A recent poster on the Vanguard made a dismissive comment regarding those who want to protect everyone. This led me to reflect on who we could agree are in need of protection. I think that most of us would agree that it is reasonable to protect children. Others might extend this through adolescence recognizing that these groups do not have the same impulse control or cognitive abilities that most adults achieve.
We seem to have general agreement that children should be protected from dangerous use of bicycles with helmet and light regulations. Driving, marrying, dropping out of school, or entering the military prior to obtaining an age felt to be associated with an assumed level of maturity are all regulated. Likewise, we restrict the use of certain medications and other substances such as cigarettes and alcohol, and entertainment in terms of games and movies felt inappropriate for youth.
Tonight, the city council took a step that may prove valuable in the protection of the youth of our community from a rapidly growing threat to their health. The council chose to extend the current restrictions on use of tobacco in public places to e-cigarettes and other inhalational devices.
One might reasonably ask how restricting the use of e cigarettes might benefit our youth. To answer this question, we first need to understand what we do and what we do not know about e cigarettes. First, what we do not know:
1) We do not have any efficacy data. The companies that produce a large portion of e cigarettes are touting them as harm reduction devices. Ironically, much of the production and marketing of e cigarettes is done by the large tobacco companies themselves. Therefore what we have is the situation in which the manufacturers are producing a product which they claim can help break the addiction to another of their products, traditional tobacco cigarettes. What would obviously be more effective would be to prevent this addiction in the first place, but this does not fit their business model which is dependent upon addiction.
2) We do not have any safety data. Because e cigarettes are not regulated by the FDA although they are claimed to be a medical harm reduction device, we do not know the amount of nicotine, or the amount of any of a number of known carcinogens that have been isolated from them are in any given product. We do not know if they are safe for the primary user and we do not know if they are safe for second hand inhalers.
So what do we know about e cigarettes ?
1) We know that nicotine, a highly addictive substance, is a key component.
2) We know that carcinogens have been found in many isolates from e cigarettes.
3) We know the intent of the manufacturers is to promote addiction to their product.
How do we know that ? We know from their own statements. I have included some quotes from executives of cigarette manufacturers to illustrate this point. Please note that all of these statements were made past the point in time when the carcinogenicity and lethality of cigarettes was well known.
1) 1978 – Newport executive TL Achey states “ The base of our business is high school students”. He says this because by that point in time it was established that most addicted adult smokers started smoking before age 18.3)
2) 1984 – RJ Reynolds CEO states “Younger adult smokers are the only source of replacement smokers….if younger adults turn away from smoking, the industry must decline.”
3) 1969 “Long after adolescent preoccupation with self-image has subsided, the cigarette will even preempt food in times of scarcity on the smoker’s priority list.” Presentation to Reynold’s Board of Directors
4) 1990 – Terrance Sullivan, a sales representative for RJ Reynolds when enquiring whether the target population was high school or junior high students quotes the CEO as replying “ They got lips ? We want them.”
5) 1992 – RJ Reynolds executive as quoted by Dave Goerlitz when asked why he didn’t smoke, “We don’t smoke that shit. We just sell it. We reserve the right to smoke for the young, the poor, the black and the stupid.”
So how might restricting devices help against this youth directed marketing goal ?
Smoking prevention and cessation in adolescence is most important since intervention in this age group may prevent nicotine dependence which is the major factor preventing teens from stopping smoking. Other factors that could also be affected include a perceived boost in social standing associated with the perception of smoking or vaping as a social norm, the use of e cigarettes for self medication in cases of depression or other mental illness, the use of e cigarettes as a coping mechanism and stress reduction device. Perhaps more importantly, bans have been shown in some small studies to be associated with decreased smoking starts.
This is of course the most important public health prevention strategy. The child or adolescent who is not exposed to the use of cigarettes and/or e cigarettes is much less likely to start, and therefore less likely to become addicted. All we as a society have to do to prevent the majority of nicotine addiction is to keep these products out of the hands of those under the age of 18. Anything that we can do to prevent the early introduction of these products will be a major benefit for both individual and public health.
My thanks to the council for taking this stand for primary prevention of a major individual and public health risk and for choosing to protect our single most vulnerable population, our children.