I concur with Dawson and Maziak’s call for real-world solutions to the challenges posed by e-cigarettes. However, any such solutions should also reflect an appreciation of, and engagement with, the relevant ethical and justice-based concerns. To think through these concerns, we need to untangle several strands of normative argument implicit in the current debate about e-cigarettes. My article focused on one such strand: the concern that e-cigarettes could contribute to the renormalization of conventional cigarettes and thereby undermine progress made in tobacco control. In my article, I argued that renormalization concerns could support the case for restricting the marketing of e-cigarettes, but that they are problematic when it comes to restricting where e-cigarettes can be used.
Although concerns about the renormalization of conventional cigarettes are playing an important role in the debate about how to regulate e-cigarettes, arguments based on these concerns have mostly gone unchallenged; my article considered which conclusions can—and cannot—be drawn from such arguments. It is crucial to these debates that we take into account not only that smokers have become heavily stigmatized,1 but also how closely smoking has come to be associated with several forms of disadvantage, including class and poverty,2 racial and ethnic minority status,3 and poor mental health4 (a recent article in AJPH also emphasizes the high smoking rates among sexual and gender minorities5).
As Dawson and Maziak emphasize, the denormalization of smoking has of course been driven by a range of factors beyond public health policy and regulation, including a better understanding of its risks and harms. However, denormalization is also an explicit goal in many tobacco control strategies and has been endorsed by bodies such as the World Health Organization.6 That many factors outside of public health policy have contributed to negative perceptions of smokers does not relieve policymakers and public health experts of the responsibility to anticipate possible stigmatizing effects of the strategies they advocate and to make a reasoned judgement about whether any such effects are acceptable.
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