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March 6, 2019


By the end of February 2019, more than 200 bills had been introduced in multiple states aimed at regulating, taxing, or prohibiting e-cigarettes.

In response to media campaigns by the U.S. Food and Drug Administration and U.S. Surgeon General, state lawmakers have introduced flavor bans, draconian taxes, and proposals to restrict access to tobacco products to persons 21 years old or older.

Strangely, legislators in Connecticut, Iowa, and Nebraska are proposing to increase the age to purchase e-cigarettes and vaping devices from 18 to 21, but they are not proposing a similar increase to the age required to purchase combustible tobacco cigarettes—even though these products are significantly more harmful. The fact that state lawmakers would restrict access to less harmful cigarette alternatives while allowing access to their more harmful counterparts indicates many lawmakers don’t understand how effective e-cigarettes are as a tobacco harm reduction product.

Since their introduction to the U.S. market in 2007, electronic cigarette devices have helped an estimated three million U.S. adults quit smoking combustible tobacco cigarettes. A 2019 study found e-cigarettes are “twice as effective” as traditional nicotine replacement therapy in helping smokers quit.

Despite being unable to advertise reduced harms, many public health groups have found e-cigarettes to be substantially less harmful than traditional tobacco cigarettes, including Public Health England; Royal College of Physicians; National Academies of Sciences, Engineering, and Medicine; and the American Cancer Society. Even Mitch Zeller, director of the Center for Tobacco Products at the U.S. Food and Drug Administration, has noted that people switching from combustible cigarettes to e-cigarettes “would be good for public health.”

The numerous bills proposed in states across the country were crafted in response to a campaign based on only one year of youth vaping data, which are, at best, questionable. While the data indicate youth vaping increased from 2017 to 2018, the data from both the “2018 National Youth Tobacco Survey” and the “2018 Monitoring the Future Survey” are unclear and should not be used as a basis for public policy decisions. For example, the authors of both studies found an increase in youth who reported vaping more than one time per month, but the data did not distinguish between a person who reporting vaping twice in a single month and those who might have vaped every single day for several months.

The evidence overwhelmingly shows that there is no reason to believe a large proportion of young people use electronic cigarettes then transition to combustible tobacco cigarettes. According to Dr. Michael Siegel, a professor at the Boston University School of Public Health,  a January 2019 study in the Journal of the National Cancer Institute “found no evidence that vaping is a gateway to smoking among youth.” Siegel found the authors of the study “were unable to report a single youth out of the 12,000 in the same who was a cigarette naïve, regular vaper at baseline who progressed to become a smoker at follow-up.”

Siegel also found that while “ever use of e-cigarettes increased the risk of smoking initiation, recent use of e-cigarettes (within the past 30 days) did not increase the risk of smoking.” It is important for lawmakers to understand that this finding is significant, as “the most definitive study to date of the [youth] issue fails to provide any evidence to support that” youth e-cigarette use leads to combustible tobacco cigarette use.

While restricting minors’ access to e-cigarettes is a laudable goal, lawmakers should understand the e-cigarette industry does not want kids to use their products and that they have made numerous efforts to keep young people away from their products. For example, associations such as the Smoke Free Trade Alternatives Trade Association and the Consumers for Smoke-Free Alternatives Association, which represent vape shops and e-cigarette users, respectively, support legislation that restricts youth e-cigarette access.

E-cigarettes are a less harmful alternative to smoking and can save states money by reducing health care costs associated with smoking. They also strengthen economies by providing growing business opportunities.

Rather than regulating tobacco harm reduction products into extinction, lawmakers should promote their use as an alternative to combustible cigarettes.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.

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