​KEY POINTS:

• Gov. Whitmer is using the Michigan Department of Health and Human Services (MDHSS) to issue a rule that would ban sales of “flavored nicotine vapor products” in the Great Lakes State.

• The agency is proposing the rule to “reduce the appeal of vaping flavored nicotine products in order to prevent the abuse of tobacco and nicotine products at a young age.”

• There is no evidence that flavor bans reduce youth usage or that electronic cigarettes or that e-cigarette use increase the likelihood of combustible cigarette use.

• According to MDHHS’ own regulatory statement, a University of Michigan analysis found that “nearly 3.3 million life-years could be saved by the year 2070.” MDHSS reports that the analysis “accounts for e-cigarettes’ possible role in both smoking cessation and initiation.”

• According to Michigan Youth Risk Behavior Surveillance Surveys (YRBSS), a decrease in youth vaping actually led to an increase in youth smoking.

• In 2015, 10 percent of Michigan high school students reported current combustible cigarette use and 23 percent reported current e-cigarette use.

• In 2017, combustible cigarette use increased to 10.5 percent of high school students (a 4.8 percent increase), while youth vaping use decreased by 55.4 percent, to 14.8 percent of Michigan high school students.

• According to the 2019 YRBSS, current use of combustible cigarette products is at an all-time low, at 4.5 percent of high school students in 2019. This is a 133.3 percent decrease from 2017 rates and a 122.2 percent decrease from 2015 rates. Regarding current e-cigarette use, in 2019, 20.8 percent of high school students reported using a vapor product, a 28.8 percent increase from 2017 – but a 10.6 percent decrease from 2015 vaping rates.

• In April 2018, a ban on flavored e-cigarettes and vapor products went into effect in San Francisco.

• According to the 2019 YRBSS, vaping increased from 7.1 percent of high school students to 16 percent of high school students reporting using an e-cigarette.

• Current cigarette use increased from 4.7 percent of San Francisco high school students in 2017 to 6.5 percent in 2019.

• Michigan’s vaping industry provided more than $608 million in economic activity in 2018 while generating 2,660 direct vaping-related jobs.

• MDHHS notes that the Centers for Disease Control and Prevention “has found that each dollar spent on tobacco prevention can eliminate up to $55 of tobacco-related health care expenditures,” yet Michigan spends a dismal amount on funding tobacco control programs.

• In 2019, Michigan received an estimated $1.2155 billion in tobacco taxes and tobacco settlement payments.

• In the same year, the state spent only $1.6 million, or less than 1 percent, on funding tobacco control programs, including education and prevention.

KEY POINTS:

• According to the National Youth Tobacco Survey, e-cigarette use – defined as using an e-cigarette on at least one occasion in the 30 days prior to the survey – decreased from 27.5 percent of high school students and 10.5 percent of middle school students, to 19.6 percent and 4.7 percent respectively

• Although some media have attributed this decline to due to the federal Tobacco 21 (T-21) law, which went into effect December 20, 2019, data from the Youth Risk Behavior Surveillance Survey (YRBSS) show that state T-21 laws had little-to-no effect on lowering vaping rates among high school students.

• Hawaii’s T-21 law went into effect January 1, 2016.

  • Between 2015 and 2017, cigarette smoking rates increased 10 percent, from 9.7 percent of high school students to 10.8 percent.

  • In 2019, although youth combustible cigarette use did decrease, to 5.3 percent (a 45 percent decrease from 2015 and a 51 percent decrease from 2017), current vaping rates increased to 30.6 percent of students.

• On July 1, 2018, Maine’s T-21 law went into effect.

  • Between 2017 and 2019, youth vaping increased by 47.6 percent, from 15. 8 percent of high school students reporting current e-cigarette use in 2017 to 30.2 percent in 2019.

• Massachusetts’ T-21 went into effect on December 31, 2018.

  • Between 2017 and 2019, combustible use by high school students decreased 28 percent from 6.4 percent to 5 percent.

  • Current vapor product use increased by 37 percent in the same time period, from 20.1 percent of high school students to 32.2 percent.

• The only state to implement T-21and see decreases in both youth tobacco and vapor product use was California.

  • From 2015 to 2017, cigarette smoking among high school students decreased by 42 percent from 7.7 percent to 5.4 percent.

  • Regarding current vaping use among California high school students, between 2015 and 2017, current vaping rates decreased by 23.6 percent, from 21.4 percent of students to 17.3 percent.

  • Interestingly, youth vaping increased by 4 percent from 2017 to 2019, to 18.2 percent of high school students, but it is still a 17 percent decrease from 2015.

• Of the mentioned states, only California dedicates tobacco control funding in levels that are near the recommended funding levels from the CDC.

  • In 2019, California spent $250.4 million on tobacco control programs – or 72 percent of the CDC recommended funding.

  • In 2019, Hawaii spent $4.5 million on tobacco control programs (32.9 percent of CDC recommendations), Maine allocated $4.8 million (30.4 percent of CDC recommendations), and Massachusetts spent $4.2 million (6.3 percent of CDC recommendations).

• It is evident that prohibitionist policies do not reduce youth tobacco and vapor product use, but robust and well-funded tobacco control programs can and do work.

KEY POINTS:

• In April 2018, the ban on flavored e-cigarettes and vapor products went into effect in San Francisco and in January, 2020, the city had implemented a full ban on any electronic vapor product.

• These endeavors have failed to lower youth tobacco and vapor product use.

• Data from the 2019 Youth Risk Behavior Survey show that 16 percent of San Francisco high school students had used a vapor product on at least one occasion in 2019, an increase from 7.1 percent that had used an e-cigarette in 2017.

• Current daily use more than doubled from 0.7 percent of high school students in 2017 to 1.9 percent of San Francisco high school students reporting using an e-cigarette every day in 2019.

• Worse, despite nearly a decade of significant declines, youth use of combustible cigarettes seems to be on the rise in Frisco.

  • In 2009, 35.6 percent of San Francisco high school students reported ever trying combustible cigarettes. This figure continued to decline to 16.7 percent in 2017. 

  • In 2019, the declining trend reversed and 18.6 percent of high school students reported ever trying a combustible cigarette.

  • Similarly, current cigarette use increased from 4.7 percent of San Francisco high school students in 2017 to 6.5 percent in 2019.

• Public health officials may be apt to attribute the increase use of combustible cigarettes to vaping products, yet in cities and states where looser regulations exist, youth combustible smoking continues to decline.

  • In Seattle, WA, combustible cigarette use decreased between 2016 and 2018 among students between grades 6 and 12 as noted in the Seattle Public Schools Healthy Youth Survey. In 2016, 7.025 percent of Seattle youth between grades 6 and 12 reported smoking cigarettes 1 to 2 times in the 30 days prior to the survey, this decreased to 2.025 percent in 2018.

  • According to the Indiana Youth Survey, past 30-day use of combustible cigarettes among high school students declined from 9 percent in 2017 to 7.3 percent in 2018.

• It is disingenuous that lawmakers continue with draconian prohibition policies that don’t reduce youth smoking and indeed may be leading to an increase in smoking rates. Lawmakers ought to revisit the drawing boards to come up with sensible policies that have a positive effect on youth substance use and do not restrict adults from tobacco harm reduction tools. 

Key Points:

• In Chicago, many youths are not using electronic cigarettes. For example, according to the Illinois Youth Survey for the City of Chicago, in 2018, 94 percent of Chicago 8th graders and 88 percent of Chicago 10th and 12th graders reported not using an e-cigarette or vapor product in the 30 days prior to the survey. Only 1 percent of 8th graders, 2 percent of 10th graders, and 1 percent of 12th graders reported using e-cigarettes “more than once a day” in the 30 days prior to the survey.

• Many youths are not overwhelmingly using e-cigarettes and vapor products because of flavors.

  • Only 23.9 percent of Connecticut high school students reported “flavors” as a reason for using e-cigarettes in 2017, compared to 41.6 percent who reported they used a vapor product because a friend and/or family member had used them.

  • Only 26.4 percent of Hawaii high school students cited flavors as a reason to use e-cigarettes in 2017.

  • In 2019, only 4.5 percent of Rhode Island high school students claimed to have used e-cigarettes because they were available in flavors, while 12.5 cited the influence of a friend and/or family member who used them. 

  • Only 17 percent of Vermont high school students reported flavors as a reason to use e-cigarettes in 2017, and 33 percent cited friends and family members. In 2019, only 10 percent of Vermont youth that used e-cigarettes cited flavors as a primary reason for using e-cigarettes, while 17 percent of Vermont high school students reported using e-cigarettes because their family and/or friends used them.

  • Only 6.2 percent of Virginia high school students reported using e-cigarettes because of flavors, while 11.3 percent used them because a friend and/or family member used them.

• Chicago vape stores and tobacco retailers are doing a good job in not selling tobacco and vapor products to minors.

  • Between January 1, 2018 and October 1, 2019, the U.S. Food and Drug Administration conducted 507 tobacco product compliance inspections in Chicago tobacco and vape retailers. Of these, only 99 resulted in a failed inspection that lead to the sale of a tobacco and/or vapor product.

• Deeply troubling is that the legislation would require adult users of such products to find alternative ways to obtain vapor products, including utilizing black markets – something Chicago is already prone to due to high cigarette prices.

• 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 an estimated $4 million worth of tobacco citations each year, however, only 15–20 percent are actually are paid.

• In February 2020, WGN followed Chicago’s Department of Business Affairs and Consumer Protection as agents “searched for illegal cigarettes in stores through” the city. In 2019, the department “issued $838,000 worth of fines for illegal tobacco sales.” Agents told WGN News that there is “a direct link between unstamped cigarettes and crime in [Chicago] neighborhoods.”

• The black market is so lucrative that in 2016 city council hearing, Alderman Roderick Sawyer “said he knows one man who makes $800 a day selling” loose cigarettes.

• According to the Vapor Technology Association, in 2018, the vapor industry created 3,770 direct vaping-related jobs, including manufacturing, retail, and wholesale jobs in Illinois, which generated $152 million in wages alone. Moreover, the industry has created hundreds of secondary jobs in the Prairie State, bringing the total economic impact in 2018 to $1.1 billion. In the same year, Illinois received more than $69 million in state taxes attributable to the vaping industry.

• In 2019, Illinois received an estimated $1.0688 billion in tobacco taxes and tobacco settlement payments. In the same year, the state spent only $9.1 million, or less than 1 percent, on funding tobacco control programs, including education and prevention

KEY POINTS:

• House Bill 882 would increase Georgia’s excise tax on cigarettes by $0.98 per pack, from $0.37 to $1.35 a pack. The legislation would also tax consumable vapor products at a rate of $1.25 per fluid milliliter. Interestingly, the legislation would decrease the tax on all cigars other than little cigars, from 23 percent the wholesale price to 12 percent.

• The Georgia Senate recently passed their FY 2021 Budget Proposal which included “spending cuts of 11 percent, approximately $2.6 billion.”

• Sin taxes are inherently unreliable, and are deeply regressive.

• Pew Charitable Trusts revealed a decline in cigarette consumption caused cigarette tax revenue “to drop by an average of about 1 percent across all states from 2008 to 2016.”

• Cigarette tax revenue is already decreasing in Georgia.

• In FY 2016, Georgia collected $175.4 million in cigarette tax revenue. This decreased to $171.4 million in FY 2018, despite the cigarette tax remaining at $0.37 per pack.

• In Georgia, lower income adults are more likely to be current cigarette smokers.

  • According to the Georgia Behavioral Risk Factor Surveillance System, in 2014, 73 percent of current smokers had incomes of $34,999 per year or less.

  • 33.5 percent of smokers had incomes that were less than $15,000.

  • In 2014, over 31 percent of smokers in Georgia had less than a high school education, compared to 5.6 percent of smokers that were college graduates.

  • Uninsured adults were twice as likely to smoke, with 31.4 percent of current smokers having no health insurance, compared to 15.4 percent that had health insurance in 2014.

The per-milliliter tax vapor tax will disproportionately impact vapor products and will virtually wipe out every small business that specializes in the sale of vapor products.

• Later-generation open-system “mods” are disproportionately affected by per-mL taxes because e-liquid is available in larger quantities compared to closed pod systems. A $1.25 per mL tax on a 120 mg bottle of e-liquid would amount to a total tax of $150, but a pod system containing 0.5 mg of nicotine would only be subject to a tax amounting to 62.5 cents.

• The proposed tax could possibly wipe out the $644 million vapor industry in the Peach State. In 2018, the industry created 2,532 direct vaping-related jobs, including manufacturing, retail, and wholesale jobs in Georgia, which generated $87 million in wages alone. Moreover, the industry has created hundreds of secondary jobs in the Peach State, bringing the total economic impact in 2018 to $644,293,500. In the same year, Georgia received more than $38 million in state taxes attributable to the vaping industry.

KEY POINTS:

• House Bill 1229 would increase the excise tax on cigarettes by $1.50, from $0.37 per pack to $1.87/pack. The legislation would also tax vapor products at rate of 39 percent of the wholesale price. 

• In Georgia, lower income adults are more likely to be current cigarette smokers.

  • According to the Georgia Behavioral Risk Factor Surveillance System, in 2014, 73 percent of current smokers had incomes of $34,999 per year or less.

  • 33.5 percent of smokers had incomes that were less than $15,000.

  • In 2014, over 31 percent of smokers in Georgia had less than a high school education, compared to 5.6 percent of smokers that were college graduates.

  • Uninsured adults were twice as like to smoke, with 31.4 percent of current smokers having no health insurance, compared to 15.4 percent that had health insurance in 2014.

• Approximately 11,700 adults die each year in Georgia due to smoking. Smoking-related health care costs exceed $3 billion each year in Georgia and the state’s Medicaid system spends $650.4 million per year on smoking-related health care.

• Georgia allocates very little of existing tobacco monies to tobacco control programs.

• In 2019, Georgia collected an estimated $393.3 million in revenue from tobacco settlement payments and tobacco taxes. In the same year the Peach State dedicated only $750,000 – less than 1 percent of tobacco monies – to tobacco control programs, including education and prevention.

• The vapor industry has been an economic boon to Georgia.

  • In 2018, the industry created 2,532 direct vaping-related jobs, including manufacturing, retail, and wholesale jobs in Georgia, which generated $87 million in wages alone.

  • Moreover, the industry has created hundreds of secondary jobs in the Peach State, bringing the total economic impact in 2018 to $644,293,500.

  •  In the same year, Georgia received more than $38 million in state taxes attributable to the vaping industry.

• A 2015 policy analysis by State Budget Solutions examined electronic cigarettes’ impact on Medicaid spending. The author estimated Medicaid savings could have amounted to $48 billion in 2012 if e-cigarettes had been adopted in place of combustible tobacco cigarettes by all Medicaid recipients who currently consume these products.

• This would have amounted to over $810 million in Medicaid savings to Georgia in 2012.

KEY POINTS:

• Senate Bill 781 would tax electronic cigarettes at 18 percent the wholesale price.

  • The first $250,000 collected from the tax would be deposited in the Department of Treasury for “tax enforcement,” the next $2.5 million would be dispersed to “local health departments for local public health programs,” the next $2.5 million would be used for “enforcement and compliance purposes under the youth tobacco act,” and the remaining balance would be deposited into Michigan’s General Fund.

• Excise taxes, often referred to as “sin” taxes, are commonly applied to cigarettes, alcohol, and sugary products to deter their consumption. Policymakers justify such taxes because “sin” products are said to be associated with high health care costs that burden state governments.

• Excise taxes are highly regressive and disproportionately impact lower income persons. For example, tobacco taxes disproportionately impact lower-income people, who spend a greater share of their income on tobacco products.

• According to the 2017 Michigan Behavioral Risk Factor Survey, in 2017, 60.6 percent of Michigan smokers had household incomes under $34,999, and 35.9 percent reported incomes of less than $20,000.

  • Uninsured adults also smoke at higher rates than insured Michigan adults. In 2017, 34.2 percent of smokers reported having no insurance, compared to 18.2 percent who were insured.

  • Current vapor product use “decreased with increasing household income level.”

• Deeply problematic with Michigan’s proposed vapor tax is that the Great Lakes State has squandered away existing tobacco monies. Indeed, in 2019, Michigan collected an estimated $1.2166 billion in revenue from tobacco taxes and settlement payments. In the same year, Michigan dedicated only $1.6 million to tobacco control efforts, including education, prevention and programs to help smokers quit.

• Lawmakers should note that the use of electronic cigarettes can actually reduce health care costs. For example, a 2015 policy analysis by State Budget Solutions examined electronic cigarettes’ impact on Medicaid spending. The author estimated Medicaid savings could have amounted to $48 billion in 2012 if e-cigarettes had been adopted in place of combustible tobacco cigarettes by all Medicaid recipients who currently consume these products. This would have amounted to over $1.5 billion in Medicaid savings to Michigan in 2012.

• Policymakers should also note that Michigan already collects sales taxes from e-cigarettes. In 2018 the Great Lakes State collected over $38 million in taxes from the vapor industry. Indeed, in 2018, the entire economic impact of the vapor industry on the state amounted to over $608 million.

​KEY POINTS:

• A May, 2020 study published in the journal Annals of the American Thoracic Society inspected flavor preferences in long term users of electronic cigarettes and vapor products.

• Adult “preference” for traditional tobacco flavors, including tobacco, menthol or mint, “decreased over time.”

• 383 adults participated in the study, completing “two online e-cigarette surveys in 2012-2014 (baseline survey) and in 2017-2019 (follow-up survey).”

• The average age of participants was 44 years old, 86 percent of participants were “exclusive e-cigarette users,” and 13 percent reported dual use – using an e-cigarette and other tobacco product.

• The authors noted that “preference for tobacco and menthol or mint decreased over time,” from 40 percent of participants citing using those flavors in 2012-2014 to 22 percent in the follow up study.

• Use of fruit flavored e-cigarettes remained stable, “but chocolate/candy or other sweets preference significantly increased” from 16 percent of participants in the baseline survey to 29 percent in the 2017-2019 follow-up survey.

• Only 6.9 percent of participants reported any adverse reactions from flavors.

• When asked if their preferred flavors were banned, “very few participants anticipated that they would stop using e-cigarettes.” Further, 20.4 percent reported they would find a way to find their preferred flavor.

• Despite adults use of flavors, policymakers across the country are seeking to ban flavored vapor products. Indeed, four states – including Massachusetts, New Jersey, New York, and Rhode Island – currently ban flavored vapor product sales. Lawmakers in California and Hawaii are currently debating banning flavored vaping devices.

• Policymakers are prematurely introducing flavor bans to combat youth e-cigarette use, yet youth are not overwhelmingly using vapor products due to flavors.

  • In an analysis of five state surveys on youth e-cigarette use, only 15.6 percent of high school students cited using e-cigarettes because of flavors.

  • A more recent May 2020 “research letter” published in JAMA examined a survey of 1,129 respondents between 14 and 24 years old. Only 4.7 percent of respondents reported “flavors” as a reason for JUUL use, compared to the 62.2 percent of respondents that cited social reasons.

• Moreover, should lawmakers truly want to address youth tobacco and vapor product use, states should divert more of existing tobacco monies on tobacco control programs, including education and prevention.

• According to the Centers for Disease Control and Prevention, in 2020, states are estimated to receive $27.2 billion in monies attributable to tobacco taxes and settlement payments. In the same year the states will only allocate $739.7 million – less than 3 percent – to tobacco control programs.

KEY POINTS:

• A June, 2020 study is providing further evidence that smokers are largely underrepresented in COVID-19 cases – a finding that Tobacco Harm Reduction 101 first looked into in early May.

• Researchers conducted “a population-based study among over 3,000,000 adult members of Clalit Health Services, the largest health provider in Israel.”

• Over 114,000 individuals underwent COVID-19 testing and 4,011 had positive cases.

  • Of the positive cases, the mean age of individuals was 43.38 years old and 48.6 percent were females.

  • Regarding smoking status, 78.2 percent of positive COVID cases were never smokers.

  • 10 percent of positive cases were current smokers

  • 11.7 percent of positive COVID-19 cases were former smokers.

• Other studies have examined the prevalence of smokers in COVID-19 cases and have reached similar conclusions: smokers are largely underrepresented among patients diagnosed with novel coronavirus.

  • An April 3, 2020 Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention published data on 5,143 COVID-19 patients. Of these, only 96, or 1.3 percent, were classified as current smokers. Only 165 patients, or 2.3 percent, were classified as former smokers.

  • An April 28 COVID-19 Weekly Report issued by the Oregon Health Authority included information on underlying conditions for 73 COVID-19 deaths, of these only one was a current smoker and 18 were former smokers.

• Researchers are currently looking into nicotine’s role in COVID-19 prevalence. One theory is that nicotine reacts to the “angiotensin-converting enzyme (ACE) 2, which is relevant because coronaviruses bind to ACE2.” Indeed, after a study was published in France that found low incidences of smokers in COVID-19 cases, officials limited the sales of nicotine replacement therapies.

• There is no significant scientific evidence connecting major health problems with the use of nicotine alone.

• According to Raymond Niaura, Ph.D., professor of social and behavioral sciences at New York University’s College of Global Public Health, existing evidence “indicates that nicotine itself, while not completely benign, carries substantially lower risks than smoking.” In a comprehensive study of nicotine health effects, Niaura noted “that even very high doses of medicinal nicotine had little effect on cardiovascular function.”

• The U.K. Royal College of Physicians notes that “nicotine, while addictive, is not the primary cause of smoking-related diseases.”

• Smokeless tobacco poses much lower health risks than smoking, despite containing nicotine. One review of 89 studies, conducted in 2011, found snus and smokeless tobacco use to be “99% less hazardous than smoking.”

KEY POINTS:

• Included in the Governor’s Budget Proposal is a new tax on vapor products and would begin and on “January 1, 2021, and will be $2 for each 40 milligrams of nicotine in the product, equivalent to the tax on a pack of cigarettes.”

• The new tax is included “[i]n order to address the rapidly increasing youth use of potent nicotine-based vaping products.”

• There is no evidence vaping taxes will stop youth use of vaping devices.

• In 2016, Pennsylvania enacted a 40 percent wholesale tax on vaping products.

  • An analysis on the effects of Pennsylvania’s wholesale tax on youth e-cigarette use found young Pennsylvanians in middle and high school actually increased their use of e-cigarettes in the period following the implementation of the tax.

• Vapor taxes are sin taxes and disproportionately impact lower income people.

• In 2016-17, 16.2 percent and 16.3 percent of Californian adult smokers were uninsured or on Medicaid/Medi-Cal, respectively.

  • Only 6.7 percent of smokers had a Bachelor’s degree, compared to 16 percent that had not received a high school diploma.

  • 15.8 percent of California smokers had incomes that were 0 to 99 percent of the federal poverty level (FPL), compared to 7.7 percent of smokers with income ranges of 300 percent “FPL or Higher.”

• A majority of adult vapers are former smokers. Indeed, in a survey of nearly 70,000 American adult vapers, only 5.2 percent “reported being never smokers.”

• Many California youth are not using e-cigarettes frequently.

• In 2019, only 2.8 percent of San Diego high school students reported daily vapor product use.

  • 84 percent of San Diego high school students reported not using an e-cigarette in the 30 days prior to the survey.

• In San Francisco, only 1.9 percent of highs school students reported using e-cigarettes daily and 84 percent of students reported not using a vapor product in the 30 days prior to the survey.

  • 31.1 percent of students reported ever using an electronic cigarette or vaping device.

• California spends little on tobacco control. In 2019, California received an estimated $2.8083 billion in tobacco taxes and settlement payments. In the same year, California allocated only $250.4 million in state funds, and only 8.9 percent of tobacco monies, toward tobacco control programs.

• In 2018, the vaping industry provided more than $2.9 billion in economic output in the Golden Gate State. In the same year, the vapor industry employed more than 6,600 Californians, generating over $346 million in wages alone. California received over $183 million in state taxes attributable to e-cigarettes and vapor products in 2018

KEY POINTS:

• House Bill 249 would increase the excise tax on all tobacco products except cigarettes from 15 percent to 22.5 percent of the manufacturer’s list price.

• House Bill 1407 and Senate Bill 2896 would define e-cigarettes as tobacco products, for the purpose of applying the state’s 15 percent manufacturer’s list price tax to vapor products.

• Senate Bill 2893 would increase the excise tax on combustible cigarettes by $1.00 per pack, from $0.68 to $1.68 per pack.

• Taxes on tobacco products are regressive and disproportionately impact lower income persons who tend to smoke at higher rates. For example, according to the Mississippi 2018 Behavioral Risk Factor Surveillance System (BRFSS), 69.5 percent of adult smokers in Mississippi earned $34,999 or less a year.

• Cigarette and tobacco taxes are also inherently unreliable. Mississippi’s last cigarette tax increase was in 2009, which nearly doubled tax revenue from $84 million in 2009 to $156.6 million in 2010. The tax collected has steadily declined in years since, with the Magnolia State collecting $145 million in 2017, an over $10 million decrease from 2010.

• Mississippi currently dedicate little funding from tobacco settlement payments and taxes on tobacco control programs, including education and prevention.

• In 2019, the Magnolia state received an estimated $284.4 million in tobacco taxes and settlement payments. In the same year, Mississippi allocated only $8.4 million in state monies, or 2 percent of tobacco monies, to tobacco control programs.

• In 2018, tobacco companies spent $126.8 million in tobacco marketing in Mississippi.

• E-cigarettes are significantly less harmful than combustible cigarettes. Indeed, numerous public health groups including Public Health England, the Royal College of Physicians, and the National Academies of Sciences, Engineering and Medicine have noted the reduced harm of vapor products.

• In 2019, the American Cancer Society declared “e-cigarette use is likely to be significantly less harmful for adults than smoking regular cigarettes […] because e-cigarettes do not contain or burn tobacco.”

• As many e-cigarette users are former smokers, taxes on vapor products are also regressive. Indeed, according to the 2018 Mississippi BRFSS, 58 percent of e-cigarette users in Mississippi earned $34,999 or less per year and 18 percent of vapers earned less than $15,000 per year.

• A 2015 policy analysis by State Budget Solutions examined electronic cigarettes’ impact on Medicaid spending. In 2012, Mississippi would have saved $402 million in Medicaid costs if all Medicaid recipients who smoked had switched to e-cigarettes.