OPINIONS, IDEAS, & PRACTICE

The authors also point out that the

Tobacco Control Leaders number of nonsmoking young people
who might be at risk from the potential
Call for a Balanced harms of nicotine addiction is far smaller
than the number of smokers in the

Assessment of the Risks United States (1 in 7 of the population) at

real and evident risk of serious harm

and Benefits of from their smoking who could benefit

from increased smoking cessation. To

Nicotine Vaping be clear, they are not arguing that vaping

should be promoted as overall benefi-
cial, just that a more appropriate balance
Martin Dockrell, PGDip, BA, and John N. Newton, MSc should be struck between the likely
ABOUT THE AUTHORS potential harms and benefits.
The problem with the current focus in
Martin Dockrell and John N. Newton are with Public Health England, London, England.
the United States on youth vaping is that
See also Balfour et al., p. 1661. many measures to discourage vaping,
such as flavoring bans, taxes, and

T he role of e-cigarettes, or nicotine

vaping products, in tobacco control
the evidence underpinning US policy on
nicotine products, mainly e-cigarettes.
e-cigarette sales restrictions, may
reduce smoking cessation and effec-
September 2021, Vol 111, No. 9

has been controversial from the outset. They briefly cover the health risks of tively protect smoking.3,4
Early divisions among public health vaping, the potential for e-cigarettes to There is another risk in antivaping
experts led to polarized coverage in the increase smoking cessation, and con- policies intended to protect youths. In
media, confused messages to the public, cerns about youth nicotine vaping. The seeking to tell a strong story, we are in
and inconsistent policymaking between context is staggering success in reducing danger of misleading the public. The
jurisdictions. For many authorities in the smoking rates to historic lows, especially authors contrast public perception with
United States, the potential health among US youths, and the announce-
AJPH

the conclusions of the US National

harms of e-cigarettes and youth-vaping ment of the aim to reduce tobacco use Academy of Sciences and the Royal Col-
concerns were overriding considera- prevalence to less than 5% by 2030.2 lege of Physicians. Nearly half of Ameri-
tions. For others (most notably in the These eminent authors conclude that cans incorrectly believe e-cigarettes to
United Kingdom), those risks have been the “singular focus of US policies on be at least as harmful as smoked
balanced more explicitly against the decreasing youth vaping” (Balfour et al. tobacco. The effect has been worsened
potential benefits for smokers of easy [p. 1661]) has been a distraction from the by the EVALI (e-cigarette or vaping use-
access to nicotine vaping products. As larger goal of tobacco control, namely associated lung injury) outbreak caused
more and better evidence becomes reducing smoking and its harms. They by adulterated marijuana products and
available and continues to accrue, some point out that despite widespread wrongly ascribed to nicotine vaping
consensus should be possible on the experimentation, frequent use remains devices. The harm to health from this
individual elements of this complex pol- much more common among youths who misattribution has had effects far
icy question. It remains, however, a sig- smoke, and if vaping were to lead to more beyond the United States and continues
nificant challenge to integrate that evi- youth smoking then we would see some to this day.5,6 The price is a high one, as
dence into a holistic view of the major evidence of it by now. Population surveil- smokers, doctors, and governments are
risks and benefits associated with nico- lance data show the reverse: youth put off supporting an approach to quit-
tine vaping products.1 smoking continues to fall and at a faster ting that can be twice as effective as
In this issue of AJPH, 15 past presidents rate than before. It seems at least plausi- licensed medicines.7 Overemphasis of
of the Society for Research on Nicotine & ble that vaping has contributed to this the risks of vaping leads to cognitive
Tobacco—the world’s leading scientific decline, with vaping replacing smoking bias that means we are inclined to reject
society for the study of smoking—review among US youths. the benefits highlighted, for example, in

1570 Editorial Dockrell and Newton

 OPINIONS, IDEAS, & PRACTICE

the recent Cochrane review.8 Public find their adolescent sons and daugh- REFERENCES
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Balfour et al. offer a refreshingly clear surprise that they are alarmed, even Reduce current cigarette smoking in adults—TU-
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September 2021, Vol 111, No. 9

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policies in the United States, the United Correspondence should be sent to Martin Dock- CD010216. https://doi.org/10.1002/14651858.
CD010216.pub4
rell, PHE, Wellington House, 133-155 Waterloo Rd,
Kingdom, and elsewhere has been to 9. Quit Strong. 2021. Available at: https://quitstrong.
London SE1 8UG, England (e-mail: martin.
increase inequalities. As Balfour et al. [email protected]). Reprints can be ordered at nz/?gclid=EAIaIQobChMI47yn2aPb8AIVkAWiAx2g
4QgYEAAYASAAEgLZSvD_BwE. Accessed June 4,
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2021.
10. New Zealand Ministry of Health—Manatu Hauora.
African Americans suffer dispropor-
PUBLICATION INFORMATION Vaping facts. 2021. Available at: https://
vapingfacts.health.nz. Accessed June 4, 2021.
Full Citation: Dockrell M, Newton JN. Tobacco
tionately from smoking-related deaths.
control leaders call for a balanced assessment of
. . . Today’s smokers come dispropor- the risks and benefits of nicotine vaping. Am J Public
tionately from lower education and Health. 2021;111(9):1570–1571.
income groups, the LGBTQ community, Acceptance Date: June 16, 2021.
DOI: https://doi.org/10.2105/AJPH.2021.306458
and populations suffering from mental
health conditions. (p. 1667)
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” (p. 1667). If doctors, ACKNOWLEDGMENTS
This work was completed in our capacity at Public
academics, and policymakers have few
Health England.
smokers among their friends and fami-
lies, the task of making smoking obsolete CONFLICT OF INTEREST
may look almost done. And when they The authors have no conflicts of interest to declare.

Editorial Dockrell and Newton 1571