Hawaii’s Tobacco Report Card is out — and the state got mixed marks.
Hawaii got an A for keeping public spaces smoke-free, but got an F for not preventing access to flavored tobacco products such as menthol cigarettes and fruit-flavored e-cigarettes, according to a American Lung Association report.
While smoking has dropped to record lows in recent years due to a series of smoke-free laws and horrible but effective public information campaignsadvocates and officials warn Hawaii and the nation continue to grapple with a “vaping epidemic” among high school students and young adults.
“We’ve seen our state be one of the best in youth tobacco use — in 20 years, much of that has been eroded by vaping,” said Pedro Haro, executive director of the American Lung Association in Hawaii. “The new generation of adult tobacco users could be truly astronomical in terms of the cost of illness and death to the state.”
The 20th annual “State of Tobacco Control,” released Wednesday, examines tobacco use policies in all 50 states and the District of Columbia, giving letter grades in five categories: smoke-free air, program funding, taxes tobacco, quit services and flavor restrictions.
Hawaii was early to ban smoking in most public spaces, Haro said, including restaurants and bars, government and private workplaces, state parks and within 20 feet of entrances, exits and air vents, and more than deserves its only A rating, Haro said.
“The state really had a comprehensive law established in 2006,” Haro said. “There are very few people who are exposed to second-hand smoke in the course of their work, which is really the foresight of the lawmakers and advocates at the time who presented this.”
According to Hawaiian law, vaping is considered to be smoking a cigarette and is subject to the same location restrictions.
But despite its early success investing in smoke-free air and being the first state to raise the legal smoking age to 21, Hawaii has largely failed to stop a new generation of teenagers from riding the cigarette wave. electronics, Haro said.
Driven by viral ‘vape’ brands such as Juul, Vuse and NJOY, e-cigarettes have exploded in popularity since the 2010s. Drawn to kid-friendly flavors with names like Frozen Lime Drop and Hawaiian POG – a version of Passion Orange Guava, the island’s favorite – vaping rates among Hawaii high schoolers have tripled 10% in 2013 at 33% in 2019according to the Hawaii Youth Tobacco Survey.
Hawaii’s high school vaping rates of 10% were more than double the national average of 4.5% in 2013, though mainland numbers have since caught up, according to the Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System.
There are flavorless and tobacco flavored e-cigarettes, but young people are overwhelmingly choosing the fun flavors. Of the 85% of young US users who switched to flavored vapes in 2021, the FDA find 72% favored fruit flavors, while around 30% said they used candy/dessert, mint and menthol flavors respectively.
Yet despite this data, Hawaii currently has no laws to target youth vaping by regulating the sale of flavored e-cigarettes, resulting in its failing grade in the ALA report card.
It’s not for lack of trying — in the 2021 legislative session alone, lawmakers introduced at least six bills banning flavored tobacco from stores, in whole or in part. Five died in committee; the last, House Bill 826, was passed by the House before the Senate amended it to exempt menthol flavored tobacco products. House lawmakers disagreed and the measure died.
“I know conventional wisdom would say, ‘Let’s get rid of the pineapple and juicy fruit or whatever, obviously the flavors targeting kids,'” Haro said. “But the data shows that menthol is a favorite flavor for young people, including Hawaii.”
There are federal limits on some flavored tobacco products, however, the regulations are patchy in nature and riddled with loopholes. For example, a Trump-era Food and Drug Administration policy banned most cartridge e-cigarette flavors, but stopped short of reducing flavors of disposable and other e-cigarette varieties.
Today, the Puff Bar disposable e-cigarette line has become a favorite brand for young people, and flavored vapes and vape refills remain. readily available online and in-store, according to a December 2021 campaign report for Tobacco-Free Kids, giving way to state-level intervention.
“States and cities cannot wait for the FDA and must act now to close the gaps left by the FDA to fully protect children,” the report wrote.
While the e-cigarette industry and some public health experts argue that vaping helps smokers quit more toxic cigarettes and therefore requires less regulation, opponents have pointed out signs of long-term lung disease and the potential of e-cigarettes to act as a “gateway” to nicotine addiction, especially among younger users.
In one 2016 Survey of Adult E-Cigarette Users in Hawaii, 40% of respondents said they had never smoked cigarettes before vaping. Another 21% continued to smoke regularly, while 12% said they started using cigarettes after they started vaping.
In addition to its endnotes for limiting second-hand smoke and flavored tobacco, the ALA gave Hawaii a C for the taxes the state levies on various tobacco products and a C in its funding for tobacco control programs. smoking, with the state allocating only 62.6% of the $13.7. million recommended by the CDC, which calculates the amount based on the number of smokers in the state.
The state fared better in public access to smoking cessation services, receiving a B for well-funded tobacco leave the line and treatment covered by the state Med-Quest Medicaid plan. The main problem, Haro said, was the lack of a state mandate requiring private insurers to pay for these services.
“We just need that initial leadership to show up again,” Haro said. “We need that initial spark to pass the legislation, allow advocates to work with communities to…finally see those smoking numbers come down.”