Smoking can be thought of as a pediatric disease.
The reason is because a substantial number of people who go on to become lifetime smokers began as children. According to a recent Eurobarometer poll* (which measures the opinions and behaviors of Europeans), 52% of smokers began before the age of 18, with 15% beginning before the age of 15.
Overall, public health officials have been effective at getting the anti-smoking message out. Rates of smoking initiation (i.e., the number of people who begin smoking per 1,000 people) have fallen over the decades. For example, a new study in PLoS ONE shows that, prior to the 1970s, the rate of smoking initiation among European men peaked at age 18 and was nearly 120 per 1,000. Today, the peak among men occurs at age 16 and is closer to 50 per 1,000.
That's good, but the same study now shows that this (partial) victory in public health is being reversed: Smoking initiation rates among the age 11 to 15 demographic in Europe are ticking upward. How should society respond?
If Only There Was an Alternative to Smoking
Coming up with an exact policy response is difficult. It's unwise and unethical to market e-cigarettes to minors, and the FDA is rightfully cracking down on stores that were caught selling e-cigarettes to minors.
However, the truth is that youngsters will do stupid things no matter what laws we pass and policies we implement. When I was a kid, some of my classmates would binge drink. Others began smoking. Throughout all of human history, getting intoxicated or lighting something on fire and sticking it in their mouths is something to which rebels without a cause are attracted. Apparently, it's part of human nature.
And human nature is tough to change. So, perhaps the best response is not policy but an honest, appropriately nuanced conversation. That means parents need to step up.
No responsible parent wants his kid to use any type of drug ever, but that doesn't change the fact that marijuana is safer than heroin. If a rebellious teenager is hellbent on trying drugs, I would much rather him puff the magic dragon than try heroin. While the former might kill a few brain cells, the latter could land him in the morgue.
The same reasoning applies to sex. No responsible parent wants his teenager doing the horizontal tango. But if he does, protected sex using a condom is better than unprotected sex. Likewise, no responsible parent wants his kid to smoke or vape, but between the two, vaping is the safer option. Pretending that both are equally unsafe ignores science and is counterproductive to public health.
The point is that not all vices are equally bad. In a perfect world, our kids never do anything stupid or rebellious, but we don't live in that kind of world. The principle of harm reduction acknowledges that reality. Teen vapers are preferable to teen smokers.
*Note: The poll is here. Clicking the link will begin an automatic download of a PDF.
