Seeking to “curb the epidemic of youth vaping,” San Francisco officials voted on Tuesday to effectively ban the sale of e-cigarettes – becoming the first US city to do so and thrusting the coastal tech hub into a fierce debate over the future of smoking.
Advocates of the ban say the city must act where federal regulators have not, protecting teens and prohibiting the sale of untested products until they undergo FDA review. Opponents say the new law leaves cigarettes – known to cause cancer and heart disease – as the only practical option for those addicted to nicotine.
But will the strict new policy make San Francisco healthier?
It depends on which public health experts you ask.
E-cigarettes are popular with smokers trying to kick the habit, as they satisfy the urge for nicotine while removing exposure to the tar and toxins of burned tobacco, but many worry they’re creating new addictions to nicotine – particularly among young people.
Influential groups have backed the measure, including the American Lung Association and the American Heart Association. Others, such as the American Cancer Society, have declined to take a position.
And while some researchers see the ban as a useful experiment in tobacco control, others think the law will hurt the very teens it seeks to help.
Jamie Hartmann-Boyce, a senior researcher in health behaviors at the University of Oxford, said the debate is often framed, “Do we protect young people from becoming addicted to nicotine, or do we help people already addicted to nicotine switch to a safer alternative?”
But the reality is more complex, she said, and doesn’t have to pit adults against teens: “There should be opportunities for balanced policies which address both priorities, and acknowledge that transitioning adult smokers to vaping also has the potential to protect the health of future generations.”
’An important test case’
Nobody quite knows how San Francisco’s e-cigarette policy will play out, and researchers will be watching closely to see what effect, if any, it has on rates of vaping and smoking in adults and teens.
“Throughout the history of the tobacco control movement, cities and localities have served as laboratories to see what measures will be most effective to reduce the death and disease caused by tobacco,” said Lindsey Freitas, senior director of advocacy for the American Lung Association of California.
The law doesn’t directly ban the sale of e-cigarettes. Instead, it mandates that any products be evaluated by the FDA before being sold in a process known as premarket review. Because no manufacturers have done that yet, the law will halt all vape sales in about seven months.
“The e-cigarette companies have been aware of the FDA’s intent for premarket review going back to 2016,” said Jodi Prochaska, an associate professor of medicine at Stanford University. Vape manufacturers, she said, “have the resources financially and legally to navigate that process.”
Prochaska called the new law “an important test case” and said San Francisco was the ideal city to test the new policy as a sort of “natural experiment.”
The city’s relatively low cigarette smoking rate – just 11% among adults – means that “there is little need for a ‘harm reduction’ nicotine approach here,” said Prochaska, referring to claims that e-cigarettes should remain legal as a safer alternative to cigarettes. Universal health care in the city, provided to the uninsured through a program called Healthy San Francisco, means those who want to quit smoking can access tobacco addiction treatment, she added.
’The thing that we have all feared the most’
Dr. Robert Jackler, founder of the group Stanford Research Into The Impact of Tobacco Advertising, doesn’t believe San Francisco’s new law is good policy – but not because of concern for adult smokers looking to switch.