Vaping and panic

January 8th, 2020

A public health crisis?

In the last year, vaping transitioned from an activity that provoked vague disapproval to the cause of a public health crisis. Hundreds of vaping-related hospitalizations and dozens of deaths made vaping into a major story, exacerbated by the inability of medical professionals and researchers to pinpoint the specific causes for why people were getting sick. Several states promptly passed, or at least considered, restrictions or prohibitions on vaping products.

The swift response by policymakers may come as a surprise in a country that took decades to begin responding to the public health implications of cigarettes and that has shown glacial patience in responding to the health effects of gun violence, climate change and air pollution. This prompts an obvious question: What is it about vaping that makes it both so appealing to users and so suspicious to state legislatures? And how did a product touted as a safer alternative to tobacco come to be regarded as a menace in its own right?

Vaping can be practiced with a wide range of devices and liquids, but they all work in essentially the same way. A liquid suspension that can contain either nicotine or THC (the active ingredient in cannabis or marijuana), along with various flavorings, is heated by a device, which often looks like a pen or a cigarette (frequently called an e-cigarette), to produce an aerosol vapor that the user inhales.

The technology wasn’t regulated by the FDA until 2016, which allowed the industry to expand quickly before the safety of its products had to be demonstrated. Vaping fluid can be manufactured to have much higher concentrations of nicotine or THC than either leaf tobacco or marijuana. Juul, for instance, came into the market in 2015 with a nicotine content in one “pod” equal to a pack of cigarettes, according to the website of Truth Initiative, a nonprofit public health organization.

Unlike burning dried plant matter, vaping doesn’t create smoke or the attendant lingering odor and irritation. It also doesn’t require the 5–7 continuous minutes of use that smoking a cigarette does. While indoor vaping bans proliferated quickly, well before the rash of illnesses, it remains much easier to vape in places where you can’t get away with smoking.

Like other innovations in consumer technology, from social media platforms to streaming television, vaping seems optimized for compulsive use. (In this way, vaping is just following in the footsteps of analog cigarettes, which made tobacco much easier to consume in larger quantities.) It’s convenient and relatively frictionless. The devices can be used with both legal and illegal, regulated and unregulated substances. With that knowledge, it should come as no surprise that people have used vaping to excess or to inhale substances that may trigger dangerous lung illnesses. 

The problem with panic

There is, however, more behind the vaping backlash than simply a clever technology run amok. Compared to other sources of avoidable illness and death, vaping is a minor contributor to human misery. More Americans die falling off ladders at work than from vaping, but workplace safety rules are loosened routinely without much public anxiety. Why is there so much concern about vaping in particular?

Like the social network TikTok and the phrase OK Boomer, vaping is a phenomenon largely identified with young people. According to the Centers for Disease Control and Prevention (CDC), 21% of high school students reported using e-cigarettes in 2018, as opposed to only three percent of adults (even these were concentrated in the 18–34 age range). Any youth phenomenon is likely to appear strange, mystifying and perhaps dangerous to those of us who have aged out of its appeal. There’s no vice as concerning as an unfamiliar one and no danger as captivating as one we haven’t accustomed ourselves to.

Our perception of risk, and whether the risk is acceptable, often has little to do with how severe that risk is. I’m taking a much bigger risk when I drive to work in the morning on the highways of Dallas than I am when I get on an airplane, but only the plane makes me anxious. This would be even truer if airplanes had only been flying for a dozen years and were mostly used by people much younger than I am.

The disproportionate response to vaping-related illnesses has some observers worried that we’re experiencing a public health panic. These experts stress that vaping is merely a delivery system that can be used for all kinds of substances. “To broadly condemn vaping for these illnesses may be akin to blaming injections instead of heroin, or coffee cups instead of arsenic-laden coffee,” author and staff writer James Hamblin writes in The Atlantic. A panic response can compound a public health risk by making the relatively less dangerous products harder to find, or even by pushing e-cigarette users into old-fashioned, deadly, but perfectly legal smoking. 

Are the kids all right?

Panic isn’t the only way to respond to a risk that’s new or unfamiliar. Citizens, advocates and lawmakers can work to distinguish real risks from exaggerated fears. We can disentangle a broad category of method from a narrow category of harm. We can stress caution and abstention while waiting for better information, and we can be clear about which choices are safest, which are less than ideal but tolerable, and which are truly dangerous. If vaping illnesses are ultimately traced to black-market products, unregulated ingredients and/or abusive overconsumption, we’ll have a better idea of how to change laws and influence behavior.

Additionally, it never hurts to keep even the things we don’t know or understand in some perspective. The high school seniors who are the object of so much vaping angst are on track to turn 30 in a world where the Antarctic ice sheet is likely damaged beyond recovery. They’ve been through lockdown drills (and sometimes actual lockdowns) and exposed to a constant stream of mass shootings. Older generations do younger generations, and ourselves, no favors when we obsess over smaller problems. As public awareness (or panic, as the case may be) over vaping has increased, I’ve noticed antivaping posters popping up every 10 feet in my son’s middle school. The disapproval of schools has, at best, a mixed record of discouraging adolescent behavior. Perhaps a more nuanced approach would have better effects. 

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