A blanket ban on vaping in smokefree areas is poor public health policy

Posted by DrMendelsohn on 2 November, 2017

The NSW State Health Minister is considering a blanket ban on e-cigarettes in all indoor and outdoor smoke-free areas of NSW, according to an ABC News report. However, a blanket ban is not evidence-based and could have unintended negative consequences. A more nuanced approach is needed.

Public health policy should be encouraging smokers to switch to vaping. E-cigarettes are a much less harmful alternative to lethal cigarettes for smokers who cannot quit with conventional treatments. Banning the use of e-cigarettes in public places sends the misleading message that they are just as harmful as smoking and could deter switching from smoking to vaping.

The health risk to bystanders is minimal

There is little justification for such a ban on health grounds. According to the report of the UK Royal College of Physicians,

'The risk of harm from vapour exposure to bystanders is negligible’

Renormalisation of smoking

Supporters of a ban raise concerns that increased visibility of an activity that resembles smoking may make smoking appear more socially acceptable again and 'renormalise' smoking.
However, there is no evidence that e-cigarettes are undermining tobacco control or leading to the renormalisation of smoking. In fact, the very opposite is occurring. Smoking rates in many countries where e-cigarettes are widely available are falling faster than in Australia.  According to Public Health England

‘There is no evidence that e-cigarettes are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it’.

According to Professor John Britton, Professor of Epidemiology at the University of Nottingham, 'All that it does is normalise electronic cigarette use... and that could only be a good thing'

Uptake by young people

Others have raised concerns that visible vaping may lead more young people to smoke (the gateway theory). However, the research finds no evidence for this. According to a comprehensive report 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’

Most use of e-cigarettes by young people is experimental and short lived. Regular use by young people who have never smoked is rare (less than 5 in a thousand) in studies in the US, UK and other countries.

An alternative policy based on the evidence

1. Outside. Allow vaping in open spaces

Exposure is even less than negligible in outdoor spaces.

2. Indoors. Allow businesses and local authorities to decide

Allow business and local authorities to make their own decisions about whether to allow vaping in their premises. For example, a pub might allow vaping in one area but not another, or a restaurant may have a vaping night every Thursday. 

Generally, governments should step in only where a material risk to bystanders has been established and the government has a proper justification to override the preferences of owners or managers. Public Health England and Action on Smoking and Health UK have both produced evidence-based guides to help public places and workplaces make local policy. This approach is also supported in New Zealand.

Vaping etiquette

Questions of ‘etiquette’ are relevant as bystanders may find e-cigarette aerosol unpleasant. Most vapers are aware of the right of other people to fresh air.

Some businesses, may choose to limit the use of e-cigarettes not for health and safety reasons but because of concerns that customers or employees will be annoyed by their use.  Hospitals, schools, public transport and airplanes would be environments suited to a vaping ban.

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