQ community,
2021: e1–e2.
and populations suffering from mental Acceptance Date: June 16, 2021.
health conditions. (https://bit.ly/ DOI: https://doi.org/10.2105/AJPH.2021.306458
2WiEPA1)
CONTRIBUTORS
M. Dockrell conceptualized and wrote the first draft
of the editorial. J. N. Newton provided additional
The authors suggest that to affluent
material, review, and comment.
Americans “today’s smokers may be
nearly invisible” (https://bit.ly/2WiEPA1). ACKNOWLEDGMENTS
If doctors, academics, and policymakers This work was completed in our capacity at Public
Health England.
have few smokers among their friends
and families, the task of making smoking CONFLICT OF INTEREST
obsolete may look almost done. And The authors have no conflicts of interest to declare.

e2 Editorial Dockrell and Newton