Testimony regarding Senate Bill 367 presented to the Connecticut Joint Public Health Committee on March 14, 2022.
Chair, members of the committee, thank you for allowing me the opportunity to submit testimony on Senate Bill 367.
My name is Guy Bentley, and I’m the director of consumer freedom at the Reason Foundation, a 501(c)3 nonprofit think tank. The consumer freedom project analyzes and promotes policy solutions that improve public health while avoiding unintended consequences and protecting consumer choice.
The intention behind Senate Bill 367 to limit tobacco use, especially among youth, is to be applauded. However, the evidence on the success of such prohibitions should raise significant concern that the flavored tobacco ban will push sales and tax revenue to other states, increase the illicit tobacco trade, and drive Connecticut vapers to more dangerous kinds of tobacco products such as combustible cigarettes.
Research Finds E-cigarette Prohibition Can Increase Cigarette Use
While they are not risk-free, e-cigarettes are a substantially safer method of consuming nicotine than traditional cigarettes. This is because lighting tobacco on fire and inhaling the resulting smoke, not nicotine itself, is responsible for smoking-related diseases. Millions of Americans have quit smoking thanks to e-cigarettes because they are substitutes, not complements, to traditional cigarettes. E-cigarettes are even recommended as a harm reduction tool from the United Kingdom to New Zealand, and the U.S. Food and Drug Administration has authorized an e-cigarette as “appropriate for the protection of public health.” That’s why draconian restrictions on e-cigarettes can lead to unintended consequences, including greater cigarette use.
In 2018, San Francisco banned the sale of all flavored tobacco products, including e-cigarettes with flavors other than tobacco. Yale University’s Abigail Friedman found that after the ban was enacted, San Francisco area youth had double the odds of smoking traditional combustible cigarettes compared to similar jurisdictions with no tobacco flavor ban. “While neither smoking cigarettes nor vaping nicotine are safe per se, the bulk of current evidence indicates substantially greater harms from smoking, which is responsible for nearly one in five adult deaths annually. Even if it is well-intentioned, a law that increases youth smoking could pose a threat to public health,” said Friedman.
According to a 2020 study by researchers at the Yale School of Public Health, the use of e-cigarette flavors is positively associated with smoking cessation outcomes for adults but not associated with increased youth smoking. Vapers who have quit smoking thanks to the use of e-cigarettes. A survey conducted by the International Tobacco Control Policy Evaluation Project found that 57 percent of vapers said they would continue vaping if flavors were banned, but half said they would find a way to get their preferred flavor. Of most concern, was the finding that close to one five vapers said they would stop vaping and smoke instead.
Nicotine Content and Smoking Cessation
Capping the nicotine in e-cigarettes to below that of regular cigarettes, as Senate Bill 367 proposes, necessarily increases the relative appeal of cigarettes. There is an emerging body of evidence to suggest that e-cigarettes with a higher nicotine content relative to lower content e-cigarettes are more effective in transitioning smokers away from cigarettes and that limiting nicotine content could increase puffing intensity.
Research funded by Cancer Research UK and published in the journal Addiction, found that vapers using lower nicotine e-cigarettes used more e-liquid, puffed more deeply and more often than those who used a higher strength e-cigarette. Research specifically examining smokers using the Juul product published in Nicotine and Tobacco Research found those smokers who had access to the higher nicotine Juul product in North America were significantly more likely to switch to vaping than those in the United Kingdom who only had access to lower strength nicotine products. In addition, a new study from a range of authors examined how e-cigarettes with two different nicotine concentrations might affect smokers with no plans to quit. At 24 weeks, those participants using the higher nicotine e-cigarette were more than twice as likely to abstain from smoking than those using the lower nicotine e-cigarette.
The UK government, which limits nicotine in e-cigarettes to 20mg/ml as a result of the European Tobacco Products Directive, is actively considering revising that limit upwards. One of the reasons for this is that the evidence showing e-cigarettes are more effective than nicotine replacement therapies (NRT) for helping smokers quit has strengthened significantly in recent years. For example, the most recent randomized controlled trial comparing e-cigarettes with NRT found smokers who used e-cigarettes were six times more likely to have stopped smoking than those using NRT.
Food and Drug Administration Review and Tobacco Harm Reduction
Last year, the Food and Drug Administration authorized an e-cigarette as “appropriate for the protection of public health” for the first time. The FDA is reviewing all remaining e-cigarette product applications. These applications contain reams of data on safety, efficacy, and potential threats to youth. If the FDA finds that any vaping product is a net harm to public health, it will be removed from the market, until it can prove otherwise.
But if the product is deemed to be net beneficial, it will be authorized for sale as appropriate for the protection of public health. If Connecticut chooses to ban these products prior to the FDA concluding its review it would limit consumer access to products the FDA may deem as a positive for public health.
While prohibiting e-cigarette flavors other than tobacco may seem an attractive solution to the problem of youth vaping, policymakers should recognize that according to the 2021 National Youth Tobacco Survey (NYTS), 89 percent of high schoolers are not using e-cigarettes at all and 95 percent are not using them frequently. Youth vaping has also fallen to its lowest point in seven years. Furthermore, data released by the Centers for Disease Control and Prevention (CDC) shows flavors are not the leading reason why youth initiate vaping. According to the CDC, the primary reason youth initiate vaping is “curiosity,” followed by “friend or family member used them,” with “they are available in flavors, such as mint, candy, fruit, or chocolate” coming a very distant third.
Writing in the American Journal of Public Health, 15 past presidents of the Society for Research on Nicotine and Tobacco argued that banning flavors could reduce smokers’ use of e-cigarettes to quit smoking. Instead of prohibition, they proposed limiting retail sales of flavored vapor products to adult-only outlets such as vape shops.
In 2020, the prestigious Cochrane Review concluded e-cigarettes are more effective than traditional nicotine replacement therapies for helping smokers quit. Prohibition of flavored e-cigarettes, which are overwhelmingly the choice of adult vapers, risks fueling illicit markets, forcing the closure of Connecticut vape shops, and driving vapers back to smoking. Thank you for your time. I’d be happy to answer any questions.