Gallup recently announced that American smoking rates have hit an a record low of 16 percent. Evidence suggests that e-cigarettes deserve some of the credit.
Nearly half a million Americans die each year of cigarettes. That is nearly three times more than the combined number of suicide, overdose and alcohol deaths, whose rise have generated headlines and been attributed to the decline in U.S. life expectancy. Cigarette smoking causes about one in every five deaths in the United States. It’s estimated 1 billion people worldwide will die prematurely in the 21st century due to cigarette smoking.
While government initiatives, including smoking restrictions, higher taxes and education campaigns, have helped cut the national smoking rate by nearly two-thirds over the last half century, one in six Americans still smoke.
Enter the private sector. The advent of e-cigarettes, which the Royal College of Physicians in Britain concludes are 95 percent less harmful than traditional cigarettes, have coincided with the biggest annual drops in cigarette smoking in decades. Just since 2012, when e-cigarettes began becoming popular, smoking rates have fallen by nearly one-quarter.
A new survey conducted by the independent Center for Substance Use Research in Glasgow of e-cigarette users adds to a growing body of evidence suggesting that the negative association between e-cigarettes and smoking is causative, not merely correlative.
The center surveyed nearly 19,000 users of Juul e-cigarettes, which command about half the U.S. market share. Nearly two-thirds of respondents who were current smokers at the time they began using e-cigarettes quit smoking as a result. Compare this quit rate to other nicotine replacement therapies, including gums and patches, of less than 7 percent.
More than half of cigarette smokers in the survey who weren’t able to quit were nevertheless able to cut their cigarette consumption by 50 percent to 99 percent after they began using e-cigarettes.
Meanwhile, just 2 percent of respondents who hadn’t previously smoked cigarettes began doing so after using e-cigarettes. This suggests the gateway effect that e-cigarette critics fear is minimal-to-nonexistent. For every one respondent who started smoking after using an e-cigarette, 137 quit. Many more significantly reduced their consumption.
These results are in line with other research, including an objective study that measured e-cigarette users’ exhaled carbon monoxide and found that two-thirds of participants had quit smoking. Centers for Disease Control data suggests at least 2.5 million American e-cigarette users have quit traditional cigarettes. Dr. Michael Siegel, a preventive-medicine physician at Boston University’s School of Public Health, believes e-cigarettes are the singular technology that could put an end to smoking.
Given these public health implications, you’d think e-cigarettes would be welcomed with open arms by government officials. Yet the opposite is true. The Food and Drug Association’s “Deeming Rule” requires e-cigarettes to comply with an approval process so arduous and expensive that it will — in the FDA’s own estimate — result in 99 percent of products not filing applications. The rule is set to take effect in 2022.
Like so many regulatory justifications, officials claim e-cigarettes must be stringently regulated to protect children. In April, 11 Democratic senators wrote a letter to FDA Commissioner Scott Gottleib stating that e-cigarettes are “putting an entire new generation of children at risk of nicotine addiction and other health consequences.”
It’s true that e-cigarettes have made their way into American high-schools, displacing traditional cigarettes as the most popular method of nicotine consumption. But the best evidence suggests they are hardly an epidemic. Recently released CDC data find that e-cigarette use has fallen among American high-schoolers since 2014, part of a broader drop in nicotine use over recent decades.
David Abrams, a professor at NYU’s College of Global Public Health, chalks up the concern to e-cigarettes being “a sheep in wolf’s clothing.” Another explanation may be that the veterans of the tobacco wars in the 1990s didn’t just retire or change fields but got positions in public health on the lookout for “the next tobacco.” Tobacco company lobbyists, for their part, also have mortgages and kids to send through college, and may see campaigns to regulate e-cigarettes as a way to maintain their dwindling market share. Like smoking, lobbying habits die hard.
Yet anecdotal and empirical data are clear: E-cigarettes are a relatively healthy alternative that help people quit smoking.