In the early days of e-cigarettes, the U.S. Food and Drug Administration (FDA) began seizing the next-generation products. In response to the federal action, a group of enthusiasts and dedicated vapers became concerned that consumers would lose access to the potentially lifesaving technology. That led to the creation of the Consumer Advocates for Smoke-Free Alternatives Association (CASAA). Alex Clark, CEO of CASAA, said the organization soon started building an army of consumers dedicated to keeping vapor products on the market.
“We truly are a grassroots consumer organization,” explains Clark. “We speak from the heart. And it is our needs as consumers, as people who are choosing a better path in the way that we consume nicotine and tobacco products; that’s where we’re speaking from, and that’s what sets our policy agenda.”
Speaking during the Global Tobacco & Nicotine Forum (GTNF) in late September, Clark disclosed that CASAA does accept donations from a variety of stakeholders, including industry stakeholders, but the organization does not have any policy, legislative messaging or financial agreements with any of its supporters. Clark says that the conversation surrounding vaping is centered in harm reduction and that is the mission of CASAA.
“Vaping … has become this conversation about tobacco harm reduction, [it] is a consumer-driven movement. I don’t think there’s anything groundbreaking in that statement,” he said. “But I bring it up because I believe—and I think many of us believe—that the industry and policymakers need to be reminded of that—that as people who used to smoke, we have endured years of other people telling our story.”
CASAA grew as a community organization through its “tight feedback loop” between consumers and independent manufacturers. Clark likened the early days of the not-for-profit organization to the local food movement where “if you wanted to know where your cheeseburger came from, you could drive down the road” and visit the farm.
“I think we can all come to embrace that spirit and that side of the industry as an asset, not necessarily something that needs to be regulated to within inches of its life,” Clark said. “As consumers, we are very deeply afraid that is what’s going to happen. That as larger firms are able to make it through the [premarket tobacco product application (PMTA)] process, that we [will] lose that very important retail experience to be able to walk into a vapor shop and learn about the products but also discuss the challenges that we’re facing in transitioning away from smoking.”
Clark says that a major concern for CASAA and its supporters is that the U.S. Food and Drug Administration (FDA) PMTA process is too expensive and arduous for small business owners. He says the organization worries that if only large tobacco companies can sell vapor products, consumers will lose the ability to have a place to learn and understand the choices available, through different types of products, to help them stop smoking.
Clark mentioned a study that evaluated the long-term success rates of quitting smoking for people who visited specialty vape shops versus people who bought their products at convenience stores. That study found that consumers that visited vape shops were more successful at stopping smoking. “They were more likely to transition completely, and they were more likely to stick with the products for longer,” said Clark.
Because of the success vape shops have had at helping people quit smoking, they began to move away from the stigma they carried in local communities early on as being businesses where “potentially unsavory elements go to get their drugs,” according to Clark. He says that, today, vape shops are seen for what they are: a contact point for public health messaging and people who smoke. “People who are looking for a way to move away from combustible tobacco visit vape shops, and it’s a very casual setting,” he says. “It’s a place where people can feel safe and welcome and [are] able to just share our stories with one another. It is very helpful, and it really looks a lot like a community support [group for smokers].”
Clark said this distinction is important for regulators and anti-vaping groups to understand. Smokers began making the decision to quit using cigarettes by switching to vapor products of their own accord. There was not a government agency telling them that e-cigarettes had the potential to help them quit deadly smoking, and small, family-owned vape shops are where the conversations and mass conversions began.
“We have made this decision on our own, which is a bit challenging to the dominant narrative painting people who smoke as victims. I, honestly, don’t feel like a victim,” he says. “I started smoking in the mid-’90s. Certainly, I was subject to all kinds of messaging about why I shouldn’t smoke. Not only why it would be negatively affecting my health but [also] why it was essentially a character flaw and I was a bad person.”
Clark says vape shop owners need to help keep vape shops available to smokers by taking steps to continue to change people’s perceptions of them. Owners need to keep their shops clean and sanitary. Don’t have such a thick cloud of vapor when opening the door that potential customers are driven away. Vape shops should have an open and welcoming environment.
“You need to have a place for your customers to talk with one another. People behind the counter need to be very knowledgeable about the products that they are selling. Regulations [need to allow] people [to] have candid conversations about these products. As it stands now, I think even sharing your personal story about making the switch while standing behind the cash register could get people into a lot of trouble,” he says emphatically. “There’s a lot of room for regulations to improve in terms of allowing people to receive important information and also the education that needs to happen among people working in vape shops.”
People often internalize messages that are intended to encourage them to change their lives for the better, according to Clark. He says people also internalize messages about being deficient. Some of the rhetoric surrounding vaping and the misinformation about its harms is detrimental to public health. Vape shops create an environment where people feel comfortable discussing their goal of quitting cigarettes. Anti-vape groups, however, are putting these “safe zones” for smokers in jeopardy.
“We have already seen the legislative agenda of the anti-vaping, anti-nicotine campaigns, which is to go after flavors, which very obviously shuts down vape shops and takes away that very important element of providing a space for people to come together and support one another,” Clark told attendees. “We must be prepared to take on these fights at the local and state level.”
Fighting the types of legislative challenges that the vapor industry is facing is complicated. Clark says that when attempting to tackle many legislative issues in the United States, it is like dealing with 50 different countries. “Certainly, you can see this in our patchwork of responses to the [Covid-19 pandemic],” he says. “Within those 50 countries, we have 39,000 local governments and all of these are potential pressure points where anti-nicotine activists will promote anti-harm reduction policies. If we don’t stand up for ourselves, we can’t rely on other people to do it for us, and we cannot surrender our voice to either anti-tobacco activists or the tobacco and nicotine industry.”