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Diminishing Returns

The campaign against (if you can believe it) third-hand smoke.

May 12, 2014, Vol. 19, No. 33 • By ELI LEHRER
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Still fresh from victories over both cigarettes and the secondhand smoke they emit, many public health advocates have turned their attention to new supposed hazards: e-cigarette “vapor” and “thirdhand” smoke. While the previous campaigns to prevent smoking have had positive results, the latest ones smack of hubris and overreach. In fact, the new focus on what you might call public health “micro-aggressions” does at least as much harm as good.

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There’s no scientific doubt that cigarettes and the smoke they emit present a real public health hazard. The surgeon general’s most recent report on smoking links it to over 20 million deaths since the mid-1960s and maladies ranging from lung cancer to sexual dysfunction. The Centers for Disease Control and Prevention report that cigarette smoke contains over 7,000 chemicals, 70 of them strongly linked to cancer. The Institute of Medicine concludes that persistent secondhand smoke exposure increases the risk of heart disease by 25 to 30 percent.

While it may well clash with many concepts of personal autonomy and private property rights, the public health rationale for both discouraging smoking and banning it in public places is strong. As a result of tobacco control efforts, the percentage of adults who smoke has declined from over 40 percent when the first stern public health warnings were issued in the mid-1960s to a bit under 20 percent today (the decline seems to have stopped in recent years, however). In addition, the near-universal ban on smoking in workplaces and indoor public gathering spots has largely ended involuntary exposure to secondhand smoke.

If thirdhand smoke or e-cig vapor caused the same ills, another campaign might be warranted. But they probably don’t.

Thirdhand smoke refers to the contamination that may linger in a place after people smoke there. Determining its actual risks, however, presents a research challenge. If a home, car, or public space gets saturated with cigarette smoke, anyone who enters it regularly is going to be exposed to secondhand smoke. If there’s a huge amount of thirdhand smoke in a place it’s highly likely to be because at least one regular occupant is a smoker. Studies about thirdhand smoke show that there are some harmful contaminants that linger (although in minute quantities). Still, it’s hardly clear that there’s enough to be harmful. One report in the journal Tobacco Control, for example, found that the difference in environmental nicotine in smokers’ and nonsmokers’ homes wasn’t statistically significant. Other research has a clear political agenda. As Boston University public health researcher Michael Siegel has pointed out, one recent report on the dangers of thirdhand smoke done by a team at the University of California, Riverside announced its conclusions before the research began—hardly a model of scientific impartiality. That report, in turn, got covered in the media with headlines like “Study: Third-hand Smoke Exposure as Deadly as Smoking.”

And that’s a problem. Whatever the harms of thirdhand smoke—and nobody has proven that they’re zero—their harm to public health overall is tiny in a country that already bans almost all indoor smoking in public places. Any effort to protect people from the dangers of thirdhand smoke will almost by definition mean going into quintessentially private spaces and regulating private behaviors.

If efforts against thirdhand smoke are intrusive and have a questionable basis in research, efforts to demonize e-cigarette vapor may prove downright harmful. Unlike the campaign against thirdhand smoke, which is mostly an academic one for now, the anti-e-cigarette effort has shown legislative success. New York, Los Angeles, Chicago, and Philadelphia have already passed municipal bans on “vaping” in public that treat the products as if they were cigarettes. But the rationale for conflating e-cigarettes and tobacco cigarettes is weak. The main ingredient in e-cigarette aerosol (other than water vapor) is propylene glycol, which is also a common propellant in asthma inhalers, and its toxicological category is “generally recognized as safe,” according to the FDA. An October 2012 study published in the journal Inhalation Toxicology found that, for all byproducts measured, e-cigarettes produced very small exposures relative to tobacco cigarettes. Common sense, as well as the great bulk of existing research, suggests that e-cigarettes and their vapor present essentially no risk to bystanders.

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