#parents | #teensvaping | View: Concerns over teen vaping have overshadowed the question of its relative safety

In a 2008 essay in The New Yorker, the humorist David Sedaris wrote about his relationship with cigarettes. “When New York banned smoking in the workplace, I quit working. When it was banned in restaurants, I stopped eating out and when the price of cigarettes hit seven dollars a pack I gathered all my stuff together and went to France.”
I wish my own relationship with smoking was ever as unabashed. I have always been the hypochondriac sort who spent more time worrying about smoking than indulging in the act, for the habit to be worth it. It’s like hours of worrying for a few seconds of pleasure, which, to be fair, is an anxious person’s relationship with most pleasures. I started relatively late (mid-20s), took to it with gusto for a while and then struggled to kick the habit and continued for years to keep it somewhat under control, lighting up four or five times a day. I would manage to quit for weeks at a time — even six months once — but in a routine familiar to most smokers, get pulled right back into the nasty habit after the one-off cheat smoke.

So while I hated the habit, I relished the act. Smoking is the blockbuster hit it is for a reason (1.1 billion people around the world were smokers at the turn of this millennium). It will kill you, but it is also very pleasurable — I say this not to praise smoking, but to be realistic about how hard it is for addicts to quit. And there exists few substances that are more addictive than nicotine. Like many smokers, I used to think wistfully, and also tell friends, that if smoking weren’t harmful, I’d smoke a great deal.

That was the seductive promise vaping held out — get your nicotine hit without the cancer-causing tar and the tissue-damaging smoke that emanates from cigarettes, apart from some 6,000-plus chemicals, many of which cause very scary diseases and conditions. Rather incredible for a piddly little stick, when you think about it. The appeal of vaping was not just that you could indulge your nicotine habit in relative safety, but once you switched to vaping, it became easier to quit altogether. Vaping satiates your craving for nicotine, but doesn’t quite deliver the same strong and instantaneous hit that makes cigarettes irresistible.

Smoked Out

Vape is actually a generic term for different kinds of devices, collectively called Electronic Nicotine Delivery Systems (ENDS). There are multiple methods and technologies, but they all aim to produce a nicotine-laced vapour without combustion. Vaping, which has zoomed in popularity in recent years, with some 40 million users around the world according to 2018 WHO estimates, has also become an entire subculture. There are endless possible combinations of flavours, oils, devices (called mods), various resistance settings to prime the device for different kinds of plumes and so on. There is a certain kind of hideous, underground-chic poster that adorns the walls of vape shops in New Delhi, making them look like a hybrid between a tattoo parlour and a portal to a spiritual cult.

My first vaping device was decidedly clumsy. It was a sizeable cylinder the size of a large cigar, with a small tank of vaping liquid that needed to be refilled and coils that needed replacing. The tank would leak, it wasn’t fun to use and we had a short-lived relationship. But it had one upside while it lasted — it kept me off cigarettes.

Then came Juul, the device and company that revolutionised vaping. Juul successfully miniaturised the vape and managed to shrink everything into a sleek device the size of a pen drive. It was quite like the transition from Walkman to the first iPod. Juul took off so quickly that it went from founding to a valuation of $38 billion in just three years.

Juul made vaping wildly popular in the US and many other markets. It also had two inadvertent effects. Because the device was small and easy to hide, teenagers could sneak it in anywhere, including their schools. And because it came in delicious, candy-like flavours, young people loved using it.

There are two critical questions around vaping. One is whether the practice is safe. The answer is easy and unambiguous — it’s not. Compared with not using tobacco in any form, vaping is harmful.

From a public health and policy standpoint, the more challenging question is the second one — is vaping less harmful than smoking, and if so, could it be an effective tool for tobacco harm reduction and cessation?

It’s important to get this one right. The disease burden on India from tobacco is enormous. As per government estimates from 2011, 35% of Indian adults use tobacco, which is a major contributor to non-communicable diseases, responsible for 60% of deaths in India. Some 111 million people smoke in India. The economic cost of tobacco to India in 2011 was calculated to be $22.4 billion.

The country that appears to have put the most thought and research effort into the question of relative harm of vaping is the UK. And they are unambiguously for it. Public Health England, the government agency, has said, after reviewing scientific literature, that vaping is about 95% less harmful than smoking and is helping some 20,000 people in the UK quit every year. It runs campaigns encouraging smokers to switch to vaping.

The basis of the pro-vaping argument is that it is the tar in cigarettes that causes devastating damage, not the nicotine (although nicotine is harmful for children and pregnant women).

The main plank of the argument opposing vaping is that we can’t know exactly how harmful vaping is, till extensive studies and randomised controlled trials deliver the verdict, maybe 20 years from now.

There is no conclusive scientific evidence at the moment about the safety or relative safety of e-cigarettes and other ENDS devices and a number of countries have banned it, while many have chosen to regulate it. The scientific community largely seems to agree that vaping is safer than cigarette smoking, but concerns, such as in the US, that the perception of relative safety is encouraging young people to take up vaping, has overshadowed the central question. The picture is further complicated because periodic studies emerge examining some aspect or the other of vaping in isolation, and media headlines, optimised to generate interest, serve up conclusions in sensationalist garbs, muddling the picture.

There really is no logic for India to ban e-cigarettes while letting tobacco remain legal, especially in light of the fact that at least some countries have found them to be an effective harm reduction tool for existing smokers. And we have a lot of them.

As for me, more than a year after I switched to vaping (with Juul), one day the device ceased to function properly. An acquaintance was going to bring me one from the US (it’s cheaper there). But it would take a week. Would that be okay? Sure, I said, and proceeded to wait. After two days I felt I didn’t really need it anymore. And by the time one week came around, I felt liberated. I hadn’t smoked cigarettes for more than a year, and now I didn’t feel the need to vape either. Vaping had successfully removed one smoker from India’s burdensome millions.

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