In July Karl Erik Lund, Research Director of the Tobacco Unit of the Norwegian Institute of Public Health published a commentary in "Nordic Studies on Alcohol and Drugs" (The Journal of Nordic Centre for Welfare and Social Issues), from which I stole the title of this post. In his commentary he asks some very important questions, and gives us some thoughts on what he thinks is the most plausible answers.
Have e-cigarettes the ability to make the virtual elimination of cigarettes a realistic future target? I would say yes, through two possible mechanisms: by increasing smoking cessation and by reducing smoking initiation.Karl Erik Lund has years of experience in the field of tobacco research, and backs up his answers referring to current research. A lot of this is not really surprising either... to me it feels like just good old common sense and logical reasoning. You see it's not only about finding answers, it's also about finding the right questions. This is where I believe (and I think Lund would agree based on reading his commentary) the regulators have failed miserably, or they have intentionally avoided asking these questions: What do we want to protect the children from, smoking or vaping? Will the provisions in the regulation schemes reduce smoking initiation? They say they want to protect non-smokers, but what do they want to protect them from?
The Swedish study that Lund refers to shows that use of e-cigarettes among adolescents is associated with many of the characteristics that also predispose for smoking onset (not living with both parents, disliking school, low socioeconomic status, alcohol use). In other words, it is very likely that a large portions of never-smoking e-cigarette users would have started smoking if e-cigarettes were not an available alternative. In the US we've seen numbers showing that imposing stricter age limits on e-cigarettes will in fact make more teens smoke cigarettes instead. Clive Bates also discussed the unintended consequences of these regulations not long ago here: Harmful and negligent to ignore unintended consequences of e-cigarette policies. So by making the safer alternative less available, are we really protecting the children? Don't even think about giving me some crap about the gateway theory, we all know that's not something that happens in the real world.
With all this in mind, another question comes up, and I guess it's a controversial one: What is the best age limit for buying e-cigarettes? Or even, should there be one? Just asking these questions will surely give you some ugly looks, not only from regulators and the anti-e-cig-movement (they'd probably be furious) but also from e-cigarette advocates, manufacturers and vendors. Here in Norway at least, it seems that everyone on both sides of the table agrees on an 18 year age limit. We do not want our children vaping.. period. And I've agreed on this in many a discussion as well. What bothers me, however is this: We know that imposing an age limit will increase smoking initiation and we know that the gateway theory is just a product of the ANTZ's imaginations. In addition to that, setting the age limit for buying e-cigarettes to the same as for buying cigarettes will lead a lot of current smokers to believe that there are similar risks associated with e-cigarettes which will discourage them from swapping. Instead of being a gateway to smoking, e-cigarettes seem to (again, common sense) work as a roadblock or firewall protecting youth from cigarette addiction. So I've come to the conclusion that putting the same age restrictions on e-cigarettes as we have on regular cigarettes is not a good idea. To be honest I'm struggling to come up with good arguments to why we should have such an age limit. To me it seems almost like putting age limit on condoms and assume that would stop kids below that limit from having sex. An age limit on e-cigarettes should at least reflect the relative risk, so setting the limit to the same as for energy drinks containing caffeine sounds more reasonable to me ... if we want e-cigarettes to play a big part in the tobacco endgame like Karl Erik Lund suggests in his commentary. That is what we want right?