After the start of the COVID-19 pandemic, I took an almost complete break from blogging about tobacco policy to concentrate on some other public health topics. Now that more than 4 years have passed, I decided to take a look at the websites of some of the major national health organizations to see whether they have started to accurately communicate the facts about vaping and smoking. I figured that during the past 4 years there has been so much definitive science about the relative risks of vaping and smoking, the cause of EVALI, the question of whether youth vaping is a gateway to smoking, and the effectiveness of vaping in helping smokers quit that the major anti-tobacco groups would by now be communicating accurately to the public. I also figured that with all the public attention being given to misinformation, these groups would certainly be a lot more careful about the validity of the public claims they were making.
I start today by reviewing recent "fact" sheets from the American Heart Association and the American Cancer Society.
American Heart Association
In a 2024 article entitled "Is Vaping Better than Smoking," the American Heart Association makes the following claims:
1. "E-cigarette promoters claim the devices can help people quit smoking. But much more evidence is needed to determine if they are an effective way to quit. Research suggests that users are more likely to continue smoking along with vaping, which is referred to as dual use."
2. "Many people think vaping is less harmful than smoking. While it’s true that e-cigarette aerosol doesn’t include all the contaminants in tobacco smoke, it still isn’t safe."
3. "E-cigarettes have been linked to thousands of cases of serious lung injury, some resulting in death. While the exact cause is still not confirmed, the CDC recommends that people not use e-cigarettes."
4. "E-cigarettes’ biggest threat to public health may be this: The increasing popularity of vaping may “re-normalize” smoking, which has declined for years. Reversing the hard-won gains in the global effort to curb smoking would be catastrophic."
American Cancer Society
In a November 7, 2024 article on the risks of vaping and smoking, the American Cancer Society makes the following claims:
1. "Misconception: Many people believe vaping doesn’t carry the same health risks as cigarette smoking because e-cigarettes do not contain tobacco."
2. "Misconception: Some people also think vaping is safer than smoking because they believe the vapor from e-cigarettes does not contain the same harmful chemicals as smoke."
The Rest of the Story
Let's analyze each of the above claims. Below are the claims followed by the actual facts.
American Heart Association
In a 2024 article entitled "Is Vaping Better than Smoking," the American Heart Association makes the following claims:
1. "E-cigarette promoters claim the devices can help people quit smoking. But much more evidence is needed to determine if they are an effective way to quit. Research suggests that users are more likely to continue smoking along with vaping, which is referred to as dual use."
The Truth: There is plentiful evidence that e-cigarettes can help smokers quit. The most recent evidence found that among smokers who tried vaping daily in an attempt to quit smoking, more than one-fourth (28%) quit smoking successfully. In the most recent clinical trial of vaping as a smoking cessation aid, subjects who were randomly assigned to receive e-cigarettes were twice as likely to quit smoking as those who did not receive e-cigarettes. As of 2022, there were 6.1 million e-cigarette users who had quit smoking by switching to vaping. If 6 million successful ex-smokers is not enough evidence to show that e-cigarettes are an effective way to quit, then no data ever will be for the American Heart Association. This is blatant misinformation.
2. "Many people think vaping is less harmful than smoking. While it’s true that e-cigarette aerosol doesn’t include all the contaminants in tobacco smoke, it still isn’t safe."
The Truth: This is intentional misinformation. The American Cancer Society avoids telling an overt lie by failing to explicitly answer the question. They intentionally use the word "safe" rather than "safer." However, few readers are going to pick this up and the implication of the first sentence is that the belief that vaping is less harmful than smoking is untrue. The clear intention here is to mislead the public into believing, falsely, that vaping is just as harmful as smoking. Even my long-time hero and mentor - Dr. Stan Glantz - acknowledges that smoking is more dangerous than vaping. And the Food and Drug Administration has concluded unequivocally that smoking is more hazardous than vaping.
3. "E-cigarettes have been linked to thousands of cases of serious lung injury, some resulting in death. While the exact cause is still not confirmed, the CDC recommends that people not use e-cigarettes."
The Truth: This is essentially an outright lie. Vaping THC carts, not e-cigarettes, was shown to be the cause of the so-called EVALI outbreak of serious lung injury that resulted in many deaths. The cause has been confirmed. The lung injury was caused by vitamin E acetate, a substance added to black market THC vapes to create the illusion of a more concentrated product so that it would reap in more money on the street. There is no evidence that e-cigarettes (nicotine-containing vapes produced for what at the time was an entirely legal market) have caused a single case of severe or fatal lung injury.
4. "E-cigarettes’ biggest threat to public health may be this: The increasing popularity of vaping may “re-normalize” smoking, which has declined for years. Reversing the hard-won gains in the global effort to curb smoking would be catastrophic."
The Truth: This statement is the exact opposite of the truth. Rather than re-normalize smoking, vaping has hastened the near complete elimination of smoking among youth. A brilliant analysis by Dr. Brad Rodu has revealed that the use of electronic cigarettes among youth has not served as a gateway to increased smoking but on the contrary has led to the virtual disappearance of smoking among high school youth. In 2011, smoking prevalence among high school students was 15.7%, while the prevalence of vaping was just 1.4%. In 2022, the prevalence of smoking among high school students dropped to just 2.0%, even though past-month vaping prevalence increased to 14.1%. It should be noted that in 2024, e-cigarette use among high school students dropped to 7.8%, while smoking declined further to 1.7%. Second only to e-cigarettes causing popcorn lung and possibly to e-cigarettes causing EVALI, the claim that youth vaping is a gateway to smoking has to go down in history as one of the greatest tobacco-related myths of all time not propagated by Big Tobacco.
American Cancer Society
In a November 7, 2024 article on the risks of vaping and smoking, the American Cancer Society makes the following claims:
1. "Misconception: Many people believe vaping doesn’t carry the same health risks as cigarette smoking because e-cigarettes do not contain tobacco."
The Truth: Like the nearly identical claim by the American Heart Association, this appears to be intentional misinformation. The clear implication is that these people--who believe vaping doesn't carry the same health risks as smoking--are wrong. Thus, the American Cancer Society is suggesting to readers that vaping does carry the same health risks as cigarette smoking. The truth, however, is that the Food and Drug Administration has concluded unequivocally that smoking is more hazardous than vaping.
2. "Misconception: Some people also think vaping is safer than smoking because they believe the vapor from e-cigarettes does not contain the same harmful chemicals as smoke."
Like the claim above, the clear implication is that these people--who think vaping is safer than smoking--are wrong. Thus, the American Cancer Society is again suggesting to the public that vaping is just as hazardous as smoking. This is unequivocally false.
Conclusion
In this age of misinformation as well as distrust of health authorities, it is more important than ever that public health organizations communicate accurately, honestly, and transparently with the public. After being away from blogging about tobacco issues for about 4 years, it is extremely disappointing for me to come back and find the situation no better than when I left. It is difficult for me to believe that this has now been going on for 15 years. It all started with that 2009 press conference when the FDA announced it was seizing e-cigarette products of Smoking Everywhere and NJOY. That was when what was to become a decade and a half long campaign of disinformation about electronic cigarettes began. It is disheartening to know that we are still talking about this campaign of disinformation in the present tense. And so the battle for truth and honesty within public health continues.
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