1 An Analysis of the Anti-vaping Policy in California Introduction Vaping has always been controversial, not just in the USA but across various regions in the world. According to Nicholas Chadi, Scott Hadland, and Sion Harris (2019), vaping refers to the practice of inhaling aerosol through the use of an electronic cigarette or any other vaping device. Typically, a vaping aerosol will contain ingredients such as nicotine, flavoring, and other products. While vaping is legal in many states in the USA, there has been increasing concern that this practice presents health risks for consumers. Most people who use vaping chose to do so as an alternative to smoking. The increasing popularity of e-cigarettes derives from the understanding that they only present half the risk of normal cigarettes even though they are not completely free of risk. However, it is worth noting that they have been linked to severe lung disease. For this reason, California decided to change its policies and legislations in so far as vaping is concerned. Public Health Issue To understand the significance of vaping in California, it is worth noting that California is where some of the largest vaping companies were based. As such, the process of developing a policy that would limit how vaping operated was directly linked to the state’s loss of revenue (Armatas, Heinzerling, & Wilken, 2020). In the end, California chose not to ban vaping but to put in place specific measures that would ultimately discourage the sale and the use of ecigarettes. The California Governor – Gavin Newsom – signed the Senate Bill (SB) 793 into law in 2020. Effective in 2021, this legislation banned the sale of flavored products in the state. According to Hector Delgado et al. (2020), the introduction and enactment of the bill into law was through the support of the American Lung Association and the American Heart
2 Association. These institutions and a significant part of the American public believed that ecigarettes were a public health crisis. The crisis was particularly critical in teenagers who were likely to be inducted into vaping because the product is flavored. Thus, in California, any person or entity found to sell e-cigarettes cartridges or flavored cigarettes would be subjected to a $250 fine. As has been noted above, the introduction of this policy in California revealed several stakeholders involved in the debate. The most important of these was the population for whom the bill was enacted. As Delgado et al. (2020) note, most people who consume vapes and ecigarettes are teens, particularly those in middle school and high school. At an age where they are just emerging from their parents’ control and starting to discover the world, teens are more likely to be convinced to smoke not just by their peers but also by the advertisements that vaping companies use. Additionally, the fact that e-cigarettes tend to be flavored means that these teenagers will not be discouraged from smoking. Instead, inciting flavors such as mango and tropical fruit will eventually create a situation where they become addicted to vaping at a young age. The other stakeholders are the American Lung Association and the American Heart Association (Delgado et al., 2020). The American Lung Association’s mandate is to improve lung health and prevent various lung diseases through education activities, advocacy programs, and research. On the other hand, the American Heart Association funds cardiovascular research to reduce deaths caused by heart diseases. These two institutions are critical in the conversation regarding vaping because they are non-partisan and act to promote and protect the interests of the public from entities such as corporations. As such, as stakeholders, these two institutions are representative of the American people.
3 Analysis of Social Determinants of Health Social Determinants of Health (SDOH) are the conditions that are shaped by one’s socioeconomic position. Things such as one’s level of education, occupation, and income level can influence their health status. When it comes to vaping for school-going children, there are several SDOH that become relevant (Magnan, 2017). The first of these is the income levels of the families from which teenagers come. In the typical case, the purchase of e-cigarettes requires that a child have access to money. In some cases, this money may be found via illegal means. In other cases, children come from families with higher incomes that can afford to purchase ecigarettes regularly. Even so, as Magnan (2017) suggests, the pressures that come with living in a poor environment could also increase the likelihood that children may gravitate towards experimenting with substances such as e-cigarettes. To escape the difficult circumstances of their lives, e-cigarettes may present an opportunity for them to have some relief. It is also worth noting that children who come from low-income families typically do not have regular adult supervision because their parents and guardians are involved in making a living. As such, because of this lack of constant supervision, there is a possibility that they may be influenced to experiment with e-cigarettes, thus risking addiction. To critically examine the social, economic, cultural, and political factors involved in vaping, it is worth noting that they are all connected to health equity. Magnan (2017) notes that health equity refers to the situation where every person can attain their full health opportunity and, more importantly, no one is disadvantaged from achieving the said potential because of their social circumstances. The fact that young teenagers from disadvantaged backgrounds are more
4 likely to suffer from the effects of vaping means that there should be specific policies that seek to prevent the most vulnerable people in society from being affected. For this reason, one could argue that the weakness of California’s anti-vaping policy is that it does not contemplate those children who may have already been affected by vaping (Armatas et al., 2020). Indeed, in charging a 250 dollar fine, it is not clear whether this money would go into ameliorating the condition of those who have been affected by vaping, particularly during their teenage years. It must be recognized that the fine is vital because it acts as a deterrent not just for retailers but also for distributors of the product. Recommendations To ensure that the anti-vaping policy in California services those who need it most, it may be necessary to devise strategies that can be used to conduct civic education in so far as vaping is concerned. In other words, the enactment of the law should be accompanied by a communication campaign that addresses the risks that come with vaping (Armatas et al., 2020). One of the ways that this could be achieved is through the use of social media networks. As more teenagers are becoming active online, teaming with online marketers to target teenagers could help raise awareness regarding the risks of vaping. Secondly, the school environment could also be another place where constant reinforcement of the anti-vaping messaging could be done. Furthermore, the state should devise mechanisms of ensuring that the teenagers who have been adversely affected by vaping receive the care they need. Indeed, as Armatas et al. (2020) suggest, banning a substance is only the beginning of the process. Ultimately, this process should also consider other ways that could be used to ensure that the banning of e-cigarettes and vaping achieves the aims it set out to achieve. Conclusion
5 In sum, it is commendable that the state of California prioritized the needs of teenagers. In banning e-cigarettes and vaping, the state has demonstrated a need to balance an individual’s responsibilities, on the one hand, and the responsibility of the state to take care of the said individual, on the other hand. However, to ensure that the law is enacted, and the policy serves the aims it was supposed to serve, it will be necessary to include more stakeholders. These stakeholders will then work in tandem with the state to ensure that teenagers in California receive the essential guidance and support that will lead them towards a healthy and prosperous future. Indeed, it is here that nurses could serve a unique role as leaders and educators by participating in both educational and community awareness programs together with state authorities.
6 References Armatas, C., Heinzerling, A., & Wilken, J. A. (2020). Notes from the field: E-cigarette, or vaping, product use–associated lung injury cases during the COVID-19 response— California, 2020. Morbidity and Mortality Weekly Report, 69(25), 801. 10.15585/mmwr.mm6925a5 Chadi, N., Hadland, S. E., & Harris, S. K. (2019). Understanding the implications of the “vaping epidemic” among adolescents and young adults: A call for action. Substance Abuse, 40(1), 7-10. https://doi.org/10.1080/08897077.2019.1580241 Delgado, H. M., Kleinman, N. P., Makarem, A. F., & Nguyen, C. (2020). Implementing California Senate Bill 493 in an outpatient pharmacy within an integrated health system: evaluation of the operational and clinical effect of pharmacist-ordered laboratory tests. Journal of Managed Care & Specialty Pharmacy, 26(3), 320-324. https://doi.org/10.18553/jmcp.2020.26.3.320 Magnan, S. (2017). Social determinants of health 101 for health care: five plus five. NAM Perspectives. https://doi.org/10.31478/201710c