Results from the 2019 Montana Youth Risk Behavior Survey (YRBS) find that a majority of Montana high school students are not using electronic cigarettes and vaping devices. The findings come after Gov. Bullock attempted to ban the sale of flavored vapor products in late 2019.

​

According to the YRBS, in 2019, 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, and only 8.7 percent of Montana high school students reported daily e-cigarette use.

​

Further, Montana youth are not using vapor products because of availability of “flavors such as mint, candy, fruit, or chocolate.” 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, compared to 55.3 percent citing curiosity and 30.8 percent citing using an e-cigarette because a “friend or family member used them.”

​

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.

​

Although youth are not using e-cigarettes because of flavors, 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.” Although the governor was responding to vaping-related lung hospitalizations – which were overwhelmingly linked to black market products containing tetrahydrocannabinol (THC) – other policymakers cited a “youth vaping epidemic,” as a reason for the temporary ban. The ban officially expired in April, but a future flavor ban threat still looms.

​

Despite fearmongering, electronic cigarettes and vapor products are a tobacco harm reduction tool that provides nicotine in a manner that is significantly less harmful than combustible cigarettes. Numerous public health groups have acknowledged their reduced harm.

​

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. Indeed, 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 $146 million in Medicaid savings to Montana in 2012.

​

Further, the vapor industry has provided economic benefits to Big Sky Country. Indeed, in 2018, the vapor industry created 313 direct vaping-related jobs, including manufacturing, retail, and wholesale jobs in Montana, 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.

​

Deeply problematic is lawmakers’ intent on restricting adult access to tobacco harm reduction products while dedicated very little of state funding on programs to help smokers quit and prevent youth access. For example, 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.

​

It is important for Montana policymakers to understand that flavors are not the main driver of youth e-cigarette use and are integral for e-cigarettes’ usefulness in helping adult smokers quit combustible cigarettes. Moreover, a majority of Montana high school students are not using e-cigarettes. Rather than restricting adult access, lawmakers should divert additional state funding on education and prevention programs.

​

Nothing in this analysis is intended to is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101. For more information on vapor products in Big Sky Country, please visit Tobacco Harm Reduction 101’s Montana page at https://www.thr101.org/montana.