ILLINOIS FLAVOR BAN UNLIKELY TO REDUCE HOSPITALIZATIONS, YOUTH USE, DISREGARDS HARM REDUCTION
November 5, 2019
In their quick veto session, Illinois Senate Democrats are seeking to outlaw flavors in all tobacco products, including cigarettes, e-cigarettes, smokeless tobacco, and the newly approved IQOS device. An amendment to Senate Bill 668 would create the “Flavored Tobacco Ban Act,” which would prohibit any “characterizing flavor” except tobacco flavor. Unlike other misguided flavor bans, the Illinois bill includes menthol and mint flavors.
According to a press release from Illinois Senate Democrats, lawmakers are “[r]esponding to a wave of [vaping-related] hospitalizations and deaths across the country.” According to Illinois Senate Democrats, SB 668 “is aimed specifically at keeping tobacco out of the hands of children.” Unfortunately, Illinois lawmakers do not seem to understand that recent vaping-related hospitalizations are overwhelmingly linked to illegal, unregulated vaping products containing tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana.
A September 2019 report by the Centers for Disease Control and Prevention (CDC) found 77 percent of patients reported vaping products that contained THC. Further, an October 2019 CDC report linked 78 percent of cases to use of THC vaping devices.
Moreover, flavor bans are unlikely to reduce youth use of e-cigarettes and are more likely to lead adult smokers back to combustible cigarettes, which are far more dangerous than regulated e-cigarettes.
CDC’s findings are similar to several state health departments. The Utah Department of Health noted 94 percent of patients with vaping-related lung illnesses reported use of “any THC cartridges.” On October 11, the Iowa Department of Public Health reported that of 38 cases of possible vaping-related lung injury, 33 patients, or 86 percent, reported vaping THC-containing devices. According to the Texas Department of State Health Services, 87 percent of patients “reported vaping products containing [THC].”
Illegal THC vaping cartridges have been confiscated in Illinois. For example, a 25-year-old was arrested in the fall of 2019 after police found more than $103,000 worth of marijuana and more than $5,000 of LSD at his residence. Law enforcement seized “253 THC vape pen cartridges.”
More notably, law enforcement recently uncovered a massive “THC vape manufacturing” operation that “produced 4,000 to 5,000 vape cartridges a day.” According to officials, the ring sold THC cartridges “in Wisconsin, Illinois and Minnesota.”
Despite lawmakers’ best intentions, flavor bans do not reduce youth vaping. The Heartland Institute examined the effects of flavor bans, finding these measures to have no impact on youth e-cigarette use. For example, Santa Clara County, California, banned flavored tobacco products to age-restricted stores in 2014. Despite this, youth e-cigarette use increased. In the 2015-16 California Youth Tobacco Survey (CYTS), 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.
Flavors are immensely popular among adult smokers, who have transitioned from combustible cigarettes to vaping. For example, a 2018 survey of nearly 70,000 American adults noted that 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively. Further, only 20 percent of respondents reported using tobacco flavors at point of e-cigarette initiation.
Flavor bans will also likely lead former smokers back to much more harmful, combustible cigarettes. A 2017 study by the National Bureau of Economic Research concluded banning flavors “would result in the increased choice of combustible cigarettes.” Indeed, the authors expect e-cigarette use to decrease by approximately 10 percent if flavors are banned.
Further, a ban on menthol cigarette and smokeless tobacco products is likely to have no impact on tobacco use. In a 2012 study, a quarter of menthol smokers indicated they would find a way to purchase, even illegally, menthol cigarettes, should a ban be enforced.
To understand how a ban on flavored tobacco products would impact Illinois, lawmakers need only look at Cook County, which has some of the highest cigarette prices in the country, and also a very large black market. Cook County, which includes Chicago, also has a Cigarette Tax Reward Program, which offers monetary awards of up to $250 to persons reporting those seeking to avoid paying cigarette taxes, including people who use unstamped or counterfeit packs or even stray cigarettes. It has been reported that Chicago police issue each year, however, only 15–20 percent are actually are paid.
Moreover, Illinois lawmakers are concerned about what they consider a “youth vaping epidemic,” yet data confirms there is no epidemic. According to the 1997 Youth Risk Behavior Survey, 42.7 percent of high school students reported using tobacco products, with 36.4 percent reporting use of combustible cigarettes. According to the 2018 National Youth Tobacco Survey, only 27.1 percent of high school students reported using any tobacco product, with 20.8 percent reporting using e-cigarettes and vaping devices. It is alarming that lawmakers would choose to prohibit adult use of tobacco harm reduction products when youth tobacco use is relatively low compared to 1997.
If Illinois lawmakers truly want to address youth tobacco use, they should divert more of existing tobacco moneys into tobacco control programs. Illinois received an estimated $1.0688 billion in tobacco tax revenue and settlement payments in 2019, yet the Land of Lincoln only “allocated $9.1 million [or 0.008 percent of tobacco moneys] in state funds to tobacco control programs” in the same year. Illinois’ spending on tobacco control is so minimal, the Lung Foundation gave the state an F grade in 2019 for the state’s “tobacco prevention and cessation funding”—or lack thereof.
It is becoming extremely apparent that recent vaping-related hospitalizations are being caused by illicit THC-containing vaping devices. Flavor bans are unlikely to reduce such lung illnesses. Further, flavors are essential in tobacco harm reduction devices including e-cigarette and smokeless tobacco, and such bans are likely to lead former smokers back to combustible cigarettes. A ban on flavored tobacco products will create even bigger black markets. Instead of banning products that have helped millions of adults quit tobacco cigarettes, Illinois lawmakers should allocate more than 0.008 percent of tobacco moneys to programs intended to reduce youth tobacco use.
Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.