By Dr. Richard Feldman
Electronic cigarette use is at epidemic proportions. Most concerning is the exponential increase among youth. Although there has been some recent decline in e-cigarette use among high school students, use increased by 135 percent between 2017 and 2019. Currently, nearly 20 percent of high school students partake in “vaping” with these electronic nicotine-delivery devices. Youth e-cigarette use is actually now higher than tobacco use. In 2019, 4.5 percent of adults used e-cigarettes regularly, and 37 percent of adult e-cigarette users also smoked traditional cigarettes. Regrettably, Indiana has one of the highest vaping rates in the nation.
E-cigarette devices commonly contain tobacco-derived nicotine with other ingredients in a liquid. With inhalation, the heated liquid “vaporizes” into a white aerosol resembling smoke. Because there is no combustion, there is no actual smoke.
It’s a myth that vaping is safe. More correctly, e-cigarettes have the potential of being less toxic than combusted tobacco. They contain fewer numbers and amounts of carcinogens, toxins, and particulates compared to tobacco smoke, because combustion liberates the highest levels of these compounds. Unfortunately, too many adolescent users still believe e-cigarettes are completely safe.
Acute adverse cardiopulmonary effects are well-documented. However, because there are no long-term studies on e-cigarettes yet, the risk of long-term adverse health effects including lung cancer is completely unknown.
Although e-cigarettes have failed to be an effective tobacco cessation aid, there’s reasonable potential of reducing harm in recalcitrant tobacco smokers who completely substitute vaping for regular cigarettes. However, switching to e-cigarettes commonly results in dual use with tobacco smoking. Non-smokers should never initiate vaping and risk addiction and compromising their health.
E-cigarettes are a public-health nightmare. Inexpensive and lacking the harshness of tobacco smoke, they are marketed to youth with various appealing flavorings. They are considered an adolescent gateway to nicotine addiction and eventual tobacco use. Vaping poses the greatest threat to unraveling 50 years of tobacco-prevention efforts by renormalizing smoking behaviors.
The FDA has long delayed exerting its full e-cigarette regulatory authority (although recently began denying industry flavoring applications), and state regulatory efforts are still in relative infancy. There have been prohibitions of sales to minors and inclusions of vaping in smoke-free air laws; a few states have prohibited e-cigarette flavorings. Thirty states have enacted e-cigarette taxes to discourage use by increasing price.
Public-health experts largely support e-cigarette taxes on a percent-of-price (wholesale or retail) basis as the best methodology to tie the cost of e-cigarettes to the cost of traditional cigarettes. However, state taxes based on percent-of-price vary widely from 7 to 95 percent.
Although some would tax e-cigarettes in parity with cigarettes, I favor an amount of tax to keep e-cigarettes somewhat lower comparatively in price. This would encourage adult smokers to switch to vaping as a likely less toxic alternative yet discourage use by younger people who are most sensitive to price.
Indiana finally enacted taxes on e-cigarettes this year. The new statute met minimum best practices of public health tobacco-policy advocates; uncharacteristically, the legislature got it right. The e-liquid tax was set at 15 percent of retail for “open systems” (think vape shop products) and 25 percent of wholesale for “closed systems” like Juul.
Occasionally the Indiana General Assembly does something respectable to advance the public health of Hoosiers. It’s a good start in addressing the vaping epidemic of Indiana youth and its considerable future negative health consequences for our children.
Now, how about mustering the long overdue political will to increase the cigarette tax?
Dr. Richard Feldman is an Indianapolis family physician and the former state health commissioner. Send comments to [email protected]