Blanket ban on vaping in smoke-free spaces could do more harm than good
My opinion piece published today in the Sydney Morning Herald. Click here to see the article on the SMH website
The proposal by NSW Labor to introduce a blanket ban on personal vaporisers, also known as e-cigarettes, in smoke-free areas is not justified on health grounds and could do more harm than good.
Unlike second-hand smoke, exhaled vapour carries minimal risk to health. According to Britain's Royal College of Physicians: "The risk of harm from vapour exposure to bystanders is negligible." Public Health England also concluded: "E-cigarettes release negligible levels of nicotine into ambient air with no identified health risks to bystanders."
There are legitimate concerns that the increased visibility of vaping may "renormalise" smoking or encourage uptake by young people (the gateway theory), but the evidence so far does not support these fears.
There is no evidence from 10 years of overseas experience that vaping is leading to the renormalisation of smoking or undermining tobacco control. In fact, the very opposite appears to be occurring. Smoking rates in many countries where nicotine-containing vaporisers are widely available are falling faster than in Australia.
There is also no good evidence that vaping is leading more young people to smoke. According to a comprehensive report this year by the University of Victoria, Canada, "There is no evidence of any gateway effect whereby youth who experiment with vapour devices are, as a result, more likely to take up tobacco use". In fact, regular use by young people who have never smoked is rare (fewer than five in 1000) in studies in Britain, the US and other countries.
Public health policy should be encouraging smokers to switch to vaping. Vaporisers are a legitimate and much less harmful alternative to lethal cigarettes for smokers who cannot quit with conventional treatments.
Banning vaping sends the misleading message that they are just as harmful as smoking and could deter switching from smoking to vaping. Banning indoor vaping forces vapers into smoking areas. Just as recovering alcoholics should not be forced into a pub, this creates a risk of relapse.
Vaping in public is more an issue of etiquette. Some bystanders may find the aerosol annoying like strong perfume, body odour or public farting, but it is not harmful to health. Most vapers are courteous and considerate of others, as most of us are with other potentially annoying public behaviours.
Governments should not step in where there is no material health risk to bystanders. A more nuanced and reasonable approach is to allow businesses and local authorities to make their own decisions about whether to allow vaping on their premises.
Public Health England and Action on Smoking and Health UK have both produced evidence-based guides to help public places and workplaces make their own policy. Under these guidelines, some businesses may choose to limit the use of vaporisers not for health and safety reasons but because of concerns that customers or employees may be annoyed by their use. Hospitals, schools, public transport and planes would be environments suited to a vaping ban.
However, other businesses may make different choices. For example, a bar may allow vaping every Thursday, or may dedicate one room where vaping is permitted. A hotel could allow vaping in its rooms and bar, but not in its restaurant, spa and lobby. A vape shop trying to help people switch from smoking could demonstrate products in the shop.
Signs have been erected in some establishments that say: "You may vape but large clouds are not acceptable or tolerated."
While a knee-jerk blanket ban seems appealing on the surface, it is not justified on the available evidence and creates important unintended negative consequences. A nuanced approach that recognises the needs and rights of both vapers and non-vapers is the best solution.
Colin Mendelsohn is a conjoint associate professor in the School of Public Health and Community Medicine, UNSW.