Volume 208 - Issue 9
Regulating e-cigarettes in Australia: implications for tobacco use by young people
Author: Wayne D Hall
Med J Aust 2018; 208 (9): 415. || doi: 10.5694/mja18.00046
Published online: 21 May 2018
Published online: 21 May 2018
To the Editor:
Wolfenden and colleagues1 fail to justify the ban on the sale of nicotine-containing e-cigarettes in Australia and do not address the supporting arguments for allowing smokers to access these products.2,3
The concern that e-cigarettes may recruit young smokers justifies a regulatory response but not a ban on sales of nicotine-containing e-cigarettes to adults,3 who are thereby prevented from using these products. The authors cite a meta-analysis of studies that showed an association between the past 30-day use of e-cigarettes and combustible cigarettes;4 however, they ignore the weaknesses in the studies.
First, most studies defined an adolescent e-cigarette user or cigarette smoker as one who had used either product in the past 30 days. These studies do not show that adolescents who used e-cigarettes were more likely to become daily smokers than their peers who did not use them.
Second, the studies had substantial subject attrition (more than 30% in four out of nine studies) and they often poorly controlled for a shared liability to use drugs. The association was weakest in the largest and best controlled study.5
In addition, Wolfenden and colleagues make no mention of the steep decline in youth smoking rates that has occurred in both the United Kingdom and the United Sates while vaping has increased among young people.5,6 Nor do they mention that the UK’s smoking prevalence is now the same as Australia’s, in the absence of plain packaging or high tobacco tax.6
The authors’ claim that a relaxation of the ban on e-cigarette sales in Australia “has the potential for unintended harm” ignores the direct harms caused by the current ban; for example, the unregulated use of e-cigarettes, a black market, and the criminalisation of e-cigarettes users.6
Finally, even if the evidence for a gateway effect were accepted, it would, at most, justify a tighter regulation of e-cigarettes; it does not justify a prohibition on adult e-cigarette use. If it did, we would be morally obliged to prohibit the sale of cigarettes to smokers because on their argument this would be the most effective way of preventing adolescents from smoking cigarettes.
Competing interests
No relevant disclosures.
References
- Wolfenden L, Stockings E, Yoong SL. Regulating e-cigarettes in Australia: implications for tobacco use among young people. Med J Aust 2018; 208: 89.
- Royal College of Physicians. Nicotine without smoke: tobacco harm reduction. London: RCP, 2016. https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0 (viewed Jan 2018).
- Hall WD, Gartner C, Forlini C. Ethical issues raised by a ban on the sale of electronic nicotine devices. Addiction 2015; 110: 1061-1067.
- Soneji S, Barrington-Trimis JL, Wills TA, et al. Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: a systematic review and meta-analysis. JAMA Pediatr 2017; 171: 788-797.
- Leventhal AM, Strong DR, Kirkpatrick MG, et al. Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence. JAMA 2015; 314: 700-707.
- Gartner C, Hall W. Submission 282 to House of Representatives Standing Committee on Health, Aged Care and Sport Inquiry into the Use and Marketing of Electronic Cigarettes and Personal Vaporisers in Australia. Canberra: Parliament of Australia, 2017. https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/ElectronicCigarettes/Submissions (viewed Jan 2018).
Linked content
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MJA Letter: by Yoong et al; Regulating e-cigarettes in Australia: implications for tobacco use by young people
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MJA Letter: by Mendelsohn; Regulating e-cigarettes in Australia: implications for tobacco use by young people