IOWA
Analysis, Commentary, Musings
IOWA
Analysis, Commentary, Musings
RESEARCH 2019
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It wasn’t until December 3 that CDC finally named specific brands of THC-devices in its report. On August 20, Lindsey Stroud warned policymakers of the possible problems associated with Dank Vapes.
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Stroud reported there was a “thriving” black market for THC vaping products.
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We found (now-defunct) listings on Amazon and eBay, where one could easily purchase empty packages under the Dank Vape label, which has overwhelmingly been noted on the black market as being a “legitimate” THC product.
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We also found empty cartridges available for sale online, and YouTube tutorials on how to extract wax from marijuana to use in a vaping device, including one tutorial employing the use of a hair straightener.
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A September report only examined patients in Illinois and Wisconsin, finding 84 percent of patients had reported using THC-vaping devices. Further, 21 of 41 patients interviewed admitted using a THC-vaping device “marketed under the ‘Dank Vape’ label.”
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In October, Stroud reported that a September report from the Utah Department of Health found 94 percent of patients with a vaping-related lung illness reported using THC vaping products. Moreover, 38 percent of patients reported using a Dank Vapes THC device.
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Since August, Stroud has been investigating both CDC and state health department profiles of lung injuries supposedly linked to electronic cigarettes and vaping devices.
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On September 10 Stroud found that of the six states (California, Illinois, Indiana, Kansas, Minnesota, and Oregon) reporting vaping-related deaths, two states (Oregon and Minnesota) explicitly linked the deaths to THC-containing vaping products.
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On September 24 Stroud reported three more states—Connecticut, New York, and Utah—also linked vaping-related lung illnesses to the use of products containing THC.
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It’s disturbing that CDC waited until December to report this particular brand, especially as the 2019 Monitoring the Future survey found that marijuana vaping among youth “ranked among the largest single-year increases ever observed by Monitoring the Future in the past 45 years among all outcomes ever measured.”
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21 percent of 12th graders, 19 percent of 10th graders, and 7 percent of 8th graders reported ever use of vaping THC products in the past 12 months.
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As of November 20, 2019, the CDC has identified 2,290 cases of vaping-related lung injuries in 49 states and Washington, D.C. This includes 45 deaths confirmed in 25 states.
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Of the deceased, the median age “was 53 years and ranged from 17 to 75 years.”
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CDC was able to obtain information on 1,184, or 51.7 percent, of patients with vaping-related lung illnesses. Of these, “83% reporting using [tetrahydrocannabinol] THC-containing products,” with “35% reporting exclusive use of THC-containing products.”
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This report comes after CDC examined 29 patients with vaping-related lung injuries, finding that vitamin E acetate was present in all 29 samples.
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It is important to note neither CDC or state health departments have been able to identify a single chemical, let alone product, that could be causing adverse health effects.
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Many other state health departments have determined a majority of their patients are reporting use of THC-containing e-cigarettes, which are often illegal, black market products, containing unknown substances.
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The California Department of Public Health found 82 percent of patients with vaping-related lung injuries reported vaping THC.
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The Connecticut State Department of Public Health noted 76 percent of the state’s patients reported using THC-containing vaping devices.
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Delaware Health and Social Services reported over 70 percent of patients with a vaping-related lung injury reported using THC.
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The Illinois Department of Public Health concluded over “80 percent of the cases in Illinois report recent use of THC-containing products.”
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The Wisconsin Department of Health Services noted 89 percent of patients “reported using e-cigarettes or other vaping devices to inhale THC products, such as waxes and oils.”
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Minnesota’s and Oregon’s health departments have linked deaths in their states to the use of THC products.
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Although vitamin E acetate’s role in the current outbreak is unknown, it “has been identified as a ‘very strong culprit’ in lung injuries related to vaping THC.”
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The New York State Department of Health announced results from laboratory testing on vaping products. The “results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.”
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The Utah Public Health Laboratory tested 39 vaping devices: 51 percent contained e-liquid nicotine and 49 percent contained THC. 90 percent “of the THC cartridges contained Vitamin E acetate.”
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Moreover, many patients are reporting vaping illegal, black market products. A report in of 53 patients in Illinois and Wisconsin noted that 84 percent reported vaping THC products, with 21 of the 41 patients reporting using a “Dank Vape” product.
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Dank Vapes is not a legitimate brand of THC cartridges. The company sells empty boxes and packaging online.
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Anyone can purchase empty cartridges and then fill these devices with their own concoction of chemicals and resell these seemingly authentic packages.
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Instructions on how to infuse THC into vaping devices is widely available on YouTube.
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Despite recent fearmongering, electronic cigarettes and vaping devices are overwhelmingly less harmful than combustible cigarettes.
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Public Health England estimates e-cigarettes are 95 percent safer than combustible cigarettes.
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The Royal College of Physicians noted that risks associated with e-cigarettes “were unlikely to exceed 5% of the harm from smoking tobacco.”
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The American Cancer Society noted in June 2019, “e-cigarette use to be significantly less harmful for adults than smoking regular cigarettes … because e-cigarettes do not contain or burn tobacco.”
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Electronic cigarettes and vaping devices are tobacco harm reduction tools.
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Since their introduction to the U.S. market in 2007, e-cigarettes have helped an estimated three million American adults quit smoking.
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E-cigarettes are twice as effective as traditional nicotine replacement therapy in helping smokers quit combustible cigarettes.
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A3178 would ban the sales of flavored electronic cigarettes and vaping devices, as well as prohibit the sales of menthol-flavored combustible cigarettes.
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S3265 would ban the sales of flavored e-cigarettes and does not include menthol tobacco cigarettes.
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S4223 “revises licensure” for vaping businesses and prohibit e-cigarettes sales in convenience stores and allow only brick-and-mortar vape shops to sell such products.
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A5922 would increase the fine for selling e-cigarettes and tobacco products to minors.
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The increase would be “$500 for a first offense, $1,000 for a second offense, and $2,000 for a third or subsequent offense.”
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The bill would also require retailers to install electronic age verification systems.
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It would require all vaping products sold in the state to be registered with the U.S. Food and Drug Administration (FDA).
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The bill would also limit the amount of nicotine in vaping products to 2 percent, or 20 milligrams per milliliter
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A5923 revises vaping licenses and would create two different types of licenses for vaping products: “basic vapor licenses for entities seeking to sell electronic smoking devices and liquid nicotine cartridges, and plenary vapor business licenses for entities seeking to sell non-cartridge vaping liquid.”
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A5923 would also increase the tax on vaping products from $0.10 per fluid milliliter and a 10 percent wholesale tax on the retail price of non-cartridge vaping e-liquid, to $0.20 and 20 percent of retail sale price, respectively.
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The bill bill would also “assess a new 20 percent tax on the retail sale price of electronic smoking devices.”
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Santa Clara County, California, banned flavored tobacco product sales to age-restricted stores in 2014. Despite this, youth e-cigarette use increased while the ban was in effect.
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In the 2015-16 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.
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Another Heartland analysis examined the effects of Pennsylvania’s 40 percent wholesale tax, which went into effect in 2016. The analysis noted in 2015, 27 percent of Pennsylvania 12th graders used an e-cigarette. This increased to 29.3 percent in 2017.
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A 2018 survey of nearly 70,000 American adults noted 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively.
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A menthol ban could lead to to racial repercussions. . While white Americans smoke more menthol cigarettes than African Americans, “black smokers [are] 10-11 times more likely to smoke” menthol cigarettes than white smokers.
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This sentiment was expressed in a recent letter from the mothers of Eric Garner and Trayvon Martin to the New York City council, who are debating a ban on menthol cigarettes. In their letter, they implored lawmakers to “pay very close attention to the unintended consequences of a ban on menthol cigarettes and what it would mean for communities of color.”
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New Jersey retailers have actually sold more cigarettes and cigars to minors than e-cigarettes. From September 1, 2018 to August 31, 2019, FDA conducted 4,667 tobacco product compliance checks on retailers in New Jersey. Of these, only 543, or 11.6 percent involved sales to minors. Of the 543 sales to minors, only 95, or 17 percent, involved sales of electronic cigarettes and vaping devices. Surprisingly, retailers were in violation of selling larger amounts of other tobacco products to minors, with cigarettes comprising 54 percent of minor sales with 297 violations, and cigars consisting of 137 violations, or 25 percent of sales to minors.
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New Jersey spends little of existing tobacco moneys on tobacco control and prevention. In 2019, the Garden State received an estimated $919.6 million in revenue from tobacco settlement payments and taxes. That year, New Jersey allocated only $7.2 million, or 0.07 percent, on tobacco education and prevention programs.
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Legislation would ban the sales of flavored e-cigarettes, as well as apply a draconian excise tax on these tobacco harm reduction products.
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H 4196 would ban the sale of e-cigarettes with “characterizing flavors,” including flavors “relating to any fruit, chocolate, vanilla, honey, candy, cocoa, dessert, alcoholic beverage, menthol, mint, wintergreen, herb, or spice.”
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Law enforcement is authorized to “seize and take possession of” e-cigarettes in violation of the ban, as well as “a motor vehicle, boat or airplane in which the [e-cigarettes] are contained or transported.”
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S 2407, an amendment to H 4196, imposes a wholesale tax at 75 percent at the time that e-cigarettes and vaping devices are “manufactured, purchased, imported, received, or acquired in the commonwealth.”
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S 2407 also enacts a nicotine limit, requiring e-cigarettes’ nicotine content be no “greater than 20 milligrams per milliliter.”
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The Heartland Institute analyzed results from the 2017-18 California Youth Tobacco Survey (CYTS) and found that despite flavor restrictions in some localities, youth use of e-cigarettes in those areas increased after the bans went into place.
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Santa Clara County, California, banned flavored tobacco product sales to age-restricted stores in 2014. Despite this, youth e-cigarette use increased while the ban was in effect. For example, in the 2015-16 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.
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Another Heartland analysis examined the effects of Pennsylvania’s 40 percent wholesale tax, which went into effect in 2016. The analysis noted that in 2015, that 27 percent of Pennsylvania 12th graders had used an e-cigarette. This increased to 29.3 percent in 2017.
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A 2018 survey of nearly 70,000 American adults noted 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.
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The vaping industry employs “approximately 2,530” Massachusetts’ citizens including eight “nicotine-vapor products manufacturers, [one] nicotine-liquid-mixture manufacturers and 221 retail vape shops.”
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Vaping companies and “their employees contribute nearly $19 million in state taxes.”
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E-cigarettes in Massachusetts are subject to sales taxes that “generate about $10.7 million annually.”
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Lawmakers should allocate additional funding from tobacco moneys on tobacco control programs.
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In 2019, Massachusetts received an estimated $864.5 million in tobacco taxes and settlement payments, yet the Commonwealth allocated just $4.2 million of state funding to tobacco education and prevention programs.
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A November 8 Morbidity and Mortality Weekly Report (MMWR) by the Centers for Disease Control and Prevention (CDC) that noted vitamin E acetate may be the chemical agent that is causing recent vaping-related lung injuries.
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CDC used data from 10 state health departments (California, Connecticut, Hawaii, Illinois, Maryland, Michigan, Minnesota, Texas, Utah, and Wisconsin) that included detailed health records on 29 patients.
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Vitamin E acetate was found in all 29 patient samples.
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23 patients “self-reported” using vaping devices containing tetrahydrocannabinol (THC).
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THC was also detected in “three patients who said they did not use THC products.”
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The report is rather late, as state health departments linked vitamin E acetate in September, 2019
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On September 5, the New York State Department of Health (NYDOH) reported lab results “showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.”
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The Utah Department of Public Health announced on September 16 the state’s Public Health Laboratory tested 39 vaping products, including 19 THC-containing cartridges and 20 nicotine-containing products.
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Vitamin E acetate was detected in 90 percent of the THC-cartridges, whereas 100 percent of nicotine-containing liquids “contained nicotine and none have shown unexpected compounds.”
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Connecticut, Minnesota, Oregon, and Texas have all found that patients with vaping-related lung injuries self-reported use of THC vaping products.
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An October 15 CDC report found 78 percent of patients with lung illnesses associated with e-cigarettes reported vaping THC-containing devices, and only 10 percent self-reported “exclusive use of nicotine-containing products.”
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Many of these THC cartridges are illegal black-market products with unknown chemical ingredients.
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A September NBC News study tested “15 black market cannabis vape carts,” finding 13 of the cartridges “came back positive for containing Vitamin E acetate.”
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A September 6 report in The New England Journal of Medicine examined vaping-related hospitalizations in Illinois and Wisconsin; in these cases, 21 of 41 patients reported “using a THC product … marketed under the ‘Dank Vape’ label.”
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Despite recent fear mongering, e-cigarettes and vaping devices are tobacco harm reduction tools that have helped an estimated three million American adults quit smoking since 2007.
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Further, they are twice as effective as nicotine replacement therapy in helping smokers quit.
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The American Cancer Society notes e-cigarettes are “significantly less harmful” than combustible cigarettes.
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NEW YORK CITY MENTHOL BAN WOULD CREATE BLACK MARKETS, NOT REDUCE SMOKING RATES
November 7, 2019
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Int. No. 1345 “would ban the sale of menthol, mint, and wintergreen flavored cigarettes.” The ban would only apply to menthol cigarettes as the U.S. Food and Drug Administration “banned cigarettes with characterizing flavors other than menthol” in 2009.
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Lawmakers should be aware that youth smoking rates are already at historically low levels. According to the Centers for Disease Control and Prevention’s 1998 Morbidity and Mortality Weekly Report, in 1997, 36.4 percent of high school students reported using combustible cigarettes in the 30 days preceding the survey. Results from the 2018 National Youth Tobacco Survey concluded that only 8.1 percent of high school students had reported using tobacco cigarettes in 2018. This is a 28.3 percent decrease.
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Nearly one-third of adult cigarette smokers smoke menthol cigarettes. In a 2015 survey from the National Health Interview Survey, “of the 36.5 million American adult smokers, about 10.7 million reported they smoked menthol cigarettes.”
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A 2015 study published in Nicotine & Tobacco Research noted that only 28 percent of menthol smokers would give up cigarettes if menthol cigarettes were banned.
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A 2012 study in the journal Addiction concluded that a quarter of menthol smokers surveyed reported they would find a way to purchase, even illegally, menthol cigarettes, should a menthol ban go into place.
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The already existing black market for illegal cigarettes is big business in the Empire State.
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In late 2018, New York officials reported the state’s attorney general had charged “17 individuals with smuggling 18 million cigarettes into the city, evading $3 million in taxes.”
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NYC recently filed a lawsuit “against the U.S. Postal Service to stop tens of thousands of cigarette packages from being mailed from foreign countries to U.S. residents.”
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A menthol ban could create racial repercussions. Although white Americans smoke more menthol cigarettes than black or African Americans, “black smokers [are] 10-11 times more likely to smoke” menthol cigarettes than white smokers.
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Lawmakers in NYC should reexamine the case of Eric Garner, a man killed while being arrested for selling single cigarettes in the city. In a recent letter to the NYC council, Garner’s mother, as well as Trayvon Martin’s mother, implored officials to “pay very close attention to the unintended consequences of a ban on menthol cigarettes and what it would mean for communities of color.”
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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.
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Lawmakers are responding to recent vaping-related hospitalizations, yet health departments continue to link these to the use of vaping devices containing tetrahydrocannabinol (THC).
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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.
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Illegal THC vaping cartridges have been confiscated in Illinois.
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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 her residence. Law enforcement seized “253 THC vape pen cartridges.”
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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.”
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Flavor bans are not effective measures to reduce youth e-cigarette use.
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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.
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Youth use of tobacco products is at an all-time low.
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Illinois should divert more of existing tobacco moneys into tobacco control programs.
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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 in state funds to tobacco control programs” in the same year.
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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.
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The Tennessee Department of Health (TDOH) is omitting information on substances vaped in recent lung injuries, despite Centers for Disease Control and Prevention (CDC) and other state health departments linking recent vaping-related lung illnesses to the use of products containing tetrahydrocannabinol (THC).
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On October 17, TDH reported “a patient with serious respiratory disease associated with use of electronic cigarettes or other vaping devices” passed away.
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On August 22, TDH issued an alert, “asking health care providers … to report any cases of suspected respiratory illness[es]” believed to be caused by vaping. On September 9, TDH identified six possible cases of vaping-related lung illnesses.
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As of October 17, TDH has identified “53 lung injury cases associated with e-cigarette use or vaping.”
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Of the 53 patients, 66 percent are male, and the “median age of patients is 24 years old and ages range from 16 to 56 years.”
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TDH does not provide any information on what type of vaping devices were used by these patients prior to their illnesses. However, TDH does note, “national data suggests the products containing THC … are linked to most of the cases and play a major role in the outbreak.”
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TDH’s lack of transparency surrounding vaping-related lung illnesses is alarming. Further, the death reported in Tennessee was a Minnesota native who admitted to vaping devices containing THC and cannabidiol (CBD) oils.
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In an October 15 update, CDC found 78 percent of self-reporting patients with vaping-related lung illnesses reported using vaping products containing THC.
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The Minnesota Department of Health (MDH) reported the state’s first vaping-related death on September 6, 2019, noting the patient’s “lung injury was associated with vaping illicit THC products.”
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On October 16, 2019, MDH reported two more deaths from vaping-related lung illnesses. According to MDH, one patient admitted to vaping “illegal THC” and the second also admitted “vaping unknown products in addition to nicotine.”
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Other state health departments have also provided details on products used by patients with lung illnesses supposedly due to vaping.
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The Utah Department of Health noted 94 percent of patients with vaping-related lung illnesses reported use of “any THC cartridges.”
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In a now defunct webpage, the California Department of Health found 81 percent of their state’s patients “vaped [a] product containing THC.”
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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.
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Tennessee law enforcement is well aware of the problem of black-market THC vaping products.
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In November 2017, the Robertson County sheriff’s department seized “seven pounds of high grade marijuana and 31 vials of high potency THC vape liquid … a street value of about $30,000.”
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In April, 2019, Nashville law enforcement collected “over 26 THC vape pens that contained 85 to 90-percent THC oil.” The 19 year-old in possession of the THC vaping devices “admitted he would buy the pens for $18 and sell them for $40.”
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Despite recent headlines, e-cigarettes are substantially safer than traditional, combustible cigarettes. The American Cancer Society declared that “e-cigarette use is likely to be significantly less harmful for adults than smoking regular cigarettes.” This is attributed to the fact that “e-cigarettes do not contain or burn tobacco.”
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County board legislators in Westchester, New York are considering a local law that would prohibit “the sale or distribution of flavored e-cigarettes and flavored e-liquids.”
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The Heartland Institute examined the effects of flavor bans, finding these measures to have no impact on youth e-cigarette use.
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Flavor bans will not address the recent outbreak of illnesses supposedly linked to vaping.
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The Centers for Disease Control and Prevention (CDC) found 78 percent of 849 patients reported vaping THC-containing vaping devices.
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This is similar to reports from many state health departments.
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The Utah Department of Health concluded 94 percent of patients with vaping-related lung illnesses reported use of “any THC cartridges.”
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The California Department of Health found 81 percent of patients had used a “product containing THC.”
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On October 18, the Connecticut Department of Public Health found 26 of 34 patients (76 percent) with vaping-related lung illnesses reported using THC-containing products. Only 2 patients, or 0.05 percent, reported “exclusive use of nicotine.” Six patients were unable to identify what they had vaped.
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Moreover, flavors are immensely popular, especially among adults.
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A 2016 Consumer Advocates for Smoke-Free Alternatives Association survey of more than 37,000 adult vapers found 72 percent of respondents “credited tasty flavors with helping them give up tobacco.”
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A 2018 survey of nearly 70,000 American adults noted 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively. In the same survey, only 20 percent of respondents reported using tobacco flavors at point of e-cigarette initiation.
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A 2017 study by the National Bureau of Economic Research examined the effects of flavor bans and found banning flavors in e-cigarettes “would result in increased choice of combustible cigarettes.” Even worse, the study’s authors expect e-cigarette use to decline by approximately 10 percent if flavors are banned.
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Despite endless fear mongering, electronic cigarettes are substantially safer than combustible cigarettes.
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In 2015, Public Health England found e-cigarettes to be “95% safer” than traditional tobacco cigarettes.
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In 2016, the Royal College of Physicians concluded the harm produced by e-cigarettes is “unlikely to exceed 5% of [the harm] associated with smoked tobacco products.”
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Most recently, the American Cancer Society declared e-cigarettes to be “significantly less harmful for adults than smoking regular cigarettes … because e-cigarettes do not contain or burn tobacco.”
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FDA conducted 374 tobacco product compliance checks with from January 1, 2018 to September 30, 2019 in Westchester County.
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Of these checks, only 41 retailers were found in violation of selling tobacco products to minors.
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Of the underage sales, 15 involved sales of cigars, 25 involved sales of cigarettes, and one sale involved a single cigarette. None involved electronic cigarettes.
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Interestingly, convenience stores were the biggest violators, and six retailers with “puff,” “smoke,” or “vapor” in their store names had zero violations.
CENTERS FOR DISEASE CONTROL AND PREVENTION REPORTS THC-CONTAINING DEVICES CAUSE MOST VAPING ILLNESSES
October 21, 2019
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Lindsey Stroud the latest report by the Centers for Disease Control and Prevention which found 78 percent of patients with vaping-related lung illnesses reported vaping products containing tetrahydrocannabinol (THC).
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On October 15, CDC reported “1,479 lung injury cases associated with e-cigarettes or vaping.” CDC was provided data on 1,358 patients and found:
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70 percent are male.
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The median age of the 1,358 patients “is 23 years and ages range from 13 to 75 years.”
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CDC obtained information on types of substances vaped for 849 patients. Of these, 78 percent reported using vaping products containing THC only 10 percent self-reported “exclusive use of nicotine-containing products.”
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On October 10, CDC found that of patients with lung-illness attributed to vaping devices, 76 percent “reported using THC-containing products,” and 13 percent “reported exclusive use of nicotine-containing products.”
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Similar to CDC’s findings, many states have linked recent vaping-related hospitalizations to THC-containing products.
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The Utah Department of Health noted 94 percent of patients with vaping-related lung illnesses reported use of “any THC cartridges.”
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The California Department of Health found 81 percent of their state’s patients vaped a product containing THC.
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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.
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Minnesota, Oregon, Texas, and Wisconsin have all linked recent vaping-related lung illnesses to the use of THC vaping products.
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Overwhelmingly, a notorious black-market THC product (that is completely illegal) is being linked to recent vaping-related hospitalizations.
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A September 6 report in The New England Journal of Medicine examined vaping-related hospitalizations in Illinois and Wisconsin. In these cases, 21 of 41 patients reported “using a THC product … marketed under the ‘Dank Vape’ label.”
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Additionally, 38 percent of self-reporting patients in Utah used Dank Vapes prior to their lung illnesses.
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Dank Vapes is an illegal, unlicensed product. Essentially, Dank Vapes is a shady packaging company and has been implicated for putting a Wisconsin man into a coma.
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Despite these findings, many states are moving to restrict access to tobacco harm reduction products that are regulated and have yet to be definitively linked to any adverse health effects.
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In June 2019, the American Cancer Society declared e-cigarettes to be “significantly less harmful for adults than smoking regular cigarettes […] because e-cigarettes do not contain or burn tobacco.”