Dr Richard Feldman
The use of electronic cigarettes is at epidemic proportions. Of most concern is the exponential increase among young people. Although there has been a recent decline in e-cigarette use among high school students, use increased 135% between 2017 and 2019.
Currently, nearly 20% of high school students are “vaping” with these electronic nicotine releasing devices. The consumption of electronic cigarettes among young people is currently higher than the consumption of tobacco. In 2019, 4.5% of adults regularly used e-cigarettes and 37% of adult e-cigarette users also smoked traditional cigarettes. Sadly, Indiana has one of the highest vaping rates in the country.
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Electronic cigarette devices generally contain nicotine derived from tobacco along with other ingredients in a liquid. If inhaled, the heated liquid “vaporizes” into a white smoke-like aerosol. Since there is no combustion, there is no actual smoke.
It is a myth that vaping is safe. More correctly, electronic cigarettes have the potential to be less toxic than burnt tobacco. They contain fewer numbers and amounts of carcinogens, toxins, and particles than tobacco smoke because burning releases the highest levels of these compounds. Unfortunately, too many teenage users still believe that e-cigarettes are completely safe.
Acute adverse cardiopulmonary effects are well documented. However, as there are no long-term studies of e-cigarettes yet, the risk of long-term adverse health effects, including lung cancer, is completely unknown.
Although e-cigarettes have not been an effective smoking cessation aid, there is reasonable potential for harm reduction in stubborn tobacco smokers who completely substitute vaping for regular cigarettes. However, switching to electronic cigarettes usually results in dual use with smoking. Non-smokers should never start vaping and risk addiction and compromise their health.
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Electronic cigarettes are a public health nightmare. Inexpensive and devoid of the harshness of tobacco smoke, they are marketed to young people with a variety of attractive flavors. They are considered a gateway for adolescents to nicotine addiction and eventual tobacco use. Vaping poses the greatest threat to unraveling 50 years of smoking prevention efforts by renormalizing smoking behaviors.
The FDA has long delayed exercising its full regulatory authority over e-cigarettes (although it has recently begun to deny flavor applications from the industry), and state regulatory efforts have stalled. still in its infancy. There have been bans on sale to minors and vaping inclusions in smoke-free air laws; a few states have banned electronic cigarette flavors. Thirty states have adopted e-cigarette taxes to discourage use by increasing prices.
Public health experts broadly support taxes on e-cigarettes on a percentage-of-price basis (wholesale or retail) as the best methodology for relating the cost of e-cigarettes to the cost of traditional cigarettes. However, state taxes based on the percentage of the price vary widely from 7% to 95%.
Although some tax e-cigarettes on par with cigarettes, I am in favor of a tax amount to keep e-cigarettes a little lower in price. This would encourage adult smokers to switch to vaping as a likely less toxic alternative, while discouraging use by young people, as they are the most price sensitive.
Indiana finally passed taxes on e-cigarettes this year. The new statute respected the minimum best practices of advocates of tobacco control policies in the field of public health; Unusually, the legislature was right. The tax on e-liquids has been set at 15% of retail sales for “open systems” (think vape shop products) and 25% of wholesale for “closed systems” like Juul.
Sometimes the Indiana General Assembly does something respectable to advance the public health of Hoosiers. This is a great start to tackling the Indiana youth vaping epidemic and its future far-reaching negative health consequences for our children.
Now, how about mustering the long overdue political will to raise the tax on cigarettes?
Dr. Richard Feldman is a former Indiana State Health Commissioner. He is Program Director Emeritus and Senior Medical Education Advisor for Franciscan Health Indianapolis Family Medicine Residency.