In recent years, there has been a concerning decline in the percentage of Americans who recognize that vaping is less hazardous than smoking. This downward trend, as revealed by a thorough analysis of data from two national surveys, highlights the damaging impact of misleading information propagated by activists, government officials, and journalists. The erosion of public understanding regarding the harm-reducing potential of vaping is a significant setback for the promotion of healthier nicotine consumption alternatives, which former FDA Commissioner Scott Gottlieb referred to as “a tremendous public health opportunity.”
The findings of the study, published online by JAMA Network Open on March 29, were based on data gathered from the Health Information National Trends Survey (HINTS) and the Tobacco Products and Risk Perceptions Survey (TPRPS). Between 2012 and 2017, the share of respondents correctly perceiving e-cigarettes as less dangerous than traditional combustible cigarettes declined from 51 percent to 35 percent in the first survey, and from 39 percent to 34 percent in the second survey. Concurrently, the share of individuals incorrectly believing that vaping is just as hazardous as smoking rose from 46 percent to 56 percent and from 12 percent to 36 percent, respectively. Shockingly, the percentage of people erroneously considering vaping to be more dangerous than smoking tripled in both surveys, reaching nearly 10 percent in HINTS and over 4 percent in TPRPS.
This decline in understanding about the relative risks of smoking versus vaping is particularly disheartening because it occurred during a period when mounting evidence highlighted the potential harm-reduction qualities of e-cigarettes. In 2015, Public Health England endorsed an estimation that vaping is approximately 95 percent safer than smoking. The following year, the Royal College of Physicians concluded that “large-scale substitution of e-cigarettes, or other non-tobacco nicotine products, for tobacco smoking has the potential to prevent almost all the harm from smoking.” Studies conducted in 2016 and 2017 demonstrated that smokers who switched to e-cigarettes experienced a significant reduction in exposure to hazardous chemicals produced through tobacco combustion, akin to those who switched to nicotine replacement products such as gum or patches (a finding that was confirmed by a recent study of Juul e-cigarettes, the leading brand in the United States).
When Scott Gottlieb assumed the position of FDA Commissioner in 2017, he publicly expressed support for transitioning smokers to less hazardous forms of nicotine consumption, including e-cigarettes, recognizing their potential to diminish tobacco-related diseases and deaths. Furthermore, a controlled, randomized clinical study published in January provided additional validation to this viewpoint by demonstrating that e-cigarettes were nearly twice as effective as nicotine replacement products in aiding smokers to quit. Despite these encouraging developments, smokers today are less likely to comprehend the life-saving potential of e-cigarettes than they were in 2012, which, unfortunately, translates to a reduced likelihood of attempting the switch and an increased probability of reverting to smoking after trying vaping.
So, what led to this concerning decline in public perception? A significant part of the blame can be attributed to government agencies such as the FDA, CDC, and the Surgeon General’s Office, which continue to categorize e-cigarettes as “tobacco products” despite the absence of tobacco in their composition. Instead of celebrating the decline in smoking rates alongside the rise of vaping, these agencies express alarm that overall “tobacco use” has not decreased or is potentially increasing, which is an inaccurate assertion. This approach implies that all tobacco and nicotine products carry equivalent risks, which is categorically untrue. In their efforts to dissuade teenagers from vaping, these agencies exaggerate the dangers of e-cigarettes, deliberately obscuring the critical point that vaping is far less hazardous than smoking.
Adding to the confusion are e-cigarette alarmists and their allies in the media. A HealthDay News story covering the JAMA Open Network study exemplifies this trend. Reporter Steven Reinberg writes, “Amid growing concern about the safety of e-cigarettes, more American adults now believe vaping is just as dangerous as smoking cigarettes.” It is evident that Reinberg’s article fails to convey the truth, as it mainly consists of quotes from anti-smoking activists who are unreasonably determined to muddy the waters.
Stanton Glantz, a prominent voice in the anti-vaping movement, claims, “The more we learn about e-cigarettes, the more dangerous they look.” He further asserts that the public’s perception of e-cigarettes becoming increasingly dangerous over time is an accurate one. Glantz’s statement, however, conveniently ignores the fact that vaping is indeed less hazardous than smoking. Similarly, Erika Sward, assistant vice president for national advocacy at the American Lung Association, dismisses the importance of considering the relative risks of vaping and smoking by stating that it is “foolish” to do so. Sward highlights the deadly nature of cigarettes but fails to recognize the significance of understanding the relative risks associated with vaping and smoking. She argues that e-e-cigarette companies have been pushing the narrative of being a safer alternative, a tactic reminiscent of the tobacco industry since the 1950s. Nevertheless, it is vital to acknowledge that no tobacco product is entirely safe, including e-cigarettes.
It is essential to emphasize that the issue at hand is not whether e-cigarettes are entirely harmless or safe. Rather, the crux of the matter revolves around their relative harm when compared to combustible tobacco cigarettes. On this point, there is no credible disagreement. The authors of the JAMA Open Network study recognize this, underscoring “the urgent need to accurately communicate the risks of e-cigarettes to the public” and advocating for communication that effectively distinguishes between the absolute and relative harms of e-cigarettes. Regrettably, Reinberg’s article falls short in fulfilling this responsibility, leaving readers with the impression that the potential health benefits of switching to e-cigarettes remain uncertain. Such a message is not only dishonest but also potentially lethal.