New York Governor Andrew Cuomo signed a bill this week banning vaping in all public indoor places throughout the state. Under the new bill, e-cigarettes would be treated the same as conventional cigarettes. Many New York municipalities already had a similar provision in place, including New York City. With the new bill, New York becomes the 11th state to ban vaping in places where conventional cigarettes are prohibited.
Failing to recognize the differences between conventional cigarettes and e-cigarettes could slow the rate at which people shift away from conventional cigarettes. Some degree of uncertainty remains regarding the risks of e-cigarettes, particularly in the long-term as they are a relatively new development. However, multiple studies and a comprehensive literature review published by several national governments have estimated that e-cigarettes are far less harmful than cigarettes. There is no uncertainty regarding the serious health risks of conventional cigarettes, which are well documented.
A recent study in the BMJ (formerly British Medical Journal) gives a sense of the costs of deterring people from switching from conventional cigarettes to e-cigarettes or vaping. The authors compare a status quo scenario, projecting forward smoking rates and health outcomes in the absence of vaping, with two scenarios where some people replace conventional cigarettes with e-cigarettes at different rates and under different assumptions. Their model is based on smoking uptake and cessation rates through 2012, and the two scenarios are not based on past trends of e-cigarette use but instead illustrate the implications of different tobacco endgame strategies.
In the pessimistic scenario, the replacement rate of cigarettes with vaping is lower, and the prevalence of conventional cigarettes is still 10 percent after a decade. The authors also assume that e-cigarette users quit at a slower rate and that the expected risk of e-cigarette use of 40 percent, in line with some of the estimates of vaping critics.
Even with these pessimistic assumptions, replacement of conventional cigarettes with e-cigarette use over a decade would lead to 1.6 million premature deaths being averted and 20.8 million fewer life years lost. As the authors put it, “even under a worst case scenario, an endgame strategy that successfully prompted most cigarette smokers to switch to vaping would secure substantial public health gains.”
In the optimistic scenario, people quit e-cigarettes at the same rate as conventional cigarettes. The excess risk of e-cigarette use compared to non-smoking is five percent, in line with estimates from a comprehensive evidence review published by Public Health England. People also replace cigarettes at a higher rate than the pessimistic scenario. The estimated gains are even greater here, as replacement of cigarettes over the period would lead to 6.6 million fewer premature deaths and 86.7 million fewer life years lost.
Young people, who seem to animate so much of the recent legislative action by Cuomo and others, would see the largest gains in average life expectancy. The cohort born in 2001, so 15 years old in 2016, would see an average increase in life expectancy of six months.
Critics of e-cigarettes worry that these products could be a gateway leading more young people to smoke, and that the use of e-cigarettes has surged in recent years. Looking at data on recent trends from the Centers for Disease Control and Prevention, use of cigarettes for high school students has halved over the past 7 years, from 16 percent in 2011 to 8 percent in 2016. For high schoolers, the drastic reduction in cigarette use has coincided with the proliferation of e-cigarettes, and e-cigarette use also seems to have plateaued.
In signing the bill, Governor Cuomo justified the new ban by saying e-cigarettes “are marketed as a healthier alternative to cigarettes but the reality is they also carry long-term risks to the health of users and those around them.” Regulation of e-cigarettes should not treat them as equivalent to conventional cigarettes. While e-cigarettes are not without some degree of risk and uncertainty, many studies have found that they pose substantially less risk than conventional cigarettes, and may even speed the shift away from more dangerous cigarette smoking. Replacing a significant amount of cigarette use with vaping could deliver immense health benefits in the coming years, but bans such as the one in New York State could make those benefits much harder to realize.
Charles Hughes is a policy analyst at the Manhattan Institute. Follow him on Twitter @CharlesHHughes.
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