Today marks the American Cancer Society’s 48th Great American Smokeout, held annually on the third Thursday of November. Promoted by the Centers for Disease Control and Prevention and many other entities, this national intervention purportedly encourages people to stop smoking, one day at a time.
But the Great American Smokeout has, in recent years, become the Great American Cop-Out. Countless organizations and health care providers now use the day to attack vaping—portraying our most effective smoking cessation tool as part of the problem, and thus betraying the millions of people in the United States who still smoke.
The American Cancer Society has facilitated this. Its page on the Great American Smokeout, far from highlighting the role of tobacco harm reduction in preventing deadly diseases, links to a page on “Quitting E-cigarettes,” which states that the organization “does not recommend the use of e-cigarettes as a method to quit other tobacco products.”
Another linked page (“Are There Other Ways to Quit Tobacco?”) further discourages harm reduction, with decontextualized warnings about dual use and “potentially serious ongoing health risks” of vaping—as if vape-related risks were remotely comparable to those of the cigarettes that claim over 490,000 lives in the US each year. They are not.
From there, the misinformation is amplified yearly through departments and institutions that should be protecting people’s health.
The shift in the Great American Smokeout mission has been so complete that some health groups in recent years have suggested renaming it the Great American Vapeout.
“The work of the American Cancer Society is far from over,” states a New York City health center in a section of its Great American Smokeout post subtitled, “Vaping: The Next Generation of Cigarettes.”
The post claims that nicotine is “known to harm adolescent brain development” and cites “cancer-causing chemicals in e-liquids.” It concludes that “there is no evidence to support that e-cigarettes are any less dangerous than smoking cigarettes. They may in fact, be just as detrimental to one’s health.”
A health care provider in Texas similarly uses the Great American Smokeout to warn of the risks of “EVALI,” “popcorn lung” and a potential “gateway effect” to smoking if you vape.
All of these claims range from dangerously misleading to outright false. Yet the shift in the Great American Smokeout mission has been so complete that some health groups in recent years have suggested renaming it the Great American Vapeout. Another group piggybacks on the Smokeout to declare “No Nicotine November.”
Even the US Army and US Coast Guard, among others, have gotten in on the act, using the day to urge vaping cessation.
Of course, none of these problems are confined to the third Thursday of November. They reflect a broader shifting of public health groups’ goals in the US and far beyond, featuring reams of misinformation and hostile or muddled messaging—all leading people to falsely believe that vaping and smoking are equally harmful.
The history of US surgeon generals’ reports perfectly illustrates this mission creep toward targeting nicotine and harm reduction, where once the clear target was smoking-related harms.
The latest surgeon general’s report, released on November 19, perpetuates this pattern. While it claims to present evidence-based strategies for reducing tobacco-related harm and promoting health equity, it fails to discuss the use of reduced-risk nicotine products. Instead, it leaves the reader with the impression that all commercial “tobacco products” are the same.
“The ACS does not recommend the use of e-cigarettes as a cessation method,” reads the American Cancer Society’s position statement on the subject. “No e-cigarette has been approved by the Food and Drug Administration (FDA) as a safe and effective cessation product.”
An omission here is that the FDA, shambolic though its regulatory process has been, has authorized a small range of vaping products as “appropriate for the protection of public health.”
Yet more broadly, people who smoke are constantly encouraged to use a variety of methods to quit smoking. Most of these methods are not FDA-approved cessation products. That should be the point. It doesn’t matter how a person quits. It just matters that they’re supported if they choose to do so.
These are the people who are abandoned to their fate when public health groups attack a safer substitute for those unable or unwilling to quit nicotine.
Much has been learned about vaping since the earliest push to include it in the Great American Smokeout. We know it’s much safer than smoking and helps people quit smoking. We know it has prompted mass smoking cessation in the real world in numerous countries.
There are other things we already knew. Including that smoking is heavily concentrated among marginalized and underserved communities: people on low incomes, Indigenous people, people with mental health conditions, veterans, LGBTQ+ people, unhoused people and many more.
These are the people who are abandoned to their fate when public health groups attack a safer substitute for those unable or unwilling to quit nicotine.
As a recent paper in the American Journal of Preventative Medicine wisely points out, “Any delays in the implementation of evidence-based policies aimed at preventing smoking initiation or promoting cessation also delay the realization of health benefits.”
Those benefits include reducing the number of people suffering from COPD, cardiovascular diseases, and many types of cancer, including lung cancer.
The United States needs to remember what the Great American Smokeout originally meant. The purpose was not to impose a nicotine-free society. The purpose was to save lives.
Image via HIV.gov
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