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Research & Commentary: Treating E-Cigs as Traditional Cigarettes Could Lead to Misguided Research and Policy

October 22, 2018

In this Research & Commentary, Lindsey Stroud examines a report urging research to distinguish the differences between combustible cigarettes and electronic cigarettes and vaping devices.

A recent report by Nicotine & Tobacco Research urges lawmakers not to treat electronic cigarettes and vaping devices the same as combustible cigarettes, because the more research measures “e-cigarettes as equivalent to cigarettes, the more the likely research may err in conclusions about these unique devices.”

Lead author Matthew Olonoff, a Ph.D. student at Northwestern University’s Feinberg School of Medicine, remarked that before “making policy changes, such as controlling nicotine or flavor options in e-cigarettes, [there is a] need to better understand what role these unique characteristics have.”

The authors used articles and studies to compare the differences between combustible cigarettes and vaping devices and noted key differences between the two, as well as differences between electronic cigarette devices. These differences include the variety of nicotine levels in electronic cigarettes, vaping versus combustion, variability in nicotine dosing, the role of marketing and technology in attracting users to e-cigarettes, and the ability to use vaping devices in places where combustible cigarettes are banned.

Increasingly, research indicates that the smoke in cigarettes causes the most harm, and tobacco harm reduction products, including e-cigarettes as well as smokeless tobacco, have proven to effectively deliver nicotine in a manner much less harmful than combustible cigarettes.

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. PHE even found the use of e-cigarettes to be an estimated “95% safer than smoking.”

E-cigarettes are facing increased scrutiny from FDA, which is examining nicotine levels and the use of flavors in e-cigarette products. States and localities have also imposed bans and restrictions on e-cigarettes, which could lead to unintended consequences and limit the potential health benefits they provide.

Regulators are placing the blame for the recent uptick in youth vaping on the selection of “desirable” flavors, although very little published data substantiates this supposed correlation. Youth combustible cigarette smoking has been on a steady decline, and is now at an all-time low. Youth vaping rates dropped significantly in 2016 and remained flat in 2017, according to the Centers for Disease Control and Prevention.

More importantly, flavors have played an integral role for adult e-cigarette users who have used the devices to quit smoking combustible tobacco cigarettes. A survey of nearly 70,000 adult vapers in the United States found that many used flavors at the start of electronic cigarette initiation, and only 20 percent of respondents reported “using tobacco flavors” at the point of initiation. There is significant concern that if flavors are banned in e-cigarettes and vaping devices, many smokers will return to or begin smoking combustible tobacco cigarettes.

Additionally, researchers have analyzed the public health cost savings these products can provide. For example, an analysis of the potential benefits of 1 percent of Medicaid recipients switching from tobacco products to e-cigarettes could result in savings of “approximately $2.8 billion” over the next 25 years, and $2.8 billion more could be saved for every additional 1 percent of Medicaid enrollees who make the switch.

As the authors of the Nicotine & Tobacco Research report note, early regulations and bans on electronic cigarettes could heavily impact the potential public health gains the products provide to millions of tobacco smokers. Policymakers should understand that e-cigarettes and vaping devices are significantly different than combustible tobacco cigarettes, and they should consider the benefits of these devices when implementing regulations. Instead of trying to regulate and tax e-cigarettes, lawmakers should promote the use of tobacco harm reduction products.

 

The following articles provide more information about e-cigarettes and tobacco harm reduction.

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.

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.

Research & Commentary: Public Health Officials Urge Use of Electronic Nicotine Delivery Systems
https://www.heartland.org/publications-resources/publications/public-health-officials-urge-use-of-electronic-nicotine-delivery-systems
In this Research & Commentary, Heartland Institute State Government Relations Manager Lindsey Stroud notes the importance of NHS Health Scotland’s joint statement encouraging the use of electronic nicotine delivery systems (ENDS) as an alternative to tobacco products. NHS Health Scotland, Public Health England, and other groups have found ENDS are 95 percent less harmful than tobacco cigarettes.

Research & Commentary: Qualitative Study on E-cigarettes Shows More Evidence of Tobacco Harm Reduction
https://www.heartland.org/publications-resources/publications/qualitative-study-on-e-cigarettes-shows-more-evidence-of-tobacco-harm-reduction?source=policybot
In this Research & Commentary, Heartland Institute State Government Relations Manager Lindsey Stroud examines a study, published in The International Journal of Environmental Research and Public Health in June 2016, that provides additional evidence showing e-cigarettes and vaporized nicotine products (VNPs) are an effective tobacco harm-reduction tool.

Qualitative Study on E-cigarettes Shows More Evidence of Tobacco Harm Reduction
https://www.heartland.org/publications-resources/publications/qualitative-study-on-e-cigarettes-shows-more-evidence-of-tobacco-harm-reduction?source=policybot
In this Research & Commentary, Heartland Institute Government Relations Coordinator Lindsey Stroud examines a study, published in The International Journal of Environmental Research and Public Health in June 2016, that provides additional evidence showing e-cigarettes and vaporized nicotine products (VNPs) are an effective tobacco harm-reduction tool.

Nicotine Without Smoke: Tobacco Harm Reduction
https://www.heartland.org/policy-documents/nicotine-without-smoke-tobacco-harm-reduction
This report provides an update on the use of tobacco harm reduction strategies related to non-tobacco nicotine products, particularly e-cigarettes. The authors conclude for all the potential risks involved, harm reduction has significant potential to prevent death and disability caused by tobacco use and to hasten the nation’s progress toward a tobacco-free society. 

Five Things to Consider Before Raising Tobacco Taxes: A Review of the Research
https://heartland.org/policy-documents/five-things-consider-raising-tobacco-taxes-review-research
This Heartland Institute Policy Brief argues, “Tax increases above current levels are not justified by appealing to the costs smokers impose on nonsmokers. Smokers already pay more than this measure could justify.”

 

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, 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 John Nothdurft, Heartland’s director of government relations, at jnothdurft@heartland.org or 312/377-4000.

Author
Lindsey Stroud joined The Heartland Institute in 2016 as a Government Relations Coordinator. In 2017, Lindsey was named State Government Relations Manager.
lstroud@heartland.org