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Testimony Before the Massachusetts Joint Committee on Public Health

July 15, 2019

Testimony before the Massachusetts Joint Committee on Public Health regarding several proposals which would restrict flavors and nicotine levels, as well as enact a new excise tax on electronic cigarettes and vaping devices.

Testimony Before the Massachusetts Joint Committee on Public Health
Lindsey Stroud, State Government Relations Manager
The Heartland Institute
July 15, 2019

Chairwoman Comerford and Chairman Mahoney, and Members of the Committee:

Thank you for taking the time today to discuss the issue of regulating electronic cigarettes and vaping devices, including proposing restrictions on flavors and nicotine levels, as well as enacting a new excise tax on such devices. My name is Lindsey Stroud. I’m a state government relations manager at The Heartland Institute, a 34-year-old independent, national, nonprofit organization whose mission is to discover, develop, and promote free-market solutions to social and economic problems. Heartland is headquartered in Illinois and focuses on providing national, state, and local elected officials with reliable and timely research and analyses on important policy issues. Heartland would like to submit the following testimony regarding the proposed regulations on e-cigarettes. 

Heartland has long advocated the use of electronic cigarettes and vaping devices, also known as tobacco harm reduction (THR) products, which have helped an estimated three million American adults quit smoking combustible cigarettes since their introduction to the U.S. market in 2007.[1]

Research overwhelmingly shows that it is the smoke created by the burning of tobacco, rather than the nicotine, that produces the harmful chemicals found in combustible cigarettes.[2] 

There are an estimated 600 ingredients in each tobacco cigarette, and “when burned, [they] create more than 7,000 chemicals.”[3] As a result of these chemicals, cigarette smoking is directly linked to cardiovascular and respiratory diseases, numerous types of cancer, and increases in other health risks among the smoking population.[4]

In contrast, e-cigarettes contain very little ingredients, and create a vapor “generated by heating a solution containing water, nicotine, propylene glycol, vegetable glycerin and typically also some flavoring.”[5]

Nicotine is an essential component of any tobacco product, with some individuals as early as the 1940s noting that although nicotine in combustible cigarettes is what makes those products addictive, it may not be the ingredient causing the most harm.[6] In 1976, a leading THR researcher, Michael Russell, declared that “people smoke for nicotine but die from the tar.”[7]

Unfortunately, many Americans “incorrectly believe that nicotine causes cancer and other health risks,” with a 2017 survey finding 53 percent of respondents believing that nicotine “causes most of the cancer related to smoking.”[8][9] Despite recent fearmongering campaigns, nicotine, while addictive, is not a harmful chemical. Nicotine is a mild stimulant and/or relaxant with many of the same properties as caffeine, another addictive substance consumed by tens of millions of Americans in a wide variety of products.[10]

Both nicotine and caffeine enhance concentration and mental performance, encourage a sense of well-being, and elevate mood. Both raise heart rates and blood pressure levels transiently during use, but neither is directly responsible for cancer, emphysema, or heart disease.

Electronic cigarettes and vaping devices help deliver nicotine without the associated harms found in combustible cigarettes. Numerous public health groups have performed extensive studies on e-cigarettes finding their use to be significantly less harmful than combustible cigarettes.

In 2015, Public Health England, a leading health agency in the United Kingdom and similar to the U.S. Food and Drug Administration found “that using [e-cigarettes are] around 95% safer than smoking,” and that their use “could help reducing smoking related disease, death and health inequalities.”[11] In 2018, the agency reiterated their findings, finding vaping to be “at least 95% less harmful than smoking.”[12]

In 2016, the Royal College of Physicians found the use of e-cigarettes and vaping devices “unlikely to exceed 5% of the risk of harm from smoking tobacco.”[13] In 2018, the National Academies of Sciences, Engineering and Medicine concluded e-cigarette use results in “reduced short-term adverse health outcomes in several organs.”[14]

Most recently, in June 2019, the American Cancer Society “found that e-cigarette use is likely to be significantly less harmful for adults than smoking regular cigarettes.”[15]

Lawmakers should note the unique flavors available in electronic cigarettes are vital to their usefulness in helping smokers quit and stay cigarette-free. Regulations which would restrict adults’ access to e-cigarette flavors should be avoided.

A 2013 study in the International Journal of Environmental Research and Public Health, noted that flavors in electronic cigarettes “appear to contribute to both perceived pleasure and the effort to reduce cigarette consumption or quit smoking.” A 2015 online survey conducted by the Consumer Advocates for Smoke Free Alternatives Association surveyed 27,434 Americans over the age of 18. Seventy-two percent of the respondents “credited tasty flavors with helping them give up tobacco.”

In 2018, in the largest survey of e-cigarette users consisting of nearly 70,000 American adults, researchers “found flavors play a vital role in the use of electronic cigarettes and vaping devices.”[16] Further, 83.2 percent and 72.3 percent of the survey’s respondents reported vaping fruit and dessert flavors, respectively, “at least some of the time.”[17]

Regarding how smokers make the switch, many adult e-cigarette users begin with tobacco flavors then transition to non-tobacco flavors. A 2017 study noted older adults “use of an e-cigarette flavored with something other than tobacco (69.3%) was … significantly higher than the same at initiation (44.1%).”[18]

Further, restricting flavors in vaping devices to only tobacco-flavored would likely increase combustible cigarette use. A 2017 study published by the National Bureau of Economic Research examined the impact of flavor bans. The authors concluded banning flavors “would result in increased choice of combustible cigarettes,” and they said they expect e-cigarette use to decline by approximately 10 percent if flavors are banned.[19]Additionally, a 2018 “systematic review of research examining consumer preference” for flavors concluded adults “in general also preferred sweet flavors.”[20]

As a THR product, lawmakers should refrain from enacting excise taxes, or sin taxes, on electronic cigarettes and vaping devices.

A 2019 study in The New England Journal of Medicine found the use of e-cigarettes to be “twice as effective as nicotine replacement therapy (NRT)” in helping smokers quit combustible cigarettes.[21] Previous studies have also noted e-cigarette to be an effective cessation tool. Polosa et al. found more than half of smokers quit smoking or reduced cigarette consumption after six months when using e-cigarettes.[22] Caponnetto et al. found 19 percent of smokers quit smoking or reduced cigarette consumption after one year.[23] Bullen et al. concluded e-cigarettes are just as effective as nicotine patches in helping smokers quit.[24]

Further, as THR products are significantly less harmful than combustible cigarettes, the use of e-cigarettes and vaping devices can provide relief to state budgets by reducing smoking-related health care costs.

A 2015 policy analysis by State Budget Solutions examined electronic cigarettes’ effect 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 cigarettes by all Medicaid recipients who currently consume tobacco products.[25]A 2017 study by R Street examined the financial impact to Medicaid costs, should a number of current Medicaid recipients switch from combustible cigarettes to e-cigarettes and vaping devices. The author used a sample size of “1% of smokers [within] demographic groups permanently” switching. In this analysis, the author estimates that Medicaid savings “will be approximately $2.8 billion per 1 percent of enrollees,” over the next 25 years.[26]

Deeply problematic with the proposal to tax e-cigarettes is that the Commonwealth of Massachusetts diverts very little in tobacco moneys on tobacco cessation and prevention programs.

In 2018, Massachusetts received an estimated $884 million in tobacco settlement payments and taxes, yet only spent $3.7 million, or less than 1 percent, on tobacco education and prevention.[27] Massachusetts did allocate more funding on tobacco prevention in 2019, with $4.2 million in state funds used on such programs. Still, this is less than 1percent of the $864.5 million the Commonwealth received in tobacco settlement payments and taxes in 2019.[28]

Moreover, there is no evidence vaping taxes will stop youth use of vaping devices. In 2016, Pennsylvania enacted a 40 percent wholesale tax on vaping products. A Heartland Institute analysis on the effects of Pennsylvania’s wholesale tax on youth e-cigarette use found young Pennsylvanians in middle and high school actually increased their use of e-cigarettes in the period following the implementation of the tax.[29] Notably, e-cigarette use among 10th and 12th graders increased from 20.4 and 27 percent, respectively, in 2015 to 21.9 and 29.3 percent in 2017.

Pennsylvania’s wholesale tax had a disastrous effect on small businesses as well. Within a year of its implementation, an estimated 120 vape shops went out of business in the Keystone State. This carries significant economic consequences. Vape shops “generate annual non-online sales of more than $300,000 per store.”[30]

It is deeply disingenuous that policymakers seek to reduce the efficacy of THR products by regulating, restricting, and taxing electronic cigarettes and vaping devices. Although lawmakers believe such policies could help deter youth use of e-cigarettes, policies regulating vaping devices should not restrict adult access to these effective smoking cessation tools. Rather than impose such erroneous regulations, lawmakers should divert additional tobacco moneys on tobacco prevention and cessation efforts and encourage adult smokers to switch to THR products.

 

 

For more information about The Heartland Institute’s work, please visit our website at www.heartland.org, or contact Lindsey Stroud by phone at 757/354-8170 or by email at lstroud@heartland.org.

 

 

[1] M. Mirbolouk et al., “Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System,” Annals of Internal Medicine, August 28, 2016, https://annals.org/aim/article-abstract/2698112/prevalence-distribution-e-cigarette-use-among-u-s-adults-behavioral.

[2] Brad Rodu, For Smokers Only: How Smokeless Tobacco Can Save Your Life (Los Angeles, CA: Sumner Books, 1995), p. 103.

[3] American Lung Foundation, “What’s In a Cigarette?” February 20, 2019, https://www.lung.org/stop-smoking/smoking-facts/whats-in-a-cigarette.html.

[4] Centers for Disease Control and Prevention, “Health Effects of Cigarette Smoking,” January 17, 2018, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm.

[5] Royal College of Physicians, Nicotine without Smoke: Tobacco Harm Reduction, April 2016, https://www.rcplondon.ac.uk/projects/outputs/nicotinewithout-smoke-tobacco-harm-reduction-0.

[6] Mark Elam, “From the birth of the smokers’ clinic to the invention of Nicorette: Problematizing smoking as addiction in Sweden 1955-1971,” Nordic Studies on Alcohol and Drugs, March 6, 2014, http://journals.sagepub.com/doi/pdf/10.2478/nsad-2014-0042.

[7] M.A.H. Russell, “Low-tar medium-nicotine cigarettes: a new approach to safer smoking,” British Medical Journal, June 12, 1976, https://www.bmj.com/content/bmj/1/6023/1430.full.pdf.

[8] Lindsey Stroud, “State Policies Help Promote Misperception that Nicotine Causes Cancer,” Research & Commentary, The Heartland Institute, March 19, 2018, https://www.heartland.org/publications-resources/publications/research--commentary-state-policies-help-promote-misperception-that-nicotine-causes-cancer.

[9] Richard Craver, “Study finds majority of adults erroneously link nicotine to cancer,” Winston-Salem Journal, March 4, 2018, https://www.journalnow.com/business/study-finds-majority-of-adults-erroneously-link-nicotine-to-cancer/article_d249b427-3993-5c35-a044-bc6334617f07.html.

[10] Brad Rodu et al., “Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking,” The Heartland Institute, February 20, 2017, https://www.heartland.org/publications-resources/publications/vaping-e-cigarettes-and-public-policy-toward-alternatives-to-smoking.

[12] A. McNeill et al., “Evidence review of e-cigarettes and heated tobacco products 2018,” Public Health England, February 2018, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684963/Evidence_review_of_e-cigarettes_and_heated_tobacco_products_2018.pdf.

[13] Royal College of Physicians, Nicotine without Smoke: Tobacco Harm Reduction, April, 2016, https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0.

[14] Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems, “Public Health Consequences of E-Cigarettes,” The National Academies of Science, Engineering, and Medicine, 2018, https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes.

[15] The American Cancer Society, “What Do We Know About E-cigarettes? June 19, 2019, https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/e-cigarettes.html.

[16] Lindsey Stroud, “Research & Commentary: Largest Vaping Survey Finds Flavors Play Important Role in Tobacco Harm Reduction,” Research & Commentary, The Heartland Institute, October 2, 2018, https://www.heartland.org/publications-resources/publications/research--commentary-largest-vaping-survey-finds-flavors-play-important-role-in-tobacco-harm-reduction.

[17] Ali Anderson, “Ex Smokers Prefer Fruity E-Liquids Says Doctor’s FDA Survey,” Vaping, August 14, 2018, https://vaping.com/blog/news/ex-smokers-prefer-fruity-e-liquids-says-doctors-fda-survey/.

[18] M.B. Harrell et al., “Flavored e-cigarette use: Characterizing youth, young adult, and adult users,” Preventative Medicine Reports, March 2017, pp. 33-40, https://www.sciencedirect.com/science/article/pii/S2211335516301346.

[19] John Buckell, Joachim Marti, and Jody L. Sindelar, “Should Flavors Be Banned in E-Cigarettes? Evidence on Adult Smokers and Recent Quitters from a Discrete Choice Experiment,” National Bureau of Economic Research, September 2017, http://www.nber.org/papers/w23865.pdf.

[20] Samane Zare et al., “A systematic review of consumer preference for e-cigarette attributes: Flavor, nicotine strength, and type,” PLoS ONE 13(3): e0194145. https://doi.org/10.1371/journal.pone.0194145.

[21] Lindsey Stroud, “Randomized Trial Finds E-Cigarettes are More Effective Smoking Cessation Tool Than Nicotine Replacement Therapy,” Research & Commentary, The Heartland Institute, February 11, 2019, https://www.heartland.org/publications-resources/publications/research--commentary-randomized-trial-finds-e-cigarettes-are-more-effective-smoking-cessation-tool-than-nicotine-replacement-therapy.

[22] Riccardo Polosa, et al., “Effect of an Electronic Nicotine Delivery Device (e-Cigarette) on Smoking Reduction and Cessation: A Prospective 6-month Pilot Study,” BMC Public Health 11 (October 2011), https://www.heartland.org/publications-resources/publications/effect-of-an-electronic-nicotine-delivery-device-e-cigarette-on-smoking-reduction-and-cessation-a-prospective-6-month-pilot-study.

[23] Pasquale Caponnetto, et al., “Impact of an Electronic Cigarette on Smoking Reduction and Cessation in Schizophrenic Smokers: A Prospective 12-Month Pilot Study,” International Journal of Environmental Research and Public Health 10 (February 2013), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635154/.

[24] Christopher Bullen, et al., “Electronic Cigarettes for Smoking Cessation: A Randomised Controlled Trial,” The Lancet 382 (November 2013): 1629–37, https://www.ncbi.nlm.nih.gov/pubmed/24029165.

[25] J. Scott Moody, “E-Cigarettes Poised to Save Medicaid Billions,” State Budget Solutions, March 31, 2015, https://www.heartland.org/_template-assets/documents/publications/20150331_sbsmediciadecigarettes033115.pdf.

[26] Edward Anselm, “Tobacco Harm Reduction Potential for ‘Heat Not Burn,’” R Street Institute, February 2017, https://www.rstreet.org/wp-content/uploads/2017/02/85.

[27] Truth Initiative, “Tobacco use in Massachusetts 2018,” June 1, 2018, https://truthinitiative.org/research-resources/smoking-region/tobacco-use-massachusetts-2018.

[28] Truth Initiative, “Tobacco use in Massachusetts 2019,” June 28, 2019, https://truthinitiative.org/research-resources/smoking-region/tobacco-use-massachusetts-2019.

[29] Lindsey Stroud, “Vaping Taxes Do Not Deter Youth Use of E-Cigarettes,” Research & Commentary, The Heartland Institute, April 4, 2019, https://www.heartland.org/publications-resources/publications/research--commentary-vaping-taxes-do-not-deter-youth-use-of-e-cigarettes.

[30] “U.S. Vape Shops Average $26,00 In Monthly Sales, According to Industry Index,” Cision PR Newswire, December 6, 2015, https://www.prnewswire.com/news-releases/us-vape-shops-average-26k-in-monthly-sales-according-to-industry-index-300193463.html.