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The Wisdom Of Children

The e-cigarette debate is full of adults behaving badly. From TV debates to Twitter, supporters and opponents of e-cigarettes hurl insults at each other. They assume that only their side truly cares about protecting children from tobacco and that the other is acting in bad faith. This approach is more teenage tantrum than curious adults peering through complexity.

So since we adults are so bad at listening to each other let me suggest a radical alternative. Why not pause to listen to what the children themselves are doing and saying?

Doing first. Two big surveys of teenage smoking by national governments have taken place as the availability of e-cigarettes has been growing fast. One is in France where 90% of school children who smoke have tried e-cigarettes, the other in the USA where 76% of school smokers also use e-cigarettes. So how have teenagers changed their tobacco use?

Sources: US CDC Research, French Government Research

When teenage smoking rates fall 45% in just three years something extraordinary is going on. “This is a big surprise” said Professor Bertrand Dautzenberg, who is President of the French Government’s Office for Smoking Prevention. These startling reductions must be petrifying tobacco executives.

But how do we explain this data? Here us adults too easily slip into our warring tribes as we seek to shoehorn the figures into our ideological frameworks. So before we ask our legitimate questions let us listen to what the children were saying in these surveys about their decision to boycott tobacco.

Professor Dautzenberg reported that youngsters, who can now choose between e-cigarettes and cigarettes, were viewing tobacco as “a dirty and nerdy product.” Their sentiments echo the views of 12 year old girls in the June 2014 Public Health Wales (UK) survey. The researcher told the BBC that in interviews:

young girls were telling us cigarettes were yucky, not nice but that e-cigarettes are better for you

So for children the arrival of e-cigarettes has seen them rebranding tobacco. It is just as when the introduction of iPhones made Nokias unsexy and PlayStations made Space Invaders look dated. In teenage eyes e-cigarettes have made smoking tobacco cigarettes seem smelly, unhealthy and expensive. These teenagers are choosing e-cigarettes because they taste better and their girl/boyfriends know that they now have an alternative to ashtray breath. The introduction of e-cigarettes means cigarettes are no longer cool.

That is the view from the teenage marketplace.

Could these declines in smoking be due to factors other than e-cigarette availability? Historically big falls in smoking have followed tax hikes and bans on public use. But by 2009 these measures had played out and smoking rates had stabilized with Tom Frieden, the CDC Director described this stalling as "tragic."

So the best fit explanation for the data is tobacco being swapped for e-cigarettes. This big switch narrative has e-cigarettes as the prime suspect. But are they also suspect? Are they just as bad for kids as tobacco? Or are they simply an intervening step in the pathway to tobacco?

The notion that widespread e-cigarette use is serving as a gateway into tobacco is much harder to run given the backdrop of the dramatic falls in tobacco use. (It’s like the Vatican’s attempts 400 years ago to crowbar the evidence to fit their belief that the Earth not the Sun was at the center of our universe.)

More detailed analysis such as the Oklahoma study shows that teenage vapers are not graduating onto tobacco. Some existing teen smokers are reducing or entirely quitting through e-cigarettes. A few others simply never take up tobacco, because of the e-cigarette alternative.

But why are they not heading into tobacco? In part the empty gateway is due to e-cigarettes delivering less nicotine than cigarettes. Even relatively strong 20mg/ml e-cigarettes supply less than a third of the nicotine intake from tobacco. Today’s e-cigarette generation are simply less hooked on nicotine than their tobacco smoking predecessors.

Then there is the teenager’s explanation. When offered the choice between modern high-tech e-cigarettes and “dirty and nerdy” tobacco cigarettes, they are voting for e-cigarettes. Why trade down to a more expensive product?

Teenagers are also savvy about the health arguments. Whether they are 100 times safer or 1000 times safer the kids get the message. For them moving from e-cigarettes to tobacco is as logical as trading in Ray-Bans for plastic sunglasses from Walmart.

So how should us adults view this rebranding of tobacco when it comes to adult politics? We could take a Californian “just say no” approach. Nancy Reagan’s mantra on teen drug use and pre-marital sex has been extended by the University of California’s Dr Stanton Glantz to total abstinence on nicotine.

We could do the harm-reduction route pioneered in needle exchanges and handing out condoms - by positively encouraging e-cigarettes.

Or we could go for the liberal ‘decriminalization’ approach which allows people to make up their own minds about how they treat their bodies.

All have their merits. However for now the US policy response is the criminalization of e-cigarettes in the classroom. Teachers are confiscating e-cigarettes as well condoms. Politicians are trying to stop e-cigarettes ever reaching children. Given the evidence, how wise are we adults?

Background Reading

1. E-Cigarettes Are Not A Gateway Into Tobacco

Global: In the world’s largest survey of e-cigarette users (19,441) a very small minority of e-cigarette users (0.4%) were not smoking before starting to use e-cigarettes “It should be emphasized that none of them became a smoker after initiating e-cigarette use, debunking the theory of gateway to smoking.” Dr Konstaninos Farsalinos Farsalinos et als, JERPH, April 2014

UK: March 2014 survey of 12,000 UK e-cigarette users by YouGov demonstrated no gateway. “There is no evidence from our research that e-cigarettes are acting as a gateway into smoking.” Deborah Arnott, Chief Executive of health charity ASH Press Release, April 2014

UK:“We could not identify any evidence to suggest that non smoking children who tried e-cigarettes were more likely to then try tobacco.” UK Government Report, May 2014 for PHE by Professor Linda Bauld, University of Stirling,

2. E-Cigarettes Are A Gateway Out Of Tobacco

US: "We have increased conviction that consumption of e-cigarettes could surpass consumption of conventional cigarettes within the next decade.” Wells Fargo, June 2013

US: E-cigarettes are “the most significant development in the history of the organised tobacco industry, stretching back some 200 years,”  Canaccord Genuity, July 2013

UK: - May 2014: A study of 5,000 smokers shows that e-cigarette are more successful at getting smokers to quit than nicotine gum and patches. They “are about 60% more likely still not to be smoking that those who used either the licensed products or nothing at all” Professor Robert West BBC News 28 April 2014

3. E-Cigarettes are Safe:

Global: “The chemicals that make cigarettes dangerous are either absent in electronic cigarettes or present only in trace concentrations” Lancet, July 2013

US: “There is no evidence that vaping produces inhalable exposures to contaminants of the aerosol that would warrant health concerns" Drexel University Study, January 2014

UK: The toxicity of vapour in e-cigarettes is “one thousandth of that in cigarette smoke” NHS Website

UK: “The risk is negligible, and compared with smoking there is no contest” Professor Robert West, University College London, July 2013

And Just For Fun: Here is Galileo complaining to a fellow scientist about the refusal of his critics to look through a telescope to see if the Earth or the Sun was the centre of the universe:

"My dear Kepler, I wish that we might laugh at the remarkable stupidity of the common herd. What do you have to say about the principal philosophers of this academy who are filled with the stubbornness of an asp and do not want to look at either the planets, the moon or the telescope, even though I have freely and deliberately offered them the opportunity a thousand times? Truly, just as the asp stops its ears, so do these philosophers shut their eyes to the light of truth."

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