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Research & Commentary: Rhode Island’s Flavor Ban Unlikely to Impact Vaping Hospitalizations as More States Link Illnesses to THC Products

October 7, 2019

Rhode Island's temporary 120-day ban on flavored e-cigarettes will shut down small businesses and restrict adult access to tobacco harm reduction products.

On October 4, 2019, the Rhode Island Department of Health issued “emergency health regulations banning the sale of flavored” electronic cigarettes and vaping devices. The ban on flavored e-cigarette products will be in effect for 120 days, “and can be extended for an additional 60 days.”

Prior to the ban’s implementation, Rhode Island Gov. Gina Raimondo issued an executive order declaring a “health epidemic of youth e-cigarette use.” The rule also comes in the wake of a recent report by the Centers for Disease Control and Prevention (CDC) that there have been 1,080 “lung injury cases associated with e-cigarette use,” and 18 deaths in 15 states.

Although addressing youth e-cigarette use is  laudable, flavor bans do not actually reduce youth use of such products. Further, banning flavors is likely to create a thriving black market. Even worse, such regulations could lead to more hospitalizations. Several states and the CDC have already linked the vast majority of vaping-hospitalizations to the use of unregulated, illicit vaping products containing tetrahydrocannabinol (THC). In other words, banning flavors will have zero impact on the true cause of the hospitalizations and will likely lead to more cases.

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 had 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.

Despite fearmongering headlines, the vast majority of e-cigarette products available in brick-and-mortar and convenience stores are regulated. Since 2012, the U.S. Food and Drug Administration (FDA) has had the authority to regulate such products. In 2016, FDA issued deeming regulations that extended the agency’s authority over e-cigarettes and vaping devices. Since 2016, all e-cigarette products must complete a lengthy and expensive process known as a “premarket tobacco product application.” Additionally, FDA required all e-cigarette products be registered with the agency by December 31, 2016.

It should be noted that these regulated devices have been on the market for years. Further, no single product has been identified as causing the recent spate of vaping-related hospitalizations. In fact, many states and the CDC have linked a majority, if not all, of such hospitalizations to the use of products containing THC.

A CDC Morbidity and Mortality Weekly Report obtained information for 514 of 805 possible vaping-related hospitalizations. Of the 514 patients, 395, or 77 percent, “reported using THC-containing products.” Furthermore, 210 patients, 41 percent, reported “using both THC-containing and nicotine-containing products.” Only 16 percent, or 82 patients, “reported exclusive use of nicotine-containing products.” The CDC is still unable to identify the “specific chemical exposure(s) causing this outbreak.”

The CDC findings are similar to other conclusions by state health departments. Oregon’s two vaping-related deaths have been attributed to THC products, as announced on September 3 and September 26. The Minnesota Department of Health reported an individual died from a “lung injury [that] was associated with vaping illicit THC products.”

The Connecticut Department of Health “interviewed 9 of [their state’s] 13 patients with vaping-related injury.” All nine patients reported the use of THC products. The Texas Department of State Health Services recently identified 75 potential vaping-related hospitalizations, with “87% of cases interviewed” reporting using THC products. Of the 23 vaping-related hospitalizations in Iowa, 18 “have reported the use of THC.”

Rather than restricting adult access to tobacco harm reduction products that are 95 percent safer than combustible cigarettes, policymakers should utilize existing tobacco moneys on programs to reduce youth e-cigarette use. In 2019, Rhode Island received an estimated $195 million in tobacco settlement payments and taxes. In the same year, the Ocean State spent only $390,926, or 0.002 percent, on tobacco control programs including education and prevention efforts.

It is disingenuous that policymakers would enforce unilateral decisions that will shut down small businesses and restrict adult access to tobacco harm reduction products. Moreover, as more data indicate that recent hospitalizations are due to illicit products, flavor bans are likely to increase hospitalizations as flavored e-cigarette products move to black markets. Rather than imposing bans on e-cigarettes, policymakers should reallocate tobacco moneys on programs to reduce youth usage.

The following documents provide more information on e-cigarettes and tobacco harm reduction.

Research & Commentary: Flavor Bans Do Not Reduce Youth E-Cigarette Use
https://www.heartland.org/publications-resources/publications/research--commentary-flavor-bans-do-not-reduce-youth-e-cigarette-use
In this Research & Commentary, State Government Relations Manager Lindsey Stroud examines the California Youth Tobacco Survey results from 2017-18, finding youth vaping has increased in several California localities that have restricted access to flavored tobacco product. Stroud finds youth vaping has increased in both Santa Clara and Contra Costa counties. Stroud also notes that banning flavored e-cigarettes is likely to reduce the number of adult smokers switching from combustible cigarettes to tobacco harm reduction devices, and could lead former smokers back to cigarettes.

Tobacco Harm Reduction 101: A Guidebook for Policymakers
https://www.heartland.org/publications-resources/publications/latest-heartland-policy-booklet-addresses-vaping-myths
This booklet from The Heartland Institute aims to inform key stakeholders on the much-needed information on the benefits of electronic cigarettes and vaping devices. Tobacco Harm Reduction 101details the history of e-cigarettes, including regulatory actions on these products. The booklet also explains the role of nicotine, addresses tax policy and debunks many of the myths associated with e-cigarettes, including assertions about “popcorn lung,” formaldehyde, and the so-called youth vaping epidemic.

Podcast Series: Voices of Vapers
https://www.heartland.org/multimedia/podcasts?fromDate=&toDate=&q=voices+of+vapers
In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
https://www.heartland.org/publications-resources/publications/vaping-e-cigarettes-and-public-policy-toward-alternatives-to-smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Policy Tip Sheet: Vaping Hospitalizations Likely Linked to Black Markets
https://www.heartland.org/publications-resources/publications/policy-tip-sheet-vaping-hospitalizations-likely-linked-to-black-markets
In this Policy Tip Sheet, State Government Relations Manager Lindsey Stroud examines recent headlines, finding vaping-related hospitalizations are likely linked to illegal black market vaping products. Stroud examines reports from January 2019 which found youth were being hospitalized due to marijuana vaping products. Further, in 2018, the U.S. Army warned of the dangers of vaping synthetic marijuana after more than 90 military personnel were hospitalized and two died after vaping such devices. Further, none of the reports on the recent hospitalizations have been able to identify a single product that would have caused adverse health effects.

Research & Commentary: Centers for Disease Control and Prevention Link Majority of Vaping-Related Hospitalizations to THC Product
https://www.heartland.org/publications-resources/publications/research--commentary-centers-for-disease-control-and-prevention-link-majority-of-vaping-related-hospitalizations-to-thc-products
In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report which found nearly 77 percent of vaping-related hospitalizations are due to the use of tetrahydrocannabinol products. These findings are similar to what have been reported in other states, including Connecticut, Oregon, Texas, and Utah.

Research & Commentary: Largest Vaping Survey Finds Flavors Play Important Role in Tobacco Harm Reduction
https://www.heartland.org/publications-resources/publications/research--commentary-largest-vaping-survey-finds-flavors-play-important-role-in-tobacco-harm-reduction
In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines a survey of nearly 70,000 adult vapers in the United States. The survey was completed in response to the U.S. Food and Drug Administration’s recent Advanced Notice of Proposed Rulemaking seeking comment on the role of flavors in tobacco products. The authors found nearly 95 percent of survey respondents were at one time smokers and the majority reported using flavors at the point of e-cigarette initiation. Stroud compares this to other surveys. She concludes, “eliminating flavors will force [vapers] to vape only tobacco-flavored e-cigarettes, which would likely cause them to return to combustible cigarettes.” Stroud also found research has found e-cigarettes are a key tobacco harm reduction product and could help alleviate state budgets by mitigating health care costs.

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. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Heartland’s government relations department, at governmentrelations@heartland.org or 312/377-4000.