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Despite all the anti-smoking campaigns, high taxes, public smoking bans, and awareness programming, roughly a fifth of youth start smoking and are hooked by the time they reach 18. The demonization of smoking is what gives it that rebel quality that appeals to teens. The more we tell teens they can’t smoke, the more they want to. Nine out of 10 smokers get hooked by the age of 21.

Smoking kills 443,000 people a year in the U.S. alone. Without radical new strategies, the war on smoking is struggling to get and keep smoking rates below 20%.

Then comes electronic cigarettes (or e-cigs or e-cigarettes for short). The small devices heat a nicotine solution into a vapor and deliver it to a user. The community calls the act vaping and members are called vapers.

Why take the otherwise uncomplicated act of smoking high tech? More than anything, it gets rid of the smoke – the source of 99% of the harm caused by cigarettes. Some experts believe that a lifetime of e-cigarette use is no more harmful than 2 months of smoking. Despite this dramatic reduction in harm, nicotine delivery from e-cig vapor is comparable to that of cigarette smoke — meaning smokers can get the effects and the “hit” without so much of the harm.

But there is a movement to demonize the products. Many anti-smoking groups view them as a loophole in the system – a smoking product that can be used in areas with active smoking bans and able to be sold to minors due to the quirk of not officially being tobacco products. The CDC raised alarms last year when it found a doubling of e-cig trial among teens from 2011 to 2012. That figure was passed around countless times as proof positive that e-cigs were attracting teens — the concern among smoking prohibitionists being that e-cigs were just as bad as the real thing or would lead teens to the real thing.

By and large, the electronic cigarette community and industry has come out against the sale of electronic cigarettes to minors. Many companies have age verification on their websites, retail vape shops often won’t even allow teens in their shops, and most of the community supports state-level efforts to legislatively ban the sale of electronic and alternative nicotine products to teens.

This stance is as much a moral issue for industry stakeholders as it is an effort to take ammunition away from anti-smoking proponents attempting to claim the industry advertises to and sells to minors. California representatives are even seeking total online sales bans against the products claiming that teens will buy them online.

It’s unlikely that the industry would ever publicly support the ability to sell electronic cigarettes to teens. The Smoke-Free Alternatives Trade Association made statements arguing against an American Cancer Society Action Network’s stance that age verification bans on e-cigarette sales should wait until more information is available. The Action Network’s stance is actually believed to be a stalling technique because the organization wants total bans against the products rather than just age-based bans.

The issue that everyone is dancing around is a touchy subject and for good reason. About a fifth of youth still pick up smoking before they reach age 18. According to current numbers, half of them will die due to smoking related complications. Most will attempt to quit multiple times and even those that manage to quit in the short-term will return to smoking 99% of the time.

But it doesn’t have to be this way.

“People could use nicotine without significant damage to their health for the rest of their lives if they wanted to,” said epidemiology expert John Britton in an interview with BBC Radio. “What kills them is the cigarette smoke.”

Electronic cigarettes may offer the rebellion without the risk. It’s the harm reduction option. Teens will do this dangerous but admittedly fun thing no matter what, so maybe we should give them the option to do it safely.

Does that sound familiar? The same argument is made about making contraception available to adolescents. Nearly half of youth have had or are having sex by age 17 – if you can’t prevent it, at least prevent it from ruining lives. And it helps. From 1991 to 2011, teen pregnancy rates dropped by about half. Does this solve the whole problem for everyone? No, but it handles a bigger piece than abstinence only and STD scare tactics will handle on their own.

Electronic cigarettes offer the same kind of risk reduction and management option. If kids are going to smoke anyway – particularly those that have started already – how about giving them something that won’t lead to an early grave. Electronic cigarettes are not without short term negative side effects, but research is finding that they appear to lack long-term harm.

Anti-smoking advocates would be appalled at the very suggestion of youth access to something that looks like smoking. Teens that got started would likely acquire a lifelong addiction to nicotine. However – absent smoke and excessive additives – a lifetime of nicotine use wouldn’t be all that bad. We do the same thing with caffeine.

Many anti-smoking advocates also claim that electronic cigarettes would only serve as a gateway to real smoking. The gateway theory (that use of one bad thing leads to worse things) has been a controversial one with many detractors. What the science looking into electronic cigarettes so far tells us is that the availability and use of electronic cigarettes reduces frequency of smoking and sates cravings to smoke.

To the point, a gateway effect can work in reverse too. A lesser harm alternative can actually prevent an individual from engaging in a more deadly habit. Smoking initiation numbers among teens had plateaued for a bit after years of decline. A renewed decline in smoking rates appears to be directly tied to the availability of e-cigs. In short, e-cigarette use appears more likely to prevent smoking initiation than encourage it.

The electronic cigarette community and industry are both too scared to discuss the topic. Interviews occasionally tread on the ground but often move on quickly.

Youth aside, abstinence-only and cessation therapy programs can’t seem to reduce population level smoking rates below 20%. The only strategy that has proven successful at getting smoking rates much below that is harm reduction.

When the World Health Organization set a goal of less than 20% daily smoking prevalence among adults by year 2000, the only country to make it was Sweden. The country did this by supporting use of moist snuff product called snus. This product has replaced smoking for many in the country and done so while doing only 1% of the harm. Experts now put smoking prevalence in Sweden is around 12%.

The nasty fact that smoking companies have thrived on for decades is that some people will continue using tobacco no matter what. Not all smokers are constantly trying and hoping to quit. Many are perfectly happy with the Faustian bargain they’ve struck, getting improved memory and responsiveness, weight loss, stress relief, and even a certain cool factor for what averages to 14 years less life expectancy.

Support for electronic cigarettes and harm reduction in anti-smoking efforts is growing among researchers and experts. Regulators and anti-smoking groups shouldn’t be fighting new methods that might get cigarettes out of smokers’ hands. They should be embracing them.

Recently, Gilbert Ross, head of the American Council on Science and Health, took a strong stance on electronic cigarettes. He declared that anyone looking to ban e-cigs was also looking to kill smokers. Essentially, electronic cigarettes are the first serious alternative to smoking to date. Patches, lozenges, drugs and more might provide some nicotine, treat some symptoms of smoking addiction, and more, but only electronic cigarettes offer essentially the same habit without the harm.

Teen smoking has been among the most impossible things to fight precisely because teens want to do it. Fighting teen smoking isn’t the same as snuffing out the spread of lice in school. Smoking provides benefits — it relieves stress, aids weight loss, and — lets be honest — still makes kids look cool to other kids. You can’t defeat something like that with counter marketing. You need a better, cheaper, safer, more widely available product that provides all the same benefits. Electronic cigarettes might be just that.

How do you save 443,000 lives a year? Any way you can.

The above is an update of a previous article published on EcigAdvanced.com.