​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.

KEY POINTS:

• Recently Public Health England (PHE) published a new evidence update in March 2020, which is the “sixth report in a series of independent reports” and analyzes e-cigarette use among youth and adults, as well as addressing vaping-related lung illnesses.

• According to PHE, “current vaping” among youth in England “has remained reasonably steady with the best recent estimates putting it at 6% of 11 to 15-year-olds in 2018 and 5% of 11 to 18-year-olds in 2019.”

  • Overwhelming most youth in England have used combustible cigarettes prior to using vapor devices with less than once percent “of young people who have never smoked are current vapers.”

  • Similar to the United States, youth in England use vaping products due to “curiosity,” and nearly 60 percent of 11 to 15-year-olds that vaped regularly – more than once a week – “reported be given vaping products, mostly by friends.”

• Among English adults, vapor product use “has remained stable since 2014,” with 5 to 7 percent of the adults in England using vaping devices.

• Further, vaping prevalence among former smokers continues to increase, with 12 to 13 percent of former smokers now being current vapers. \

• Similar to English youth, less than 1 percent of adults “who have never smoked [are] currently vaping.”

• PHE addresses vaping-related lung injuries, noting that in the United States “where there is a very different regulatory system for vaping products […] there was a spate of serious lung diseases and deaths which appeared to peak in late 2019.”

  • PHE remarks that most of these “seem” to be caused by vaping devices containing “tetrahydrocannabinol (THC) oil and vitamin E acetate.”

  • Interestingly, there “has been no similar lung disease outbreak in England.”

• Deeply problematic in PHE’s report is the increased misinformation surrounding the reduced harm of e-cigarettes and vapor products, with PHE remarking that “[p]erceptions of harm from vaping among smokers are increasingly out of line with the evidence” and that the “proportion who though vaping was less harmful than cigarettes declined from 45% in 2014 to 34% in 2019.”

• In 2018, PHE reiterated its findings that e-cigarette use is at least “95% safer” than smoking combustible cigarettes.

KEY POINTS:

• In its landmark 2015 report, E-cigarettes: an evidence update, Public Health England (PHE) concluded “that e-cigarettes are around 95% safer than smoked tobacco and they can help smokers to quit.”

• In March 2018, PHE provided an evidence update to its 2015 report. The 2018 report examines the role of nicotine and its health effects, e-cigarette product use and effectiveness as a cessation tool, the health risks of vapor products and perceptions of harm.

• The harms of nicotine have not been extensively studied, with the agency noting that combustible cigarettes’ addictiveness “may be enhanced by compounds in the smoke other than nicotine.”

• PHE also remarks that although nicotine “has effects on physiological systems that could theoretically lead to health harms,” there have been no increases in health risks among users of snus – a “low nitrosamine form of smokeless tobacco” – or any detrimental effects to fetuses of pregnant women who use nicotine replacement therapy.

• Among adult e-cigarette users in England, less than one percent of users were never smokers, which is similar to adult use of nicotine replacement therapy.

  • The most popular flavors among e-cigarette users were fruit, tobacco, menthol and/or mint.

  • More than 40 percent of e-cigarette users reported purchasing products in “specialist vape shops.”

• PHE notes that e-cigarettes may have played large role in England’s quit smoking success rates, as in the beginning of 2017, “quit success rates were at their highest rates so far observed and for the first time, parity across different socio-economic groups was observed.”

• PHE estimates that between 22,000 and 57,000 adults have quit smoking due to the use of e-cigarettes.

• PHE assesses e-cigarettes health risks by examining several risk factors that have long been associated with combustible cigarette use. Regarding lifetime cancer risks, one study noted that the “cancer potencies of e-cigarettes were largely under 0.5% of the risk of smoking.”

• PHE also examines whether flavors can contribute to adverse health outcomes finding that “there is no clear evidence that specific [flavorings] pose health risks.”

• Further, PHE notes that “[b]iomarkers of exposure assessed to date are consistent with significant reductions in harmful constituents … similar levels to smokers abstaining from smoking or non-smokers were observed."

• PHE concludes that “stating that vaping is at least 95% less harmful than smoking remains a good way to communicate the large difference in relative risk” of electronic cigarettes and vapor products.

• Deeply troublesome in PHE’s evidence update is that more adults in Great Britain – similar to the United States – believe that e-cigarettes are more harmful than combustible cigarettes. PHE attributes this to misperceptions about nicotine’s relative harm.

KEY POINTS:

• A new study in JAMA, analyzed 2,155 patients that had been diagnosed with a vaping-related lung injury.

• In the May, 2020 study, researchers analyzed “360 hospitalized or deceased adolescents (age range, 13-17 years),” 859 “young adults (age range, 18-24 years),” and 936 adults, categorized as being 25 to 49 years old.

  • Of the adolescents, 50.5% and 96.5% relied on informal sources to obtain nicotine and THC-containing vapor products, respectively.

  • Of the young adults, only 19.8% relied on informal sources for nicotine, and 86.9% relied on such sources for THC-containing vaping devices.

  • Of the adults, 24.3% and 75.1% utilized informal sources to obtain nicotine-containing and THC-containing products, respectively.  

• As of January 14, 2020, the Centers for Disease Control and Prevention (CDC) had information available on 2,022 patients that had been hospitalized due to a vaping-related lung injury. Of these, 82 percent reported using THC-containing products and 33 percent of patients reported exclusive use of THC-containing vaping devices.

• A U.S. Food and Drug Administration study found that 86 percent of youths aged “15 to 17 years old obtained cigarettes by asking someone else,” and 89 percent relied on these sources for e-cigarettes. These so-called social sources include siblings, friends, parents, and even strangers.

• Data from 2019 Youth Risk Behavior Surveys (YRBS) indicate youth are obtaining e-cigarettes through the same social sources.

  • In the 2019 Montana YRBS, 10.6 percent of Montana high school students reported “borrowing” e-cigarettes and 6.9 percent reported giving “someone else money to buy them.”

  • According to the 2019 Vermont YRBS, 52 percent of high school students under 18 years of age reported borrowing e-cigarettes and 26 percent reported giving “someone else money to buy them.”

• In 2018, the vapor industry the industry created 87,581 direct-vaping related jobs, including manufacturing, retail, and wholesale jobs, which generated more than $3.2 billion in wages alone. Moreover, the industry has created thousands of secondary jobs in the United States, bringing the industry’s total economic impact in 2018 to $24,457,512,300. In the same year, the industry provided more than $4.9 billion in taxes.

• In 2019, states collected a total of $27.3 billion in monies from tobacco taxes and tobacco settlement payments. In the same year, states spent only $655 million, or 2.4 percent, on tobacco control programs including education and prevention.

KEY POINTS:

• House Concurrent Resolution 2034 would charge all vapor products to a 43 percent wholesale tax – in addition to the state’s sales tax of 5.6 percent. The additional monies from the tax will be deposited into a fund administered by the Arizona Board of Regents to provide college scholarships.

• E-cigarettes are a disruptive technology that deliver nicotine in a manner that is significantly less harmful than combustible cigarettes. Lawmakers should refrain from excise taxes on such products and promote their use. 

• Numerous public health groups have acknowledged the reduce harm of vapor products, including Public Health England, the Royal College of Physicians, and the National Academies of Sciences, Engineering and Medicine. In 2019, the American Cancer Society declared that e-cigarette use to be “significantly less harmful for adults than smoking regular cigarettes […] because e-cigarettes do not contain or burn tobacco.”

• 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 $1.4 billion in Medicaid savings to Arizona in 2012.

• The vapor industry provides economic benefits to the Grand Canyon State. According to the Vapor Technology Association, in 2018, the industry created 2,905 direct vaping-related jobs, including manufacturing, retail, and wholesale jobs in Arizona, which generated $132 million in wages alone. Moreover, the industry has created hundreds of secondary jobs in the Grand Canyon State, bringing the total economic impact in 2018 to $415,136,600. In the same year, Arizona received more than $4 million in state taxes attributable to the vaping industry.

• Arizona allocates very little of existing tobacco monies on such programs. For example, in 2019, received an estimated $429.5 million in monies generated by tobacco taxes and tobacco settlement payments. In the same year, the Grand Canyon State dedicated only $17.3 million in state funding, or 4 percent of tobacco monies, to tobacco control programs, including education and prevention. In 2018, tobacco companies spent $115.6 million on marketing their products in Arizona.

• Unlike traditional excise taxes which are usually taxed by volume, wholesale taxes are ad valorem taxes, meaning the tax imposed is based on the price of the product. There are several problems with applying this tax to vapor products. For example, some e-cigarettes can be used only once, while other devices can be reused multiple times. Under a wholesale tax, single-use vapor products are subject to a greater tax burden.

• Another issue with wholesale taxes on vapor products – and HCR 2034’s language – is they tend to apply to a device’s components and not just the final product, including components that don’t contain nicotine.

KEY POINTS:​

• According to the 2019 Montana Youth Risk Behavior Survey (YRBS), 69.8 percent of Montana high school students reported using an on 0 days in the 30 days prior to the survey.

  • 12.2 percent reported using a vapor product between 1 to 9 days in the 30 days prior

  • 4.0 percent reported vaping on 20 or more days

  • 8.7 percent of Montana high school students reported daily e-cigarette use.

• Of the 54.8 percent of respondents that indicated a reasoning for e-cigarette use, only 7 percent reported flavors. Interestingly, 13.5 percent of respondents cited “friend or family member used them” and 25.9 percent cited “other reason.”

• These findings are similar to other state youth surveys. In an analysis of five states, only 15.6 percent of high school students cited using e-cigarettes because of flavors. A 2019 analysis of the National Youth Tobacco Survey reached similar conclusions, finding only 22.4 percent of middle and high school students said flavors are a reason for e-cigarette use.

• 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.

• American adults rely on flavored products to quit smoking cigarettes and remain smoke-free. Indeed, a 2018 survey of nearly 70,000 American adult vapers “found flavors play a vital role in the use of electronic cigarettes and vaping devices.” Moreover, 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively, “at least some of the time.”

• These findings are significant, as on October 8, 2019, Montana Gov. Steve Bullock “directed the Montana Department of Health and Human Services to implement emergency administrative rules to temporarily prohibit the sale of flavored e-cigarettes.” The ban officially expired in April, but a future flavor ban threat still looms.

• In 2015, Public Health England (PHE) found e-cigarettes to be 95 percent less harmful than combustible cigarettes. In 2018, PHE reiterated this finding, noting that e-cigarette use is “at least 95% less harmful than smoking.” Other public health groups including the Royal College of Physicians, the National Academies of Sciences, Engineering, and Medicine, and the American Cancer Society have acknowledged the reduced harm of electronic cigarettes and vapor products.

• Moreover, the use of e-cigarettes can alleviate state budgets by reducing smoking-related health care costs. 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 $146 million in Medicaid savings to Montana in 2012.

• In 2018, the vapor industry created 313 direct vaping-related jobs, which generated $11 million in wages alone. Moreover, the industry has created hundreds of secondary jobs in Big Sky Country, bringing the total economic impact in 2018 to $67,507,100. In the same year, Montana received more than $2 million in state taxes attributable to the vaping industry.

• Montana spends very little of state funding on programs to help smokers quit and prevent youth access.

• In 2019, Montana received an estimated $108.5 million in tobacco settlement payments and excise taxes. In the same year the state allocated only $5 million, or 4 percent of tobacco monies, in state funds on tobacco control programs, including education and prevention. In 2018, tobacco companies spent $29.5 million on marketing tobacco products in Montana.

KEY POINTS:

• A10418 and companion bill S8330 would increase the state’s excise tax on cigarettes by $1.89 a pack, from $4.35 to $6.24 per pack. New York City imposes an additional local excise tax of $1.50 per pack, with the new legislation, this would increase to $7.74 per pack in NYC.

• Tobacco taxes disproportionately impact lower-income people, who spend a greater share of their income on tobacco products. A Cato Journal article notes that from 2010 to 2011, “smokers earning less than $30,000 per year spent 14.2 percent of their household income on cigarettes, compared to 4.3 percent for smokers earning between $30,000 and $59,999.”

• Cigarette taxes are also inherently unreliable, and while an increased tax on cigarettes and tobacco products might create short-term fiscal increases, these taxes eventually lead to long-term revenue shortfalls.

  • The National Taxpayers Union Foundation found from 2001 to 2011, “revenue projections were met in only 29 of 101 cases where cigarette/tobacco taxes were increased.” 

  • 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.”

• The increased tax will also increase smuggling. NYC is already considered “the cigarette smuggling capital of the nation,” with a black market that cost the city approximately $750 million in 2015. According to the Tax Foundation, New York state “has the highest inbound smuggling activity, with an estimated 55.4 percent of cigarettes consumed in the state deriving from smuggled sources in 2017.”

  • In late January, 2020, a Staten Island resident was convicted of tobacco smuggling, including transporting “almost $40 million worth of tobacco from Pennsylvania to New York.”

• New York spends very little on tobacco prevention efforts. In 2019, the Empire State received an estimated $2.0371 billion in tobacco taxes and tobacco settlement payments, yet in the same year, New York dedicated only $39.3 million, or 1 percent, on tobacco control programs, including education and youth prevention.

• It is estimated that between 1999 and 2019, New York collected $16 billion in tobacco settlement payments and another $23 billion in tobacco taxes and “has spent less than $1 billion on tobacco control” since 1999.

• Further, due to New York sharing the costs of Medicaid with localities, local governments are apportioned a share of tobacco settlement payments with little to no accountability to where those funds are going. Indeed, in Niagara County, $700,000 of tobacco settlement monies “went for a public golf course’s sprinkler system, and $24 million for a county jail and office building.”

• Deeply problematic with the proposed legislation is that is has been introduced after New York lawmakers approved a budget that banned the sale of flavored electronic cigarettes and vapor products.

• In 2018, vape shops contributed more than $1.9 billion in economic activity to the Empire State. Further, the vapor industry created 4,416 direct vaping-related jobs, including manufacturing, retail, and wholesale jobs in New York, which generated $237 million in wages alone. In the same year, New York received more than $99 million in state taxes attributable to the vapor industry.

KEY POINTS:

• House Bill 799 would require sales of flavored e-cigarettes to be sold only at retail establishments “were people under 18 years of age are prohibited.” The legislation does not include menthol, mint, and tobacco-flavored vapor products.

• The legislation would also require that manufacturers of e-liquids and vapor products that reside outside of Louisiana to “apply to the state office of alcohol and tobacco control for a permit to engage in delivery sales of e-liquid and vapor products.”

• The most recent report on youth e-cigarette use in Louisiana is from the 2019 Youth Vaping Report. In 2019, 31.6 percent of Louisiana high school students reported using a vapor product on at least one day in the 30 days prior to the survey.

  • 54.2 percent of Louisiana high school students reported using vapor products because of “curiosity” and not because of flavors.

• According to the 2017 Louisiana Youth Risk Behavior Survey, in 2017, only 1.4 percent Louisiana high school students reported daily e-cigarette use.

• Evidence continues to indicate that youth are not using e-cigarettes because of flavors, but rather due to social reasons and peer pressure. For example, a May 2020 “research letter” published in JAMA surveyed 1,129 youth aged between 14 and 24 years old. Only 4.7 percent of respondents cited “flavors” as a reason for using JUUL, compared to 62.2 percent of respondents that reported using JUUL due to “social reasons.”

• Should legislators truly want to address youth vapor product use, they ought to start investing more of existing tobacco monies in tobacco control efforts.

• In 2019, Louisiana received an estimated $459.6 million in tobacco taxes and settlement payments. In the same year, the Pelican State dedicated only $5.4 million in state funding, or 1 percent, to tobacco control programs, including education and prevention.

• In 2018, tobacco companies spent $189.3 million on marketing their products in Louisiana.

• ​In 2018, the vapor industry created 1,301 direct vaping-related jobs, including manufacturing, retail, and wholesale jobs in Louisiana, which generated $45 million in wages alone. 

• The vapor industry has created hundreds of secondary jobs in the Pelican State, bringing the total economic impact in 2018 to $492,639,500. In the same year, Louisiana received more than $23 million in state taxes attributable to the vaping industry.

KEY POINTS:​

• A4001, and companion bill S2399, would allow “only licensed vapor businesses … to be permitted to sell container e-liquid with a characterizing flavor.”

• The legislation imposes a $5,000 annual licensing fee, as well as the creation and maintaining of “an electronic database that is to track all container e-liquid with a characterizing flavor.”

• The legislation also calls for the “development of a standardized tracking feature to be included on all container e-liquid with a characterizing flavor.

• The legislation also bans certain types of vapor product designs, including devices that are designed to look like a “flash drive or universal serial bus drive.”

• In 2018, the vapor industry’s total economic impact was more than $565 million. In the same year, the vapor industry created 2,119 direct vaping-related jobs, generating over $91 million in wages. Further, in 2018, New Jersey received more than $41 million in state taxes attributable to e-cigarettes and vaping devices.

• New Jersey spends very little of existing tobacco monies on tobacco control programs. For example, in 2019, the Garden State received an estimated $919.6 million in revenue attributable to tobacco taxes and settlement payments. In the same year, the Garden State dedicated only $7.2 million, less than one percent, of state funds to tobacco control programs, including education and youth prevention.

• The most recent state data on youth e-cigarette use is from the 2016 New Jersey Youth Tobacco Survey. In 2016, 21 percent of New Jersey high school students had ever used an e-cigarette and only 9.6 percent reported using vapor products on at least one occasion in the 30 days prior to the survey.

• The $5,000 annual license fee is an exorbitant rate compared to the licensing fees for combustible cigarettes. As of the 2020-2021 fiscal year, in New Jersey, the “annual fee for a [cigarette] retailer or vending machine is $50 (per location).” The “fee for a [cigarette] manufacturer’s representative license is $5.”

• Between January 1, 2018 and October 1, 2019, the FDA performed 7,932 tobacco and vapor retailer inspections with minors attempting to purchase age restricted products.

  • Only 850, or 10 percent, resulted in sales of tobacco and vapor products to minors.

  • Among the sales to minors, only 150 of the 850 sales (17 percent of failed inspections and 1 percent of all inspections) resulted in the sale of an e-cigarette to a minor.

  • Of the failed e-cigarette inspections, only 11 retailers had “vape” or “vapor” in their store name, compared to 17 failed inspections in 7-Eleven retailers in New Jersey.

​KEY POINTS:

• Senate Bill 793 would prohibit the sale of flavored tobacco products and tobacco product flavor enhancers, and includes bans on menthol cigarettes, as well as flavored cigars. 

• There is increasing evidence that youth are not using e-cigarettes due to flavors.

• A 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.

• 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 ban on menthol cigarettes is unlikely to reduce youth combustible use. A 2020 report found that states “with more menthol cigarette consumption relative to all cigarettes have lower rates of child smoking.”

• 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 and this could lead to issues among law enforcement and communities of color.

  • In 2019, the mothers of Trayvon Martin and Eric Garner, a man who died in police custody after being arrested for selling illegal loose cigarettes, implored the New York City council to “pay very close attention to the unintended consequences and what it would mean for communities of color.”

• According to the Vapor Technology Association, 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.

• Flavors made up 78 percent of e-liquid sales in 2016.

​KEY POINTS:

• • Data from the Arkansas 2019 Youth Risk Behavior Survey indicate that a majority of high school students are not using e-cigarette products.

  • 24.3 percent of Arkansas high school students reported using an e-cigarette or vapor product on at least one occasion in the 30 days prior to the survey.

  • 10.1 percent of high school students used e-cigarettes on 20 or more days

  • 8.5 percent reported daily e-cigarette use.

  • Youth combustible cigarette use continues to decline. Only 9.7 percent of students reported cigarette use on at least one occasion in the 30 days prior the survey and only 1.5 percent cited daily cigarette use.

  • The findings are significant as many policymakers have alluded to a so-called epidemic of youth vaping as reasoning to regulate, tax, and in some cases, outright ban tobacco harm reduction products such as e-cigarettes and vapor products.

  • One policy is to ban flavors, other than menthol and tobacco, in e-cigarettes, but flavors are significantly underrepresented in studies on reasons why youth use vapor products.

  • A May 2020 survey found that only 4.7 percent of respondents between the ages of 14 and 24 years old, cited “flavors” as a reason for e-cigarette use, compared to 62.2 percent that cited social reasons.

  • Numerous public health agencies have found e-cigarettes to be significantly less harmful than combustible cigarettes.

  • In 2015, Public Health England (PHE), a leading health agency in the United Kingdom, found e-cigarette use to be “around 95% safer than smoking.” In 2018, PHE reiterated their findings, noting that vaping is “at least 95% less harmful than smoking.”

  • In 2016, the Royal College of Physicians noted that e-cigarettes are “unlikely to exceed 5% of the harm from smoking tobacco.” 

  • In 2018, the National Academies of Sciences, Engineering and Medicine concluded e-cigarette use results in “reduced short-term adverse health outcomes in several organs.”

  • Most recently, in June 2019, the American Cancer Society found “e-cigarette use [is] significantly less harmful for adults than smoking regular cigarettes […] because e-cigarettes do not contain or burn tobacco.”

KEY POINTS:​

• Senate Bill 1085 would require “new tobacco product manufacturers … submit to the Director of the Department of Revenue … a certification that a [PMTA] has been submitted to the FDA.”

  • The Department of Revenue will be required to maintain an online listing of all certifications and is permitted to “designate a fee of not more than $500 per new tobacco product … to cover the costs of processing the certifications and maintaining the directory.”

  • The legislation would also increase the state’s age to purchase tobacco and vapor products from 18 to 21 years old.

• Currently, e-cigarettes and vapor products are regulated by the US Food and Drug Administration (FDA). FDA’s regulations require e-cigarette manufacturers to comply with regulations governing tobacco, including completing a lengthy and expensive study process called the “premarket tobacco application” (PMTA).

• SB 1085 would disproportionately impact small businesses in Missouri.

  • Large vapor manufacturers, such as JUUL, would be subject to a very small fee. For example, JUUL offers two flavors, menthol and tobacco, in two different nicotine strengths. Their license burden would only be $2,000, should the Department of Revenue instate a $500 licensing fee per product.

  • A small manufacturer that sells 20 different flavors, available in three different nicotine strengths, would be subject to a $30,000 licensing fee.

• SB 1085 is a redundant regulatory bill. The federal government already regulates vapor products and it is not necessary for the state to create a new online tobacco product listing catalog, as the FDA already does so.

• The legislation requires new positions to be created within the Department of Revenue, yet there is no specific funding allocated to the program, outside of the proposed $500 licensing fee.

• In 2018, the vapor industry created 2,253 direct vaping-related jobs in the Show-Me State, which generated $62 million in wages alone. In the same year, Missouri received more than $25 million in state taxes attributable to the vapor industry, bringing the total economic impact in 2018 to over $475 million.

• Policymakers should note that many Missouri youth are not using vapor products. For example, in 2019, 79.3 percent of Missouri youth reported not using a vapor product.

• Missouri spends very little on helping smokers quit.

• Missouri received an estimated $258.9 million in revenue from tobacco settlement payments and tobacco taxes and dedicated only $48,500 in state funding, less than one percent of tobacco monies, on tobacco control programs, including education and prevention.

• Missouri spends over $3 billion annually in health care costs related to smoking.

KEY POINTS:

• Smokers and vapers are largely underrepresented among COVID-19 cases with data available on underlying conditions.

• In an April 3, 2020 Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention (CDC) published data on 5,143 COVID-19 patients.

  • Only 96, or 1.3 percent, were classified as current smokers.

  • Only 165 patients, or 2.3 percent, were classified as former smokers.

  • Only 9.2 percent of patients were diagnosed with chronic lung disease.

• CDC is now omitting smoking status in recent reports, but chronic lung illnesses remain underrepresented.

• As of April 25, 2020, CDC reported 2,028 COVID-19 hospitalization cases with data on underlying conditions. Of these, only 12.7 percent of adults had asthma, and only 20.9 percent of adults had been diagnosed with chronic lung disease.

• The findings by the CDC are similar to state health departments.

  • As of April 28, Georgia Health has identified underlying conditions in 182 of the state’s 241 deaths. Of the 182 patients with data, only 23 percent of patients were diagnosed with chronic lung disease.

  • As of April 27, the Louisiana Department of Health has reported 1,950 COVID-19 deaths. Of these, only 3.62 percent of patients were diagnosed with asthma. Further, only 11.65 percent of patients had underlying pulmonary issues

  • In Mississippi, smoking-related lung illnesses are largely underrepresented as well. In a racial breakdown of deceased COVID-19 patients in the state, as of May 1, 2020, 43 percent of African American and 42 percent of white patients were diagnosed with lung disease as an underlying condition.

• Further, in states with smoking status listed, smokers are largely underrepresented.

  • In the Oregon Health Authority’s (OHA) April 28, 2020 COVID-19 Weekly Report, as of “April 26, there have been 2,345 cases of COVID-19 reported to” OHA. OHA was able to obtain comorbidity data for 73 of the deceased patients.  

    • Of the 73, only one was a current smoker, representing 1.4 percent of COVID-19 deaths with data available. 18 of the deceased patients were former smokers, or 24.7 percent of deceased patients.

  • As of April 20, 2020, the West Virginia Department of Health and Human Resources (WVHHS) was providing information on smoking status in COVID-19 cases. In its April 20 report WVHHS noted that only 8 percent and 14 percent of COVID-19 cases were current and former smokers, respectively. Further, only 7 percent of patients had been diagnosed with COPD.

• Researchers in other countries are looking into the effects of nicotine on COVID-19.

  • On April 21, French researchers published a study examining the nicotine acetylcholine receptor and its “key role in the pathophysiology of Covid-19 infection.”

  • The researchers hypothesize that “a substance in tobacco – possible nicotine – may be stopping patients from catching Covid-10.”

  • In light of these findings, the French government limited sales of nicotine replacement therapy in pharmacies and halted online sales.

• Unfortunately, despite their reduced harm, numerous localities and states have attempted to eliminate e-cigarettes.

  • In November, Massachusetts banned the sale of flavored e-cigarette products, which took effect immediately.

  • In January, New Jersey banned the sale of flavored e-cigarettes which took effect on April 20, 2020.

  • In March, Rhode Island permanently banned the sale of flavored vapor products.

  • In April, New York banned the sale of flavors in vapor products except tobacco flavor.

KEY POINTS:

• Senate Bill 810 would require permits for persons or corporations, enact a retail fee for the sale of vapor products, and would prohibit persons “from selling, delivering, bartering, furnishing, or giving flavored liquid nicotine products to any other person.”

• Smoking-related health issues costs Florida $8.64 billion in annual health care costs, including $1.51 billion in Medicaid costs. According to the Florida Health, 28,600 Floridians die annually from smoking-related illnesses.

• Vapor products have helped an estimated three million smokers quit combustible cigarettes and are twice as effective in helping smokers quit.

• According to numerous public health organizations, vapor products are significantly less harmful than smoking, with Public Health England noting that e-cigarettes are "95% safer than smoking."

• E-cigarettes and vapor products have also been an economic boon to the Sunshine State.  

  • In 2018, the vapor industry’s total economic impact to Florida was over $1.4 billion, including more than $82 million in state taxes.

  • In the same year, the industry created 5,353 direct vaping-related jobs, which generated $198 million in wages.

• There is no evidence flavor bans will reduce youth e-cigarette use.

  • Santa Clara County, California banned flavored tobacco products to age restricted stores in 2014.

  • Youth use of e-cigarettes increased after the ban went into effect. For example, in 2015-16, 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In 2017-18, this increased to 10.7 percent.

• There is no evidence that youth use e-cigarettes products solely due to flavors. In 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.

• Florida dedicates very little in existing tobacco moneys on programs that can help Floridians quit.

  • In 2019, Florida received an estimated $1.5347 billion in revenue generated by tobacco settlement payments and tobacco taxes.

  • In the same year, the Sunshine State dedicated only $70.4 million of state funds, or less than one percent of tobacco moneys, on tobacco control and prevention programs.

KEY POINTS:

• Senate Bill 2228 would ban the sale of flavored e-cigarettes, as well ban any sale of any tobacco product “other than through retail sales via a direct, in-person exchange.”

• Senate Bill 2538 would ban the sale of all flavored tobacco products, including cigars, cigarettes, and vapor products.

• House Bill 2457 would also ban the sale of flavored tobacco products and require the Department of Education “to establish a safe harbor program” for minors to dispose of e-cigarettes.

• Senate Bill 2903 would ban the sale of all flavored tobacco products.

• The most recent data on Hawaiian youth tobacco use is from the 2017 Youth Risk Behavior Survey. In 2017, only 3.5 percent of Hawaiian high school students reported using e-cigarettes daily. Further, only 1.2 percent reported smoking combustible cigarettes daily, and only 8.9 percent reported smoking a cigarette on at least one day in the 30 days prior to the survey.

• In analyses by The Heartland Institute, less than 10 percent of youth are using e-cigarettes daily as indicated in Kentucky, Montana, Oregon, and Vermont.

• Youth are not using vapor products because of flavors, but rather because of peer pressure and because their friends and/or family members have used these products. In an analysis of five states, only 15.6 percent of high school students cited using e-cigarettes because of flavors.

• There is no data indicating that menthol cigarettes lead to an increase in youth tobacco use. Analysts at the Reason Foundation examined youth tobacco rates and menthol cigarette sales. The authors of the 2020 report found that states “with more menthol cigarette consumption relative to all cigarettes have lower rates of child smoking.”

• In 2018, the vapor industry provided over $100 million in economic output in Hawaii, with 451 direct vaping-related jobs that generated over $18 million in wages. Further, Hawaii collected over $9 million in state taxes attributable to vaping.

• In 2019, Hawaii received an estimated $160.3 million in revenue attributed to tobacco taxes and settlement payments. In the same year, the Aloha state dedicated only $4.5 million on tobacco control programs, including education and prevention. To put it in a greater perspective, in 2018, tobacco companies spent $26.1 million marketing tobacco products in Hawaii.

KEY POINTS:

• The most recent data on Colorado youth e-cigarette use is from the 2017 Healthy Kids Colorado Survey. In 2017, 27 percent of Colorado high school students reported using vapor products on at least one day in the 30 days prior to the survey. There is no data on frequent and/or daily use.

• In analyses by The Heartland Institute, less than 10 percent of youth are using e-cigarettes daily as indicated in Kentucky, Montana, Oregon, and Vermont.

• Youth are not using vapor products because of flavors, but rather because of peer pressure and because their friends and/or family members have used these products. The Heartland Institute recently analyzed several statewide youth vaping surveys to understand the role of flavors in youth e-cigarette use. In an analysis of five states, only 15.6 percent of high school students cited using e-cigarettes because of flavors.

• There is no data indicating that menthol cigarettes lead to an increase in youth tobacco use. Analysts at the Reason Foundation examined youth tobacco rates and menthol cigarette sales. The authors of the 2020 report found that states “with more menthol cigarette consumption relative to all cigarettes have lower rates of child smoking.”

• In 2018, the vaping industry created 2,821 direct vaping-related jobs in the Centennial State, generating $60 million in wages alone. The industry provided more than $412 million in economic activity in 2018, including $25 million in state taxes.

• In 2019, Colorado received an estimated $286.3 million in tobacco monies generated by taxes and tobacco settlement payments. In the same year, Colorado dedicated $23.6 million, or 8 percent of what was received in tobacco monies, on tobacco control programs, including education and prevention. To put it in greater perspective, in 2018, tobacco companies spent $136 million in marketing tobacco products in Colorado, or five times what the state spent on tobacco control and education programs.

KEY POINTS:

• HF 3032 would ban the sale of “any tobacco, tobacco-related device, electronic nicotine delivery device … that imparts a taste or smell, other than the taste or smell of tobacco.”

• Banned flavors include, but are not limited to, “chocolate, cocoa, fruit, honey, menthol, mint, vanilla, wintergreen, or any candy, dessert, alcoholic beverage, herb, or spice.” Under the bill, flavored cigars and cigarettes would be banned as well.

• The sponsor of the legislation points to a so-called “public health epidemic of injury in addition to addiction,” as the reasoning for the ban, it is imperative that lawmakers understand recent vaping-related lung injuries have been overwhelmingly linked to the use of vapor products containing tetrahydrocannabinol (THC), a fact that The Heartland Institute first pointed out in August 2019.

• As of December 30, 2019, the Minnesota Department of Health (MDH) has reported 141 confirmed or probable cases of vaping-associated lung illnesses, including three deaths.

  • The state’s first death was reported September 6, 2019, with the patient over the age of 65 years-old and had vaped “illicit THC products.”

  • MDH reported the additional two deaths on October 16, 2019, noting both patients were over the age of 50 and one had vaped “illegal THC,” and the other was “believed to have vaped unknown products in addition to nicotine.”

  • These illegal vaping products are rampant in the Gopher State. In September 2019, Minnesota police seized more than 75,000 illicit THC cartridges, worth an estimated $4 million. The suspect apparently sold the products using Snapchat.

• According to the 2019 Minnesota Student Survey, in 2019, 83.7 percent of 9th graders and 73.6 percent of 11th graders reported not using a vaping device in the 30 days prior to the survey

• A ban on menthol cigarettes is unlikely to reduce youth combustible use. Analysts at the Reason Foundation examined youth tobacco rates and menthol cigarette sales. The authors of the 2020 report found that states “with more menthol cigarette consumption relative to all cigarettes have lower rates of child smoking.”

• According to the Vapor Technology Association, in 2018, the industry created 1,152 direct vaping-related jobs in Minnesota, which generated $44 million in wages alone.

  • Moreover, the industry has created hundreds of secondary jobs in the Gopher State, bringing the total economic impact in 2018 to $336,366,200.

  • In the same year, Minnesota received more than $20 million in state taxes attributable to the vaping industry.

• In 2019, Minnesota received an estimated $703.6 million in tobacco settlement payments and taxes. In the same year, only $17.3 million in state funds, and 2 percent of what was received in tobacco monies, was dedicated to tobacco control. In 2018, in 2018, tobacco companies spent $110 million in marketing tobacco products in Minnesota, or over six times what the state spent on tobacco control programs.

KEY POINTS:

• House Bill 69 defines “enhanced vapor products” as vaping devices that contain flavorings and/or have a nicotine content of “four percent” or greater.

  • Enhanced vapor products include reusable and disposable products as well as any type of device including open tank mod-styles and cartridge-based systems.

  • Retailers of enhanced vapor products would be required to maintain annual licenses.

  • Moreover, these products would be sold exclusively in age-restricted stores, and all sales must be in-person, essentially banning all other sales, including online, catalog, and phone sales. 

• House Bill 32 would apply the tobacco tax to vapor products and increase the excise tax from 15 percent to 27.5 percent of the wholesale price.

  • The legislation also eliminates previous legislation that recognized tobacco harm reduction.

• According to the 2019 Kentucky High School Youth Risk Behavior Survey, Kentucky does not have an epidemic of youth using e-cigarettes. In 2019, 73.9 percent of Kentucky high school students reported not using a vapor product in the 30 days prior to the survey. Only 8.7 percent reported daily e-cigarette use.

• The Heartland Institute recently analyzed several statewide youth vaping surveys to understand the role of flavors in youth e-cigarette use. In an analysis of five states, only 15.6 percent of high school students cited using e-cigarettes because of flavors. Overwhelmingly, youth are using vapor products because a friend and/or family member had used them.

• Rather than taxing tobacco harm reduction products, lawmakers should note their use reduces current costs.

  • ​For example, one analysis estimated Medicaid savings could have amounted to $48 billion in 2012 if e-cigarettes had been adopted in place of combustible cigarettes by all Medicaid recipients who currently consume cigarettes.

  • A 2017 study found Medicaid savings “will be approximately $2.8 billion per 1 percent of enrollees,” over the next 25 years if 1 percent of Medicaid recipients switched from combustible cigarettes to e-cigarettes.

• Kentucky lawmakers should rely on existing tobacco funding for programs that can reduce youth e-cigarette use and help adults quit smoking.

  • In 2019, Kentucky received an estimated $507.3 million in tobacco taxes and tobacco settlement payments.

  • In the same year, the commonwealth spent only $3.8 million, or 0.07 percent, on tobacco control programs, including education and prevention.

KEY POINTS:

• More than 18,000 Vermont high school students participated in the biannual survey questionnaire known as the 2019 Youth Risk Behavior Survey (YRBS).

• According to the results, in 2019, 50 percent of Vermont high school students reported ever using an electronic cigarette or vapor product.

  • 26 percent reported having used an e-cigarette in the past 30 days.

  • Only 8 percent reported using a vapor product every day in the 30 days prior to the survey.

• 80 percent of Vermont high school students reported using a “JUUL/rechargeable pod” device, while only 8 percent reported using a larger, mod device commonly sold in vape shops

• 10 percent of current e-cigarette users 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

• 52 percent of Vermont high schoolers under the age of 18 reported using a vapor product that they borrowed and/or was given to them. Only 3 percent of students under age 18 reported buying e-cigarettes online.

• Flavors are an essential component in tobacco harm reduction.

  •  In 2015, an online survey of more than 27,000 American adult vapers found that 72 percent of respondents “credit[ed] interesting flavors with helping them quit.” 

  • A 2018 survey of nearly 70,000 American adult vapers “found flavors play a vital role in the use of electronic cigarettes and vaping devices.” 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively, “at least some of the time.”

• On January 2, 2020, FDA issued final guidance that bans the sales of “flavored, cartridge-based [e-cigarette] products,” beginning February 6, 2020. The ban should help reduce Vermont youth e-cigarette use, as in 2019, 80 percent of current e-cigarette users cited using such products.

• In 2018, the vaping industry created 159 direct vaping-related jobs, which generated $5.4 million in wages alone, and created a total economic impact in 2018 of more than $34 million, including $7 million in state taxes

• In 2019, 2019, Vermont received an estimated $99.8 million in tobacco taxes and tobacco settlement payments, yet allocated only $3.8 million, or 3 percent, on funding tobacco control programs.

KEY POINTS:

• Senate Bills 1559 and 1557 would both ban the sales of vaping products that have “been manufactured to impart a characterizing flavor.”

• Numerous public health organizations, including Public Health England (PHE), Royal College of Physicians, National Academies of Sciences, Engineering, and Medicine, American Cancer Society, and U.S. Food and Drug Administration (FDA)—have acknowledged there is a reduced harm associated with e-cigarettes and vaping devices, compared to traditional tobacco products.

• A 2019 study published in The New England Journal of Medicine noted that e-cigarettes and vaping devices are “twice as effective as nicotine replacement therapy at helping smokers quit.”

• A 2018 survey of nearly 70,000 American adult vapers “found flavors play a vital role in the use of electronic cigarettes and vaping devices.” Further, 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively, “at least some of the time.”

• In 2019, only 4.4 percent of Oregon 11th graders reported daily e-cigarette use. Notably, 78.6 percent reported not using a vapor product in the 30 days prior to the survey.

• The Heartland Institute recently analyzed several statewide youth vaping surveys to understand the role of flavors in youth e-cigarette use. In an analysis of five states, only 15.6 percent of high school students cited using e-cigarettes because of flavors. Overwhelmingly, youth are using vapor products because a friend and/or family member had used them.

• Lawmakers should also refrain from prohibitionist policies in order to examine the effects of the federal flavor ban. On January 2, 2020, FDA issued final guidance that bans the sales of “flavored, cartridge-based [e-cigarette] products,” beginning February 6, 2020. The ban will stay in effect until the manufacturers are issued an approved premarket tobacco product application (PMTA).

• In 2018, the industry created 963 direct vaping-related jobs in Oregon, which generated $28 million in wages alone.

• The total economic impact to Oregon was more than $215 million in 2018, including $9 million in state taxes.

• Oregon dedicates little funding to help smokers quit. In 2019, Oregon received an estimated $338.8 million in tobacco taxes and settlement payments, yet in the same year only dedicated $10 million, or 2 percent, on funding tobacco control programs, including education and prevention.

KEY POINTS:

• Overwhelmingly, youth are using vapor products because friends and/or family members are using the products. In Heartland’s analysis of available youth surveys in five states, only 15.6 percent of high school students cited using e-cigarettes because of flavors.

• Existing evidence indicates that flavor bans have not reduced youth e-cigarette use in several localities that track this data.  

• Adults rely on flavors in tobacco harm reduction products. In a 2018 survey of nearly 70,000 American adult e-cigarette users, 83.2 percent and 72.3 percent reported vaping fruit and dessert flavors.

• The vaping industry provided more than $24 billion in economic activity in 2018, including 87,581 direct vaping-related jobs and provided $4.9 billion in taxes. Flavors made up 78 percent of e-liquid sales in 2016.