On July 22, the US Food and Drug Administration announced the launch of two new videos promoting the message that vaping is a “gateway” to smoking. It’s part of the agency’s ongoing youth-vaping prevention campaign, “The Real Cost,” that has repeatedly leaned on fear-mongering.
In the ads, which you can watch above or here, British street magician Julius Dein makes a teen’s vape disappear, replacing it with combustible cigarettes. The campaign’s tagline—”It’s not magic, it’s statistics”—centers on the claim that teens who have never used a nicotine product are more likely to begin smoking if they first start vaping. It alludes to the findings of one study from February 2019 that observed, “prior e-cigarette use was associated with more than four times the odds of ever cigarette use.”
Although the findings can be generalized to the national population of youths aged 14 through 17, the key word is “associated.” The researchers also noted that they “cannot establish causal relations or rule out the possibility of residual confounding by underlying risk-taking propensities,” and thus their findings “should be interpreted with caution.”
While youths who are more likely to try vaping may also be more likely to try smoking, this does not mean that vaping causes smoking. When former FDA Commissioner Scott Gottlieb tweeted the study, many respondents pointed this out.
The new videos aim to educate youth about how “using e-cigarettes, just like cigarettes, puts them at risk for addiction and other health consequences,” according to an FDA press release. Nicotine use can lead to dependence—although many definitions of addiction, including substance use disorders described by the American Psychiatric Association, require serious life harms, so calling vaping dependence “addiction” is controversial. Vapor does contain “numerous potentially toxic substances,” concluded the National Academy of Sciences, Engineering and Medicine—though in very small quantities, as found in many common household products.
The FDA would be correct to point out that vaping is not risk-free. The problem is when its public messaging makes it sound as if smoking and vaping pose comparable risks. To the contrary, the UK government found that vaping is 95 percent less harmful than combustible cigarettes, while the National Academy concluded that “completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.”
The FDA itself cited the harm reduction potential of vaping for current smokers in a recent court argument, which makes its new campaign particularly disappointing.
In 2017, FDA-supported ads portrayed vapes as “hacking” teens’ brains and infecting them with parasitic worms—images reminiscent of the notorious anti-drug campaigns of the 1980s. Even as the FDA now turns towards evoking scientific evidence in its campaign against teen vaping, it continues to sideline evidence of vaping’s huge net-positive public health impact.