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October 10, 2019

On September 27, 2019, Washington Gov. Jay Inslee issued an executive order requesting the State Board of Health to use its emergency rulemaking authority to impose a ban on all flavored vapor products, including flavored [tetrahydrocannabinol] THC vapor products.” On October 9, 2019, the Washington State Department of Health passed an emergency rule banning the sale of flavored e-cigarettes and vaping devices. The rule takes effect October 10, 2019 “and lasts for 120 days.”

Although reducing youth use of vaping devices is laudable, flavor bans are ineffective measures to do so and eliminate tobacco harm reduction options for adults. Further, many recent vaping hospitalizations are being linked to illegal and unregulated vaping devices containing THC and other unknown chemicals.

Flavor bans have had little effect on youth vaping rates. The Heartland Institute analyzed results from the 2017-18 California Youth Tobacco Survey (CYTS) and found that despite flavor restrictions in some localities, youth use of e-cigarettes in those areas increased after the bans went into place.

Santa Clara County, California, banned flavored tobacco product sales to age-restricted stores in 2014. Despite this, youth e-cigarette use increased while the ban was in effect. For example, in the 2015-16 CYTS, 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.


Further, the role of flavors is essential in helping adult smokers quit and maintain abstention from combustible cigarettes. In 2016, the Consumer Advocates for Smoke-Free Alternatives Association surveyed more than 27,000 American adult vapers. According to the results, 72 percent of survey respondents “credited tasty flavors with helping them give up tobacco.” A 2018 survey of nearly 70,000 American adult vapers found flavors play a vital role in the use of e-cigarettes. Indeed, 83.2 and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively, “at least some of the time.”

Moreover, a ban on flavored e-cigarettes will likely lead smokers back to much more harmful tobacco cigarettes. A 2017 study found that banning flavors in e-cigarettes “would result in increased choice of combustible cigarettes,” with the authors expecting e-cigarette use to decline by approximately 10 percent if flavors are banned.

Despite lawmakers’ intentions, banning regulated products is unlikely to reduce vaping-related hospitalizations. In a September 2019 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC), the agency identified 805 possible cases of vaping-related lung injury and was able to gather data on 514 patients. Of these 514 patients that self-reported, 395, or about 77 percent, “reported using THC-containing products.” An October 3 update from CDC identified more vaping-related hospitalizations, bringing the total to “1,080 confirmed and probable lung injury cases associated with e-cigarette product use.” Of these, CDC was able to gather information on 578 patients. Of the 578 patients, 78 percent “reported using THC-containing products.”

CDC’s recent conclusions are similar to findings in many states. Connecticut, Minnesota, Oregon, Texas, Utah, and Wisconsin have attributed THC use to vaping-related hospitalizations.

Since 2007, electronic cigarettes and vaping devices have been available on the U.S. market. Until recently, these products were not linked to any significant adverse health effects. In fact, e-cigarettes have been responsible in helping an estimated three million American adults quit smoking. Further, a January 2019 study found the use of e-cigarettes to be twice as effective as nicotine replacement therapy in helping smokers quit.

Numerous public health groups—including Public Health England and the National Academies of Sciences, Engineering, and Medicine—have found using e-cigarettes to be significantly less harmful than combustible cigarettes. The Royal College of Physicians, which is the same public health body the United States relied on for the 1964 surgeon general’s report on smoking, noted that the “long-term risks associated with smoking [e-cigarettes] … are unlikely to exceed 5% of those associated with smoked tobacco products.” Further, the American Cancer Society noted in June 2019 that “e-cigarette use [is] significantly less harmful for adults than smoking regular cigarettes … because e-cigarettes do not contain or burn tobacco.”  

Moreover, Inslee is worried about youth e-cigarette use, yet the Evergreen State dedicates very little funding on programs that could prevent such use. For example, Washington received an estimated $552.6 million in tobacco settlement payments and taxes in 2019, yet the state directed only $1.5 million (0.002 percent) of state funding on tobacco control programs, including education and prevention during the same period.

Rather than limit adult access to tobacco harm reduction products, Washington policymakers should address the real issue behind recent vaping-related hospitalizations: use of illicit THC products, which have been overwhelmingly linked to recent ailments, according to CDC and numerous state health departments. Further, if Evergreen State lawmakers truly want to address the issue of youth vaping, they should dedicate more than 0.002 percent on education programs. In conclusion, it is beyond disingenuous for lawmakers to rely on smokers for programs other than tobacco control while eliminating options that have proven extremely useful in helping them quit deadly 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.

Centers for Disease Control and Prevention Link Majority of Vaping-Related Hospitalizations to THC: Welcome
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