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Testimony Before The Phoenix City Council Public Safety and Justice Subcommittee

October 14, 2020

Testimony before the Phoenix City Council regarding a potential city ordinance that would place a ban on flavored nicotine products and flavored tobacco products in Phoenix.

Testimony before the Phoenix City Council Public Safety and Justice Subcommittee
Samantha Fillmore, State Government Relations Manager
The Heartland Institute
October 14, 2020
 
Honored Members of the council and subcommittee, thank you for taking the time today to discuss the issue of banning sales of flavored electronic cigarettes and vaping devices. The Heartland Institute is 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 on a potential city ordinance that would place a ban on flavored nicotine products, flavored tobacco products such as menthol cigarettes, and flavored cigars in Phoenix.  
 
Many localities and states have proposed and enacted banning flavored tobacco products altogether in an effort to combat what the media and some public health officials have declared is a “youth vaping epidemic.”
 
Although addressing youth use of nicotine products is admirable, there is little evidence that flavor bans reduce youth e-cigarette use. Undoubtedly, such a ban would devastate local vape shop owners in a time when Phoenix residents and small business owners are already facing an uphill battle due to COVID-19 restrictions. Furthermore, an outright flavor ban would create a booming black market for flavored e-cigarettes that are consumed legally by millions of American adults.
 
The Alleged Youth Vaping Epidemic
Heartland Institute experts have examined the effects of flavor bans[1], finding these measures to have no significant reduction on youth e-cigarette use. For example, Santa Clara County, California, banned flavored tobacco products to age-restricted stores in 2014. Despite this, youth e-cigarette use increased in the county thereafter. In the 2015-16 California Youth Tobacco Survey (CYTS), 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS[2], this increased to 10.7 percent.
 
Additionally, bans on electronic cigarettes and vaping devices have seemingly increased youth use of other tobacco products. For example, after initiating a task force to combat youth e-cigarette sales, Lancaster County, Nebraska reported sales of vaping products to minors decreased “from 21.2 percent in 2017 to 5.3 percent in 2018.”[3] Meanwhile, sales of non-vaping tobacco products increased during the same period, from 5.9 to 8.7 percent. A 2015 study reached similar conclusions, finding bans on the sales of e-cigarettes to youth increased smoking rates by “1.0 percentage point.”[4]
 
E-Cigarettes and Tobacco Harm Reduction
E-cigarettes have emerged as an effective smoking cessation tool, with a recent study in the New England Journal of Medicine finding their use to be “twice as effective” as nicotine replacement therapy (i.e. gums and lozenges), in helping smokers quit.[5] Since their introduction to the U.S. market in 2007, an estimated three million American adults have used these products to quit combustible cigarettes. [6]
 
Combustible tobacco cigarettes contain 600 ingredients and when burned, emit an estimated 7,000 chemicals. Ample research indicates it is the smoke created by burning cigarettes that produces the most severe harm. Whereas, e-cigarettes generally contain five ingredients and when used, emit a vapor significantly less harmful than combustible cigarettes.[7]
 
These findings have been noted by numerous public health groups. Most recently, the American Cancer Society noted in June 2019, “that e-cigarette use is likely to be significantly less harmful for adults than smoking regular cigarettes.”[8]
 
Furthermore, 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.”[9] In 2018, the agency reiterated its findings that vaping is “at least 95% less harmful than smoking.”[10]
 
In conclusion, flavored products have helped millions of adults transition from combustible cigarettes to tobacco harm reduction products. A 2018 survey of nearly 70,000 American adults shows 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively. Additionally, only 20 percent of respondents[11] reported using tobacco flavors at point of e-cigarette initiation.
 
An Inevitable Black Market with Substantial Dangers
A black market is all-but guaranteed to fill the void because the law of supply and demand is always victorious. However, the black market brings with it dangers far greater than what is already available.
 
Many recent vaping-related hospitalizations dealing with vaping-related lung illnesses are being increasingly linked to the use of vaping devices containing tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana.
 
On October 15, 2019, the Centers for Disease Control and Prevention (CDC) noted 78 percent of patients with vaping-related lung injuries, reported using THC vaping devices.[12]
 
State health departments have reached similar conclusions. In October 2019, the Utah Department of Health concluded 94 percent of the states’ patients with a vaping-related lung injury, “self-reported vaping THC products.”[13] In August, the Wisconsin Department of Health Services reported 89 percent of patients interviewed had “reported using e-cigarettes or other vaping devices to inhale THC products, such as waxes and oils.”[14] Further, a September 6 report in The New England Journal of Medicine examined hospitalizations in Illinois and Wisconsin. Of the 53 case patients the authors examined, 84 percent “reported having used [THC] products in e-cigarette devices.”[15]
 
The CDC, and other state health departments, have also linked vitamin E acetate as the probable chemical agent causing vaping-related lung illnesses. In a November 8 Morbidity and Mortality Weekly Report, the CDC examined data from 29 patients in 10 states, with recent vaping-related lung injuries. Vitamin E acetate was found in all 29 patient samples.[16]
 
On September 5, the New York State Department of Health (NYDOH) reported lab results “showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed.”[17] Since September, NYDOH investigated the health effects of vitamin E acetate “when inhaled because its oil-like properties could be associated with the observed symptoms.”
 
Banning flavored nicotine products will likely lead to an influx in the black market, which could hold a myriad of unknown dangers to the residents of Phoenix.
 
An Already Struggling Economy
What’s more, following the coronavirus pandemic, small businesses in Phoenix are still struggling to remain open after the mandated lockdown. Arizona initial claims for pandemic unemployment assistance[18] rose from 3,151 in the beginning of March to 266,674 at its height in August. Placing additional regulations on businesses in the current environment is the exact opposite approach the City Council should be taking during this precarious economic period.
 
*****
 
It is disingenuous that lawmakers would purport to protect public health, yet restrict access to safer products. Rather than restricting access to tobacco harm reduction products and flavored tobacco products, lawmakers should encourage use of e-cigarettes and earmark adequate funding for smoking education and prevention programs.
 
Thank you for your time today.
 
For more information about The Heartland Institute’s work, please visit our website at www.heartland.org, or contact Samantha Fillmore at Sfillmore@heartland.org
 

[1] Heartland Staff, “Flavor Bans Do Not Reduce Youth E-Cigarette Use” Research & Commentary, The Heartland Institute, March 29, 2019, https://www.heartland.org/publications-resources/publications/research--commentary-flavor-bans-do-not-reduce-youth-e-cigarette-use
[2]California Department of Public Health, “Results of the Statewide 2017-2018 California Student Tobacco Survey”, https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/ResearchandEvaluation/Reports/2017-18CaliforniaStudentTobaccoSurveyBiennialReport.pdf
[4] Heartland Staff, “How Do Electronic Cigarettes Affect Adolescent Smoking,” Research & Commentary, The Heartland Institute, March 28, 2016, https://www.heartland.org/publications-resources/publications/research--commentary-how-do-electronic-cigarettes-affect-adolescent-smoking?fbclid=IwAR3MXDoO2v8rmSyez8yhSxLDNe_pTQJAPzbKRlWx8AIMTZeBMsMg88o7xnw.
[5] Heartland Staff, “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.
[6] 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.
[7] 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.
[8] 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.
[10] 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.
[11] Heartland Staff, “Largest Vaping Survey Finds Flavors Play Important Role in Tobacco Hard Reduction” Research & Commentary, October 2, 2018, https://www.heartland.org/publications-resources/publications/research--commentary-largest-vaping-survey-finds-flavors-play-important-role-in-tobacco-harm-reduction
[12] Heartland Staff, “Research & Commentary: Centers for Disease Control and Prevention Reports THC-Containing Device Cause Most Vaping Illnesses,” Research & Commentary, The Heartland Institute, October 21, 2019, https://www.heartland.org/publications-resources/publications/research--commentary-centers-for-disease-control-and-prevention-reports-thc-containing-devices-cause-most-vaping-illnesses.
[13] Heartland Staff, “Research & Commentary: Utah Department of Health Links More Than 90 Percent of Vaping Hospitalizations to THC, Still Restricts Access to Tobacco Harm Reduction Products,” Research & Commentary, The Heartland Institute, October 16, 2019, https://www.heartland.org/publications-resources/publications/research--commentary-utah-department-of-health-links-more-than-90-percent-of-vaping-hospitalizations-to-thc-still-restricts-access-to-tobacco-harm-reduction-products.
[14] Heartland Staff, “Research & Commentary: Vaping-Related Hospitalizations and Deaths Linked to THC Products,” Research & Commentary, The Heartland Institute, September 10, 2019, https://www.heartland.org/publications-resources/publications/research--commentary-vaping-related-hospitalizations-and-deaths-linked-to-thc-products.
[15] Jennifer E. Layden, M.D., et al., “Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report,” The New England Journal of Medicine, September 6, 2019, https://www.nejm.org/doi/full/10.1056/NEJMoa1911614?fbclid=IwAR0kTs_r_tf_FmGLzEWRoaLk7-yS1URk9xe1euOoKQuwpZwx0CN79edr5Do.
[16] Heartland Staff, “Research & Commentary: Latest CDC Reports Link Vitamin E to Lung Illnesses,” Research & Commentary, The Heartland Institute, November 12, 2019, https://www.heartland.org/publications-resources/publications/research--commentary-latest-cdc-reports-link-vitamin-e-to-vaping-lung-illnesses.
[17] New York State Department of Health, “New York State Department of Health Announces Update on Vaping-Associated Pulmonary Illnesses,” September 5, 2019, https://health.ny.gov/press/releases/2019/2019-09-05_vaping.htm.
[18] Arizona’s Economy: Economic and Business Research Center, “COVID-19 Tracking Economic Impacts”, https://www.azeconomy.org/covid-19-tracking-economic-impacts/#AZUI