On June 1, 2020, Massachusetts became the first state in the US to implement a comprehensive prohibition on all flavored tobacco products, including menthol cigarettes. My study for Reason Foundation revealed that cross-state trafficking led to a net increase in cigarette sales for the Massachusetts region after considering the rise in cigarette sales in surrounding states after the ban. 

Now, the medical literature also acknowledges that the increase in cigarette sales has manifested in increases in smoking for various populations, especially those the prohibition intended to target. Indeed, the letter’s authors specifically advise, “As the FDA plans to eliminate menthol as a characterizing flavor in cigarettes, interventions should address possible increases in cigarette smoking among Black females.”

According to Asare et al., the menthol cigarette ban in Massachusetts led to an 8.1% relative decrease in smoking among adults 25 years and older, with the prevalence of current cigarette use dropping from 13.0% in 2019 to 12.0% by 2021. Part of this decrease was due to a reported 56.8% relative decrease in smoking among black men. However, with a 58.6% relative increase in smoking among black women and an equal prevalence of smoking among both genders in 2019, the menthol cigarette ban led to a net increase in smoking among black adults in Massachusetts. 

The authors’ approach involved a difference-in-differences analysis, looking at whether the changes in smoking for various populations in Massachusetts differed from other states throughout the country after the menthol cigarette ban. Referencing individual-level data from the Behavioral Risk Factor Surveillance System (BRFSS) survey, Asare et al. created state-level estimates for the prevalence of current smoking from 2017 to 2021. However, the significant percentage change estimates for the black population are suspicious. As a technical matter, the Centers for Disease Control and Prevention (CDC) instruct researchers to estimate prevalence from the BRFSS with survey weights in combination with strata and primary sampling units (PSUs). Still, the supplementary section makes no mention of strata or PSUs. Regardless, the observed net increase in smoking among black adults, instead of a significant decrease, considerably departs from what researchers expected.

These results undermine the saliency of tobacco flavor ban policies, especially menthol cigarette prohibitions. Like illicit drugs, the black market organizes to fill the void when regulated sellers can no longer legally provide products. In the case of Massachusetts, surrounding states, like New Hampshire, have a cigarette tax that is almost half of that in Massachusetts. This means that when the black market was able to organize, in many circumstances, it could buy cigarettes in New Hampshire and offer buyers in Massachusetts cigarettes at a lower price relative to the previous pre-menthol ban market, which increased access to cigarettes overall.

Much of the original motivation to pursue a menthol cigarette ban was to try to achieve “health equity,” which meant addressing disparities in health between black and white Americans. Although black adults and youth have historically smoked less than whites, the medical literature often reports that they “suffer disproportionately from tobacco-related diseases compared to non-Hispanic whites.” These observations have led influential public health institutions to advocate for menthol cigarette bans, hoping to reduce smoking in the black community further to improve health outcomes. 

But, with the flavor ban in Massachusetts leading to more cigarette sales in the region and an increase in smoking among black women, it seems clear that menthol prohibitions are ineffective mechanisms for improving public health in the black community. Instead, public health officials should promote safer alternatives to combustible cigarettes, such as e-cigarettes, which have proven effective in helping smokers quit.

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Chairperson Griffith and members of the committee:

My name is Michelle Minton, and I am a senior policy scholar at the Reason Foundation, a 501(c)(3) nonprofit, nonpartisan public policy research organization. As an expert in public policy, a Maryland resident, and former smoker, I am grateful for the opportunity to submit my testimony regarding the proposed prohibition of flavored tobacco products.

The aim of the proposed prohibition to reduce adult smoking and discourage youth initiation of any tobacco or nicotine product is a laudable one. However, based on science and historical evidence, we fear this proposal will not achieve its goal, but rather lead to greater health disparities and criminal justice inequities while radically increasing the size and danger of the illicit tobacco market.  

There is no question that smoking is deadly, but guilt by association is a poor foundation for government policy. Lumping everything under the definition of “tobacco” doesn’t change the scientific fact that noncombustible sources of nicotine (such as patches, gums, e-cigarettes, and snus) are vastly less harmful than the combustible cigarettes that will continue to be freely available throughout our state. Treating products that pose less than five percent of the risk of smoking the same as deadly combustible cigarettes, which kill half their users, is simply bad health policy.  

This proposal would prohibit the sale of any flavored tobacco product, including non-combustible, and, therefore, less harmful substitutes for cigarettes. This would include the flavored versions of products, like snus, on which many adults in Maryland rely to stay smoke-free and the availability of which the U.S. Food and Drug Administration (FDA) has deemed to be in the best interests of public health. If this proposal is enacted, Maryland would outlaw, under criminal penalty, the sale of safer products that exist now or will exist in the future.  

Youth

As with nearly all prohibitions, SB 259 is predicated mainly on the need to protect youth. While concern over youth experimentation with or the use of nicotine-containing products is worthy of attention, lawmakers should recognize that most youths do not use any form of tobacco at all.  Recent data from the Centers for Disease Control and Prevention (CDC) indicates that less than two percent of youth currently smoke, and just over 14 percent use e-cigarettes. 

In 2021, the Maryland Youth Risk Behavior Survey found that just 11 percent of Maryland high schoolers reported the use of electronic cigarettes, with the highest prevalence among white students (15 percent compared to 5 percent among black students), a significant decline from 2018  when 23 percent of high school students in Maryland reported any past-month e-cigarette use. 

Outlawing legal sales of flavored e-cigarettes and other products is unlikely to make more progress for several reasons. First, the research continues to indicate that youth do not initiate vaping because of flavors. CDC surveys show the main reason youth cite for vaping is “curiosity,” followed by peer influence or family members. The results are similar for Maryland, with 39 percent of youth citing “curiosity” as their reason for using electronic cigarettes, followed by 19 percent who said they used them because a friend or family member does. Flavor availability was cited by just 9 percent of Maryland youth as the reason they use them.

Second, most youths do not acquire the tobacco products they use from licensed retailers, but rather from friends, family, or illicit sources. For example, of the 23 percent of Maryland youth who indicated current e-cigarette use in 2018, nearly half said they got them by borrowing them from a friend.

Given the current size of the illicit tobacco market and the massive increase we expect to occur in the wake of a menthol cigarette ban, the current proposal may unintentionally provide youth with greater access to flavored tobacco products through illicit dealers who typically do not verify the ages of their customers. Moreover, youth who do avail themselves of the illicit market may have greater access not just to tobacco, but other substances as well. For example, when the Department of Justice arrested two brothers in Baltimore for conspiracy to traffic $6.6 million worth of contraband cigarettes, they were also found to be dealing in illicit oxycodone.

Illicit suppliers may also choose to make their own flavored tobacco products instead of buying them where they are legal and transporting them to Maryland. With regard to menthol cigarettes,  this task would be exceedingly simple, requiring nothing more than a would-be trafficker to legally purchase unflavored cigarettes and add menthol-flavoring with flavor beads, eucalyptus oil, sprays, and numerous other methods, the safety of which depend entirely on what is used as a flavoring agent. If this prohibition is enacted, Maryland lawmakers should probably be prepared for another outbreak of “vaping-related” lung injuries as we saw in the illicit market for cannabis oil vaping cartridges during the summer of 2019.

Lastly, laudable as the desire to prevent youth tobacco use may be, research suggests that banning flavored tobacco products may result in the perverse outcome of increasing youth smoking. For example, Yale University’s Abigail Friedman found that after the city of San Francisco enacted its ban on all flavored tobacco products in 2018, youth in San Francisco were twice as likely to smoke compared to adolescents in similar jurisdictions without such bans.

Illicit Sales  

Supporters of this and similar prohibition proposals argue that outlawing products for which there is significant demand, particularly among Marylanders of color, will not lead to increased illicit tobacco trafficking nor cause increased interactions with law enforcement. But the experiences of other jurisdictions which have attempted similar bans, as well as Maryland’s own experience with drug prohibition, make such assertions hard to believe.  

The harm or benefit of any prohibition largely depends on how those living under it respond.  With regard to this proposal, some current users of flavored tobacco may respond by quitting tobacco use altogether, eliminating the risks to those individuals. However, according to the Food and Drug Administration’s own analysis of its proposed national menthol cigarette ban,  around half will simply switch to equally non-menthol cigarettes, conferring zero health benefits. Moreover, the federal government estimated that roughly half of the public health benefits anticipated by outlawing combustible menthol cigarettes would come as a result of smokers switching to flavored non-combustible products, which Maryland’s proposed prohibition would also outlaw.

In Maryland, menthol cigarettes account for about half of all cigarettes sold in the state. Even without including all of the other flavored tobacco products, this represents a significantly-sized market which, if this proposal is enacted, would be pushed into the arms of the unlicensed tobacco dealers already operating in our state. Rather than encouraging healthier behaviors from  Maryland residents, this could increase risks to their welfare, increase enforcement costs, and divert millions in tax revenue to other states and criminal operations.  

Case Study: Massachusetts 

Massachusetts implemented the country’s first state-wide ban on flavored tobacco products in  June 2020. My colleague Jacob Rich, a policy researcher for both Reason Foundation and the  Center for Evidence-Based Care Research at the Cleveland Clinic, analyzed the ban’s impact by comparing cigarette sales in Massachusetts before and after its implementation. His analysis of national cigarette sales data shows that in the year following the prohibition, sales of menthol and non-menthol cigarettes declined in Massachusetts. However, sales in bordering counties increased, leading to a net overall increase in cigarette sales within the region of approximately 7.2 million packs. This indicates that the ban in Massachusetts merely diverted current menthol smokers to equally harmful non-menthol cigarettes and pushed sales of both menthol and non-menthol cigarettes to neighboring states.  

The result was no decrease in overall tobacco use and $125 million lost tobacco tax revenue for  Massachusetts. In Maryland, tobacco trafficking is likely to be significantly worse than in Massachusetts, given our residents’ proximity and access to neighboring states which do not yet outlaw flavored tobacco.  

Public Health 

The FDA acknowledges a “continuum of risk” for the variety of tobacco and nicotine products currently on the market, with cigarettes being the most dangerous and non-combustible alternatives,  such as snus, e-cigarettes, heated tobacco, and nicotine pouches, being the least dangerous. The FDA  has already authorized some of these products, deeming their availability to be in the best interest of public health, and allowed some to even be marketed as reduced-risk substitutes for smoking.  

The proposal before this committee would unnecessarily strip adults in Maryland of access to these  FDA-authorized and potentially life-saving alternatives, now and in the future.  

According to a 2020 study by Yale School of Public Health researchers, e-cigarette flavors are positively associated with smoking cessation outcomes for adults but not associated with increased youth smoking. Moreover, the prestigious Cochrane Review concluded that e-cigarettes are more effective than traditional nicotine replacement therapies in helping smokers quit smoking cigarettes. Criminalizing the sale of flavored e-cigarettes in Maryland, which are overwhelmingly preferred by adult vapers, risks driving users of these alternatives back to smoking while also fueling illicit tobacco markets, causing net harm to our state’s public health, social welfare, and economic well-being.  

Nicotine is not risk-free and the interest in preventing youth uptake is understandable. We all want to see fewer people smoking and fewer youth experimenting with tobacco. But the desire to protect adolescents from all risks, even those that are relatively small, does not justify at-any-cost measures like the one currently under consideration. Regulators must show regard for the needs of other populations, including youth once they reach adulthood, and consider the harm such laws may have on their welfare.  

If Maryland’s state and local authorities are competent enough to regulate flavored alcohol and soon-to-be-legalized flavored cannabis in ways that preserve adults’ ability to purchase them safely and legally without encouraging youth use, they should be similarly capable of limiting the sale of flavored nicotine products to adults in Maryland, especially when they offer current and future smokers in the state a life-saving alternative to combustible cigarettes. 

The post Testimony: Maryland Senate Bill 259 would lead to greater health disparities and criminal justice inequities appeared first on Reason Foundation.

The ban has served as a test for what other states and municipalities might expect if they enact similar prohibitions on flavored tobacco products. Although officials often promote tobacco control policies as ways to protect public health, the unintended consequences of menthol cigarette bans on total cigarette sales have puzzled many public health officials and raised important questions about the effectiveness of the prohibitions.

In my analysis of the comprehensive flavored tobacco ban implemented in Massachusetts, the data show that the prohibition of menthol cigarettes was followed by millions of additional cigarette sales in the six-state region of Massachusetts and its bordering states. The year following the ban on menthol cigarette purchases saw 15 million fewer packs of menthol cigarettes sold than the year before the ban. However, approximately 22 million additional packs of nonmenthol cigarettes were sold in those states in the year after the flavor ban, leading to a net increase in cigarette sales.

In the 12-month period following the implementation of the comprehensive flavor ban in Massachusetts, the state sold 29.96 million fewer (22.24% less) cigarette packs compared to the prior year. However, a total of 33.3 million additional cigarette packs were sold during the same post-ban period in the counties that bordered Massachusetts in the states of Connecticut (3.05 million additional packs), New Hampshire (25.84 million), New York (1.04 million), Rhode Island (6.01 million), and Vermont (1.21 million). Thus, considering the change in cigarette sales in the entire six-state region, there was a net increase of 7.21 million additional cigarette packs sold in the 12 months after the menthol cigarette ban in Massachusetts, a 1.28% increase in cigarette sales compared to the prior 12-month period before the ban.

A paper by Samuel Asare et al. (2022) published in JAMA Internal Medicine publicized a reduction in cigarette sales in Massachusetts following the menthol cigarette ban but failed to include all but one of the bordering states in its analysis. Additionally, the paper analyzed Nielsen Retail Scanner data, which only represented approximately 30% of all US mass merchandiser sales volume that year. In contrast, the Management Science Associates Inc (MSAi) data in my analysis represents all cigarette distribution throughout the entire US.

In conclusion, policymakers must be careful about enacting prohibitions for a variety of reasons, including when the banned product is still available for sale in nearby municipalities. This is especially true when tax rates in neighboring states are relatively low. In 2020, the sales tax for cigarettes in New Hampshire ($1.78 per pack) was approximately half that of Massachusetts ($3.51 per pack), which further incentivized bulk purchases of cigarettes and allowed for a sizeable smuggling market for black market sellers after the flavored tobacco ban was implemented. 

With similar flavored tobacco prohibitions being proposed in states like Maryland, which currently has a cigarette sales tax of $3.75 a pack, policymakers should keep in mind that neighboring Virginia has a much-lower sales tax of $0.60 per pack and that the cross-border smuggling of cigarettes would inevitably follow a menthol cigarette prohibition in Maryland.

The data from Massachusetts and neighboring states show the menthol ban did not stop people from buying cigarettes, with sales increasing by seven million packs in the year after Massachusetts’ flavored tobacco ban. Massachusetts’ flavored tobacco ban primarily sent buyers to others states and illicit markets, so other cities and states should consider the real-world impacts of implementing similar prohibitions.

The post The effect of menthol bans on cigarette sales: Evidence from Massachusetts  appeared first on Reason Foundation.

New York already enjoys the dubious honor of having the highest rate of illegal cigarette smuggling in the country. More than half of all cigarettes smoked in New York come from smuggled sources. The black market sales cost New York an estimated $1 billion dollars a year in tax revenue, according to the Tax Foundation.

Banning menthol cigarettes would put rocket boosters under the illicit tobacco market and reduce the state’s tax revenues. That’s what happened when Massachusetts banned flavored tobacco. One year after Massachusetts’ 2020 ban on menthol cigarettes was implemented, nearly 30 million fewer packs of cigarettes were sold in the state, Reason Foundation’s Jacob James Rich found. But, as smokers sought their preferred products elsewhere, 33 million additional cigarette packs were sold in bordering states than were sold the year before Massachusetts’ ban.

There’s no doubt the governor has been sold on good intentions and the virtues of prohibition. Advocates claim that menthol cigarettes are more addictive, easier for kids to start using, and harder for smokers to quit. But none of these claims are true.

Research shows menthol smokers tend to start smoking later in life and smoke fewer cigarettes per day than non-menthol smokers. States that have higher rates of adult menthol smoking relative to non-menthol smoking actually have lower youth smoking rates. Research from Vanderbilt University Medical Center, published in the Journal of the National Cancer Institute, found no statistically significant difference in successful quit rates between menthol and non-menthol smokers. There was also no difference in the quit rates between Black and white smokers.

Supporters of prohibition claim a menthol ban is needed to tackle smoking in the Black community because the majority of Black smokers choose menthol products. But the Black youth smoking rate in New York is just 4.2%, while the white youth smoking rate is 4.4%. For adults, white New Yorkers are the most likely to smoke at 12.9% compared to the 11.3% of Black New Yorkers who smoke. Given menthol and nonmenthol cigarettes are equally toxic, it’s odd that one should be singled out over the other. Gov. Hochul isn’t advocating for banning products preferred by the largest group of smokers in the state — white New Yorkers.

It’s also a sad irony that Hochul is pursuing this policy when New York City was where Eric Garner was pointlessly killed by police during an arrest for selling untaxed cigarettes in 2014. Last year, the mothers of Garner and Trayvon Martin, and George Floyd’s brother pleaded with the Biden administration not to ban menthol cigarettes nationwide.

Yet supporters of menthol prohibition frequently cloak the ban in the language of equity. It’s an eccentric argument to claim that banning sales of cigarettes favored by Black smokers while the preferred choice of white smokers remains legal is the most equitable policy when they smoke at similar rates. There are uncomfortable tinges of the government’s unjust sentencing differential that hurt minority communities by mandating harsh sentences for crack cocaine and lighter sentences for powder cocaine, which had disparate use rates but similar risks, just like menthol and nonmenthol cigarettes.

Few issues unite conservatives like Grover Norquist of Americans for Tax Reform with progressives like the Rev. Al Sharpton and the American Civil Liberties Union, but opposition to menthol bans is one of them. Whether viewed through the lens of individual choice or social justice, Hochul’s proposed prohibitions can be relied upon to unite a diverse coalition of opponents.

Gov. Hochul should abandon the proposed ban. Youth smoking is at its lowest rate in decades and has almost disappeared in the state. With safer nicotine alternatives making traditional smoking increasingly obsolete, public health can continue to improve without a menthol ban that would surely bring negative racial justice implications and usher in criminal punishments that would disproportionately impact New York’s minority communities.

A version of this column first appeared in the New York Daily News.

The post New York shouldn’t ban flavored tobacco products appeared first on Reason Foundation.

Public polling indicates many American smokers say they want to quit using combustible cigarettes. Despite the existence of tobacco control policies and traditional cessation methods, 30.8 million adult smokers remain, many of whom have not tried to quit or have not quit successfully. For this population of smokers, a suite of safer nicotine alternatives such as e-cigarettes, nicotine pouches, snus, and heat-not-burn products may succeed in helping them quit where other policies have failed.

Traditional tobacco control strategies such as education, taxation, marketing restrictions, and bans on smoking in a growing list of public spaces have contributed to a gradual reduction in the smoking rate from its peak of around 40 percent in the mid-1960s to 12.5 percent today. Safer nicotine alternative products are a newer, yet crucial, component of a tobacco harm reduction strategy, giving those smokers who would not otherwise have quit a way to use nicotine without the smoke that may kill them. A substantial body of evidence demonstrates that these tools are more effective in helping smokers quit than traditional cessation methods, such as nicotine replacement therapies (NRTs), and are vastly less harmful to human health than combustible tobacco. 

To maximize these products’ potential to help improve public health while limiting youth access and uptake, Congress, the U.S. Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC) must ensure consumers have access to these products at reasonable prices and are accurately informed about their risk relative to cigarettes. 

Correcting misperceptions

Millions of Americans have successfully switched from combustible cigarettes to safer nicotine alternatives. While the overall smoking rate has declined to a generational low, smoking remains disproportionately high among low-income communities, people without college degrees, and those with mental health problems.

A substantial barrier preventing greater uptake of safer alternatives to cigarettes is the widespread misperception among a majority of the public and physicians that these products are just as dangerous or more dangerous than combustible cigarettes.

For example, though the spate of lung injuries and deaths that occurred in 2019 were quickly linked to the proliferation of adulterated cannabis vapor products, public polling suggests a majority of adults attribute the outbreak to nicotine vapor products.

In Dec. 2022, a group of public health experts urged the CDC to correct rampant misinformation regarding the dangers of e-cigarettes. Speaking to the Associated Press in 2022, the Director of FDA’s Center of Tobacco Products (CTP) Dr. Brian King said there were widespread misperceptions around the use of e-cigarettes.

“I’m fully aware of the misperceptions that are out there and aren’t consistent with the known science,” King said. “We do know that e-cigarettes — as a general class — have markedly less risk than a combustible cigarette product.”

But, as of now, it appears the FDA has no plans to correct these misperceptions.

Congress can contribute to communicating clear and accurate information on the relative risks of noncombustible products and potential benefits for adult smokers who switch to these products. Unfortunately, the FDA and the CDC are currently falling short of this mission, and neither agency has outlined any plans to address the problem. It is the responsibility of Congress to hold both to account.

Reagan-Udall Foundation evaluation

After a series of missteps handling e-cigarette product applications, FDA Commissioner Robert Califf asked the Reagan-Udall Foundation (RUF) to evaluate the FDA’s tobacco program. RUF was established by Congress “to advance the mission of the FDA to modernize medical, veterinary, food, food ingredient, and cosmetic product development, accelerate innovation, and enhance product safety.”

In Dec. 2022, the Reagan-Udall panel delivered its verdict on FDA’s performance. The report found several failings at the FDA, including opacity and confusion regarding the agency’s refusal to authorize safer nicotine products. 

In 2009, Congress passed the Tobacco Control Act, which established a pathway for authorizing safer nicotine products, ensuring tobacco harm reduction could play some role in reducing smoking rates. But in practice, the process has created a functional barrier to entry for legitimate companies and products, costing vast sums of time and money per application and leaving applicants unsure of what materials they need to provide for a successful application. In the meantime, the vapor market, bereft of FDA-authorized options, has been flooded with illegitimate products in order to fill the vacuum.  

In particular, RUF’s report called on the FDA to define what is “appropriate for the protection of health,” a central factor in determining whether to authorize new products. The evaluation also called on the FDA to develop and implement a comprehensive plan for the Center of Tobacco Products’ goals and priorities, greater transparency, engagement with industry stakeholders, clarity on when FDA decisions prioritize public policy or political concerns rather than the strength of the underlying science, removing illicit products from the market, and simpler processes for authorizing certain novel products that may benefit individual and public health. Congress should closely monitor the FDA’s efforts to implement RUF’s recommendations and, if it refuses to do so, investigate why.   

Taxation

Research shows e-cigarettes are substitutes, not compliments to traditional cigarettes. There are good reasons to tax combustible cigarettes, such as recouping costs to the health care system attributable to smoking-related diseases and discouraging youth smoking. But since noncombustible nicotine products, like e-cigarettes and other reduced-risk products, present significantly less danger to consumers and offer a net benefit to public health if smokers switch from cigarettes, sound public policy dictates that these products should be taxed at a significantly lower rate than cigarettes, if at all. 

In the last Congress, there were attempts to introduce the first federal e-cigarette tax, which would’ve set the tax to be equivalent to the tax on cigarettes. According to modeling from Georgia State Univerity Professor Michael Pesko, the tax would have resulted in fewer adult e-cigarette users and an increase of 2.5 million more smokers than there would be otherwise. Taxing less harmful products at a level equal to or higher than the most deadly products provides a clear disincentive for smokers to switch, thus resulting in net harm to public health. Additional federal taxes on e-cigarettes and other harm reduction taxation tools would prevent a significant number of smokers from switching, harming public health, and should be resisted. 

Conclusion

Innovation presents promising opportunities to improve public health and support small businesses. While the economic benefits are secondary to the public health benefits, in 2019, The Washington Post reported that vape shops were the fastest-growing U.S. retail segment of the previous decade. Unfortunately, many of these stores have already been forced to shut their doors over the past three years in large part due to the flood of misinformation about these products and the byzantine regulatory process the FDA has yet to fix.

A sound regulatory framework for safer alternatives to cigarettes would ensure these harm reduction options are available to the consumers who need them at reasonable prices while still limiting the access young people have to them. Ensuring the FDA and the CDC are supporting, rather than hampering this public health objective is a sure way Congress can bear down on the public health toll of smoking. 

The post Tobacco harm reduction should be on Congress’ agenda appeared first on Reason Foundation.

Thank you for the opportunity to testify today. My name is Jacob James Rich, and I am a researcher at the Cleveland Clinic Center for Value-Based Care Research pursuing my Ph.D. at the Case Western Reserve University School of Medicine. I am also a health care policy analyst at Reason Foundation, a 501(c)3 nonprofit policy research organization. I write academic research on how to reduce tobacco use and was recently awarded Case Western’s Diversity, Equity, and Inclusion (DEI) award to pursue research that addresses health disparities among marginalized populations.

The potential regulation of flavored tobacco in the city of Columbus is designed to reduce tobacco use, particularly among communities of color. Given that rates of lung disease among black Americans are higher than other populations, even amid lower rates of historic tobacco use, pursuing interventions to reduce smoking rates in this population should be applauded. However, there is little evidence that comprehensive tobacco flavor bans significantly reduce rates of smoking among adults or youth, and the criminal justice implications of a menthol ban may, in fact, further exacerbate health disparities in the black community.

Policymakers should be concerned about the differential racial impact of this regulation. Menthol cigarettes are preferred by the black population. Therefore, a menthol cigarette ban would likely allow most white people to freely and legally continue to smoke their preferred cigarettes, while communities of color would need to either travel outside city limits or source from unlicensed cigarette providers. This could be disastrous, as it may increase police officer confrontations and increase the number of street sellers who are more likely to sell cigarettes to young people.

Additionally, in just about every way possible, nonflavored cigarettes cause much more harm in the United States than menthol cigarettes. First, more people smoke nonflavored cigarettes than menthol cigarettes — both adults and youth. Second, people who smoke menthol cigarettes tend to smoke fewer cigarettes a day. Given these considerations, nonflavored cigarettes are typically the more addictive product, so a true public health approach would prioritize controlling nonflavored cigarettes. It is also not clear that the regulation will even reduce smoking.

Case Study: Massachusetts Comprehensive Tobacco Flavor Ban

On June 1, 2020, Massachusetts implemented a tobacco flavor ban. I authored an analysis that compared cigarette sales in Massachusetts after the flavor ban to the year prior to the ban, finding millions of additional cigarette sales in and around Massachusetts when combined with its bordering states. It is true that menthol cigarette bans reduce cigarette sales locally. However, if surrounding localities have lower cigarette taxes — just like they did near Massachusetts and do near Columbus — total cigarette sales actually tend to increase as residents drive across borders and buy cigarette cartons in bulk.

Conclusion

In conclusion, flavor bans at the local level have little effect on public health and potentially disastrous consequences for communities of color. Massachusetts has already conducted multiple raids after implementing its flavor ban, mostly in communities of color. I urge the city of Columbus to collaborate with community members in determining an inclusive approach to improving health outcomes among its historically marginalized populations.

Thank you for your time and consideration.

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I want to thank the expert panelists for including this public dialogue as part of their evaluation of the U.S. Food and Drug Administration (FDA). I would also like to make it clear that my interest in this conversation is not to advocate for or against any particular product or company. My interest is in people, the individual human beings whose lives can be drastically affected, for good or for bad, by the way government agencies approach regulation. It is people who are at the heart of the discussion about tobacco regulation and this investigation into how well the FDA is fulfilling its public mission. 

While there is no shortage of debate when it comes to how tobacco products should be regulated, there is widespread agreement that the current approach adopted by the FDA is not working. The enormous challenge facing the experts on the panel is to shed light on why that is the case and what can be done to fix it for the benefit of the public. To that end, I offer the following comments, and I hope they will bring some sober clarity to a controversial issue. 

The overarching message I would like to communicate is this: Unless there is a viable pathway for safer products to enter the market legally, there will be no innovation toward safer products, and we will continue to condemn the millions of current and future adults who enjoy the non-medical use of nicotine to one of two undesirable options—illicit market products or deadly combustible cigarettes. 

Challenge #1: A comprehensive approach to tobacco and nicotine regulation that is principles-based, reasonable, and implemented consistently across all programs

For nearly every other risky or potentially harmful behavior, we recognize that incentives matter. It is generally acknowledged that regulation cannot prevent risk, but it can encourage markets and people to be as safe as possible. Seatbelts, helmets, electric vehicles, contraception, pre- and post-exposure prophylaxis, ridesharing, opioid maintenance therapy, and Narcan are just a few examples of how the market, unhindered by regulation, has provided means to reduce the potential harm of risk-taking behaviors, both for the individuals engaging in that behavior and for those around them. 

Yet, when it comes to tobacco, the FDA, whether accidentally or not, has adopted an approach that maximizes, rather than minimizes, harm. Instead of promoting public health through a regulatory process that champions innovation, the agency has made it all but impossible for such innovation to occur or, at least, for the products of innovation to make it into consumers’ hands.

The result is that, unlike all other areas of our lives, FDA regulation has preserved and protected the most dangerous form of nicotine use, smoking combustible cigarettes, from extinction. 

This is, in part, because the regulatory framework was structured around cigarettes with the goal of suppression. Unfortunately and unsurprisingly, this framework has made it impossible for truly novel products to enter the market. Many see this blockade of new nicotine products as a positive outcome, but the perverse unintended effect is that it is still easier for combustible cigarettes to gain FDA authorization than the safer products that could displace them. Worse, it leaves consumers who already rely on less harmful forms of nicotine use frustrated and most of the public confused about the relative risks and benefits of various products.  

It doesn’t have to be this way and, for a moment in 2017, it seemed the FDA recognized the need to modernize its approach in response to the market’s rapid shift toward tobacco harm reduction. In that year, the agency announced its comprehensive plan for tobacco and nicotine regulation which recognized that tobacco products exist on a continuum of risk, that nicotine, while not risk-free, is not the main source of tobacco-related mortality or morbidity, and acknowledged that in the best interest of public health, the agency’s approach to reducing the harms caused by smoking required an equal effort to promote less harmful alternatives.  

This plan, had it been implemented, would have likely addressed many of the challenges the FDA now must address. Unfortunately, while the agency has taken steps to reduce the appeal of combustible cigarettes, it has apparently abandoned its promise to promote the development of and consumer access to safer nicotine alternatives. And the continued failure of the FDA to adhere to any sort of comprehensive approach could have disastrous consequences. Take, for example, the FDA’s proposed prohibition on menthol as a characterizing flavor in combustible cigarettes and cigars. 

The goal of the proposed menthol ban is to reduce the appeal of combustible cigarettes, used disproportionately by people of color. According to the FDA’s calculations, the ban would result in less initiation of cigarettes by youth, increase smoking cessation among adults, and lead to better health outcomes in many populations.

Those calculations, however, were based on certain assumptions about how consumers might respond to such a ban, given the other options available to them. Surprisingly, a great amount of the health benefits the FDA expects a menthol ban to produce, upwards of half, come from consumers replacing combustible menthol cigarettes with mentholated versions of noncombustible e-cigarettes. The problem with this is that few menthol smokers will have this option as the FDA has so far not authorized a single mentholated e-cigarette and has given little reason to believe they ever intend to do so. 

Recommendations for FDA: 

• Issue an updated comprehensive approach to tobacco and nicotine that is principles-based, reasonable, and implemented consistently across FDA programs to guide regulation and research. In addition to the 2017 plan, we suggest they refer to the Institute of Medicine’s 2001 Clearing the Smoke report. 

Challenge #2: Compliance standards that are clear, transparent, and predictable

In the first public meeting the Reagan-Udall Foundation held on this topic, one of the stakeholders expressed his belief that tobacco manufacturers, including those of lower-risk nicotine products, have no interest in being regulated and have intentionally submitted deficient pre-market tobacco applications in order to slow down enforcement by the agency. 

But within the nicotine alternatives market are thousands of small businesses who desperately want to understand what the FDA wants from them in order to approve their products for legal sale and reasonable regulations that would protect their companies, as well as the entire market, from bad actors. 

The problem is not that the industry doesn’t want to comply with FDA regulations, the problem is that they cannot. By constructing an opaque and seemingly arbitrary pre-market authorization process and by failing to set reasonable standards, the FDA has created regulatory hurdles too high for all but the largest tobacco makers to surmount. 

Recommendations for FDA: 

• Set clear and consistent standards, requirements, and thresholds.
• Provide detailed definitions for critical terms like “appropriate for the protection of public health” and disclose how those definitions are calculated or determined.
• Be more transparent, cooperative, and flexible; convening meetings for public discourse, workshops, and unbiased explanations for its decisions and conclusions.

Challenge #3: A more appropriate balance between innovation, risk, and the needs of various populations

The FDA’s interest in preventing potentially harmful products from entering the market is understandable. However, aversion to this risk must not come at the expense of squashing innovation that could have a positive net benefit to public health. Nor should the agency’s aversion to the small potential risks presented by new products blind the FDA to the potential risks caused by a market that is too tightly regulated that it spurs the proliferation of illicit markets or denies consumers potentially life-saving alternatives.

Similarly, the FDA’s concern about youth experimentation and initiation with novel nicotine products is reasonable. But that concern should not lead to decisions made at the expense of current and future adult smokers. The FDA certainly has a role to play in addressing the population-level risks associated with novel tobacco products, but unlike matters such as those relating to product safety, these concerns do not justify the existing bottleneck created by the FDA’s onerous pre-market approval regime.

Challenge #4: More efficient pathways to the authorization of lower-risk products

Many of the challenges faced by the FDA’s Center for Tobacco Products (CTP) in recent years stem less from resource limitations than they do from choices regarding implementation and priority-setting.

The FDA has thus far given marketing orders to just a handful of noncombustible products, the vast majority of which are owned by large tobacco firms. This will continue to be the case so long as the approval process remains onerous, slow, and wasteful. Other nations have structured regulations based on standards and thresholds, which make compliance and, more importantly for the FDA, verification a far easier and less resource-intensive task.

The results of this standards-based approval regime are vibrant markets, with devices and flavors that meet consumers’ needs, without the problems of youth experimentation that have so vexed U.S. health authorities. Adopting a similar standards-based approach, with streamlined pathways, categories for products and components, and a substantial equivalence for novel lower-risk products would allow companies (as well as the FDA staff) to conduct more efficient reviews, ensuring that the rules encourage compliance, protect the public, and leave nobody behind. 

Recommendations for FDA

• Use rulemaking power to establish streamlined Premarket Tobacco Product Application (PMTA) pathways for non-combustible products rather than forcing those products likely to be significantly less harmful than smoking to an outdated pathway even more onerous than for combustible cigarettes.
• Create a standards-based regime, with a small number of reasonable criteria for products the FDA would approve, similar to how regulation occurs in France and the United Kingdom.
• Create a substantial equivalence pathway for novel lower-risk products. This could be accomplished by “deeming” all those products which have or will receive marketing orders by the FDA as “predicate” on a rolling basis.
• Create a definition for “minor” changes as opposed to “significant” changes and created a streamlined approval process for minor changes (such as those relating to packaging, container size, and other modifications not expected to increase the potential risk of the product).
• Conduct periodic performance reviews to assess how well FDA regulation is working for consumers of reduced-risk products, based on turnaround for applicants, number of approvals for sufficient applications, and market dynamism.
• Hold public meetings with small industry participants to inform such performance reviews.

The post Testimony: FDA regulation has preserved and protected the most dangerous form of nicotine use—smoking combustible cigarettes appeared first on Reason Foundation.

Reason Foundation’s policy analysts are examining statewide ballot initiatives on issues related to consumer freedom, including, sports gambling, flavored tobacco and e-cigarettes, wine and alcohol sales, and more.

California Proposition 26 (2022): In-person sports betting regulation and tribal gaming expansion

California Proposition 27 (2022): Legalizes online sports betting, funds homelessness and mental health programs

California Proposition 31 (2022): Banning flavored tobacco products

Colorado Initiative 96 (2022): Concerning liquor licenses

Colorado Initiative 121 (2022): Sales of wine in grocery stores

Colorado Initiative 122 (2022): Third-party delivery of alcoholic beverages

Maryland Question 4 (2022): Marijuana legalization amendment

Voters’ guides for other states and policy issues can be found here.

The post The 2022 ballot initiatives about consumer freedom issues appeared first on Reason Foundation.

On August 28, 2020, California Gov. Gavin Newsom signed into law a ban on the sale of flavored tobacco products. California Senate Bill 793 bans menthol cigarettes, e-cigarettes in flavors other than tobacco, as well as oral tobacco products. Exceptions were made for hookah, premium cigars, and pipe tobacco. Retailers selling flavored tobacco products may be subject to a $250 fine for each sale. Proposition 31 on California’s November 2022 statewide ballot seeks to overturn that law, SB 793, so that the sale of flavored tobacco would remain legal in the state. 

Fiscal Impact

“Proposition 31 likely would reduce state tobacco tax revenues by an amount ranging from tens of millions of dollars per year to around $100 million annually,” according to the Legislative Analyst’s Office (LAO).

If a substantial number of smokers quit because of the ban, it could engender some savings to the state’s health care system. On the other hand, the LAO points out that if these smokers quit and live longer, it could increase the government’s health care costs. “Given the possibility of both savings and costs, the resulting long-term net impact on government health care costs is uncertain,” LAO concludes.

Arguments in Favor

Supporters of a ‘yes’ vote to uphold the law passed by the state legislature and signed by the governor include California Gov. Gavin Newsom, Campaign for Tobacco-Free Kids, American Cancer Society Action Network, California Teachers’ Association, and many others.

Proponents of prohibition argue flavors such as menthol in combustible cigarettes, sweet and fruit flavors in e-cigarettes, oral tobacco, and little cigars are targeted to and disproportionately impact young people and minorities.

In the case of menthol cigarettes, supporters of the law observe that around 85 percent of black smokers use a menthol cigarette, compared to a little more than a third of white smokers, with the tobacco industry gearing its marketing of menthol cigarettes toward black Americans. It’s also alleged that menthol cigarettes are especially appealing to young people because menthol acts as a cooling agent masking the harsh taste of burnt tobacco allowing new smokers to become hooked easier than they would if they tried a regular cigarette.

Regarding flavored e-cigarettes, the sweet flavors and fruit e-liquids are claimed to be responsible for the upswing in youth vaping that California and the rest of the country experienced beginning in 2017. Supporters of prohibition argue these flavors are hooking a new generation of kids on nicotine. Banning flavors, proponents claim, would help reduce the number of young people trying tobacco products and cause a substantial portion of adult smokers and vapers to quit nicotine for good.  

Arguments Opposed

The groups arguing for a ‘no’ vote on Prop. 31 include companies in the tobacco industry, the Howard Jarvis Taxpayers Association, and the Republican Party of California.

Opponents of the bans argue that the increase in the tobacco age to 21 in 2020 has already substantially reduced youth access to tobacco products. While the desire to protect youth may be well-intentioned, opponents say the laws would primarily affect adult tobacco users who enjoy flavors and argue that adults should have the right to choose whether to use these products just like with alcohol and marijuana.

They also say there is an unfairness to the legislation since hookah, pipe tobacco, and premium cigars are exempted.

The opponents warn that prohibition would have a negative financial impact on small businesses operating on tight margins. The ban would transfer flavored tobacco sales to the black market, which would mean not just a loss of tax revenue for California.

A ban would also entail criminal enforcement, which brings with it the possibility of increased targeting of minorities by law enforcement, opponents note. The ban on flavored e-cigarettes is also problematic from a health care standpoint because e-cigarettes are safer than combustible cigarettes and limiting access to these products could cause many vapers to relapse to smoking and prevent some smokers who would otherwise have switched from doing so, limiting tobacco harm reduction. 

Discussion

The claims made against menthol cigarettes in California mirror the arguments that were made to the Massachusetts legislature when it was considering a ban on flavored tobacco in 2019. To date, Massachusetts is the only state in the country to have implemented a comprehensive flavored tobacco ban.

According to a pre-print (not yet peer-reviewed) analysis by Reason Foundation Policy Analyst Jacob Rich, one year after the ban, menthol sales within Massachusetts did decline dramatically. But the sales of non-menthol cigarettes within Massachusetts increased substantially. There was also a dramatic rise in cigarette sales in the states bordering Massachusetts. The entire six-state region near Massachusetts reported a net increase in cigarette sales of 7.21 million packs compared to the year before the state ban came into effect. According to the Tax Foundation, the ban also cost Massachusetts $125 million in tax revenue in its first year.

When adult products are relegated to the illegal market consumers often respond by seeking out these products or substitutes on the black market, presenting opportunities for criminals to supply these goods as we’ve seen with alcohol and illegal drugs and sex work.

Supporters of a ‘yes’ vote on Prop. 31 are correct that black smokers, young people and adults, disproportionately use menthol cigarettes. But this obscures some important facts. According to the most recent data from the Youth Risk Behavior Surveillance System in 2017, California’s black youth have the lowest smoking rates of any group, while black adults have the highest. If menthol cigarettes are as appealing to youth as has been suggested it is unclear why youth who are most exposed to menthol have the lowest smoking rates. The data is however in accordance with a Reason Foundation study published in 2020 showing that states with higher menthol sales, such as California, have some of the lowest youth smoking rates in the country. According to the Centers for Disease Control and Prevention (CDC) most of the young people who do smoke, 61 percent, use nonmenthol cigarettes. While we do not have recent data for youth smoking rates in California, nationally, they’re at a record low of 1.5 percent. Considering California’s smoking rate historically underperforms the national average we should expect the state’s smoking rate to be even lower. 

While the ban purports to target only retailers, the reality is that prohibition creates a significant potential for menthol cigarette smuggling and black market activity. Given that menthol products are disproportionately popular among black smokers it’s reasonable to assume black communities could suffer from further unnecessary contact with law enforcement if menthols are banned. The American Civil Liberties Union (ACLU) and law enforcement organizations such as the National Organization of Black Law Enforcement Executives (NOBLE) are among the groups that have voiced concerns as it relates to a proposed national menthol ban by the Food and Drug Administration. Similar concerns would exist in California.

The other major target of the flavored tobacco ban is e-cigarettes. As the use of vaping products by young people rose from 2017 to 2019, it’s unsurprising that some legislators saw prohibition as an easy answer to the problem. But it is important to note that e-cigarettes are a much safer form of nicotine consumption than traditional combustible cigarettes and have helped many Americans quit smoking. Because e-cigarettes heat a liquid solution containing nicotine instead of burning tobacco the number and levels of harmful and potentially chemicals are substantially reduced.

The Royal College of Physicians reports that the risks of vaping are unlikely to exceed five percent of those of smoking. There’s also a growing body of evidence showing that e-cigarettes are more effective than traditional nicotine replacement therapies at helping smokers quit. While e-cigarette flavors are portrayed as being targeted at youth, most adult vapers trying to quit smoking use non-tobacco flavors. According to research conducted by Yale University’s Abigail Friedman, vapers using non-tobacco flavors are more likely to successfully quit smoking than those who don’t.

Banning e-cigarette flavors may have the unintended consequence of not just damaging the state’s vape stores, but could push some vapers back to smoking cigarettes. It could also reduce the number of smokers looking to transition to a safer alternative to cigarettes.

While there is limited evidence on the effects of e-cigarette flavor bans thus far, a recent study published in the journal Nicotine and Tobacco Research examining seven California cities that implemented flavored tobacco bans found no significant effect on the likelihood that youth would vape.  An earlier study published in 2018 concluded that a comprehensive tobacco flavor ban would reduce overall tobacco use, but there would be more cigarette smoking than the status quo. Fortunately, youth vaping has fallen by 60 percent since 2019, despite there being no federal prohibition of e-cigarette flavors. 

California’s voters have to decide whether banning flavored tobacco products is likely to achieve the intended public health benefits at minimal cost to taxpayers and social justice, or whether a path of using e-cigarettes and flavors as a harm reduction tool to reduce smoking in a regulated market can achieve similar outcomes without the unintended negative consequences we’ve witnessed with previous experiments in prohibition.

Voters’ guides for other propositions on California’s 2022 ballot.

The post California Proposition 31 (2022): Banning flavored tobacco products appeared first on Reason Foundation.

• Removing 95 percent or more of the nicotine from cigarettes.
• Slashing the number of retailers that can sell tobacco by 90-to-95 percent.
• Criminalizing the sale of tobacco to people born in 2009 or later.

While yet to be passed into law, the New Zealand policy is under consultation and will no doubt be the subject of intense discussion among stakeholders, policymakers, and the general public. 

The plan’s call to reduce the amount of nicotine in cigarettes by more than 95 percent is not a simple product reformulation—it amounts to a prohibition on cigarettes in New Zealand. The New Zealand government’s hope is that drastically reducing nicotine in cigarettes will prevent young people from starting to smoke and encourage a large slice of current adult smokers to quit nicotine or switch to safer alternatives like e-cigarettes. 

Some evidence from small trials suggests smokers are more likely to quit smoking or reduce their cigarette intake when using very low-nicotine cigarettes. However, one of the most prominent trials published in the New England Journal of Medicine in 2015 showed that more than 70 percent of those assigned to use low-nicotine cigarettes broke the rules and smoked regular cigarettes during the study period. 

Some of these studies on reducing the amount of nicotine in cigarettes found that vulnerable populations, like individuals with psychiatric or mood disorders, those suffering from opioid use disorders, and low-income women showed no difference in quit rates when compared to regular smokers. 

Speaking to The New York Times in reference to a similar proposal to reduce the amount of nicotine in cigarettes in the United States, Lynn T. Kozlowski, a tobacco control expert from the University at Buffalo, urged caution:

Lynn T. Kozlowski, a tobacco researcher at the University at Buffalo who has contributed to four Surgeon General reports on smoking since 1981, said nicotine was a highly addictive drug, with a stranglehold on users that could rival cocaine and heroin, and that the F.D.A. needed to consider how a sweeping decrease of nicotine in cigarettes would affect smoker behavior.

“What scares me is a national experiment with the very low nicotine cigarette that is done without some testing in the real world,” he said. The studies many experts cite when promoting a 95 percent drop in nicotine levels relied upon paid participants, he noted, adding that some of them secretly smoked their own brands at the same time that researchers were plying them with low-nicotine cigarettes.

When it comes to New Zealand’s plan to restrict the number of retail outlets that can sell cigarettes, the only country New Zealand can point to with a comparable policy is Hungary. In 2013, Hungary cut the number of outlets in the country allowed to sell tobacco by 83 percent. A 2020 study published in Tobacco Control examining tobacco retail licensing systems in Europe found there is “little empirical evidence for the effect of tobacco licensing on smoking behaviors.” And, as of 2019, Hungary’s smoking rate, 19.3 percent, remained above the European Union average of 18.4. 

The untested interventions being pursued in New Zealand also risk severe unintended consequences, many of which will fall most heavily on the country’s indigenous Māori population. Māori smoking rates are elevated compared to the rest of New Zealand’s population. It is a pattern not unique to New Zealand. Groups with fewer educational opportunities and lower incomes are far more likely to smoke. This is important because one of the main goals and arguments for the current tobacco control plan is to narrow health inequities within New Zealand’s population. 

Of course, with prohibition, there will be a huge incentive for smugglers to import cigarettes into the country, already a major problem when it comes to evading tobacco tax. There will also be an incentive for entrepreneurs to find ways to add nicotine to cigarettes. Because Māori have higher smoking rates, we can reasonably expect much of the illicit market activity related to cigarettes to be concentrated in Māori communities. 

The government will have to answer some tough questions if these policies are to come into effect. For example, what will the criminal penalties be for the sale or trade of these cigarettes? Will the possession of any or large amounts of full nicotine cigarettes be criminalized? 

Criminalizing the conventional tobacco market will likely increase the already substantial inequities in New Zealand’s criminal justice system. New Zealand’s incarceration rate, 170 per 100,000, is well above the Organization for Economic Co-operation and Development average of 147.

Māori are 5.7 times more likely to have a police interaction than other New Zealanders. Though Māori account for just 16 percent of the country’s population, they make up 51 percent of New Zealand’s prisoners. Māori are also more likely to be handcuffed, pepper sprayed, arrested, convicted, sentenced, and imprisoned, according to a 2017 report from the New Zealand police.

The government’s regulatory impact statement concedes that it does not “consider compliance and enforcement, including any offenses and penalties.” Fortunately, New Zealand has begun to accommodate safer nicotine alternatives like e-cigarettes, which have helped many New Zealanders quit smoking. 

Instead of launching a new experiment in prohibition, New Zealand should inform cigarette smokers about the potential health benefits of switching to safer alternatives and ensure greater Māori access to smoking cessation services.

The post The potential consequences of New Zealand’s plan to be smoke-free appeared first on Reason Foundation.

Based on its own number crunching, the FDA claims the move will save around half a million lives over the next 40 years and reduce health disparities. Supporters of the ban argue that this can be accomplished without triggering the devastating consequences caused by every other drug prohibition in history. The problem, however, is that the FDA’s math is wrong. For millions of adults, communities around the nation, and public health at large, this could prove a deadly miscalculation. 

Like all federal agencies, the FDA is required to provide some justification for major rules, showing why it expects the benefits of that rule to outweigh its costs to society. In the case of banning menthol cigarettes, that justification centers primarily on the lives it is expected to save, which the FDA estimates at between 324,000 to 654,000 by the year 2060. To come up with that number, the agency relied on a series of studies that used predictive modeling to guess how menthol cigarette smokers, now and in the future, might behave in the wake of such a ban.  

These models predict that, while around 56 percent of current and future menthol smokers would respond in ways that do not improve health (such as switching to equally-harmful non-menthol cigarettes or relying on illicit markets), a significant portion—45 percent—would alter their behavior in ways that promote better health. According to these models, however, nearly half of the public health benefits would come from smokers switching to mentholated versions of lower-risk nicotine products, like e-cigarettes. The issue with this in the real world is that smokers may not have that option thanks to the FDA’s own irrational policies. 

Nicotine, though a habit-forming substance, is not what makes smoking dangerous. The danger comes from combustion; the chemicals created by burning tobacco and paper. Despite nearly all evidence indicating that non-combustible sources of nicotine, like e-cigarettes, are safe and effective substitutes for smoking, the FDA continues to do everything in its power (and arguably beyond it) to eliminate the e-cigarette market. Only a handful of options have been approved for sale and the FDA has refused to approve any in menthol flavor (indicating it never will). Smokers already have limited access to any sort of FDA-sanctioned e-cigarette, let alone the type and flavor they might find an acceptable replacement for their cigarettes. As the FDA continues to pull e-cigarettes off the market, including the most popular and effective brands, and as cities and states implement their own e-cigarette bans, issues with limited access will grow. 

If nearly half of the public health benefits the FDA expects from a menthol cigarette ban come from the expectation that many smokers will switch to e-cigarettes, what will happen when the agency’s own policies prevent this from happening? It is possible that more smokers will choose to quit tobacco and nicotine use altogether, making a menthol cigarette ban even more beneficial for public health than the FDA currently predicts. But, evidence suggests smokers will instead choose to switch to non-menthol cigarettes, gaining zero health benefits, or turn to illicit markets, where their risks might actually be increased.

To make matters worse, the FDA’s math also suffers from incorrect assumptions about how illicit markets would respond to a menthol cigarette ban. Though menthol cigarettes make up over a third of all cigarette sales, generate more than $21 billion in revenue, and are used by an estimated 19 million Americans, the FDA claims a ban won’t lead to increases in illicit cigarette sales. But this is yet another miscalculation. 

The already-booming illegal cigarette market in America has traditionally operated via domestic bootlegging, with primarily “mom and pop” enterprises legally purchasing cigarettes in low-tax jurisdictions, such as Virginia, and selling them in high-tax jurisdictions, like New York. Since the scheme involves a product that is legal everywhere in the country, the risks illicit operators face for this sort of smuggling are relatively low. For the same reason, the potential profits smugglers can make are also relatively low, since illicit cigarette dealers must keep the prices they charge for smuggled cigarettes lower than what their customers would pay for legal cigarettes where they live. Because a nationwide ban on menthol cigarettes would prevent would-be menthol cigarette dealers from simply hopping state lines to supply their trade, the FDA assumes they would not even bother. But this is a dangerous underestimation of the resourcefulness of illicit supply chains. 

A national prohibition, whether for menthol cigarettes or anything else, certainly increases the risks for those hoping to profit by selling illicit goods. But, it also vastly increases the rewards for those who do so successfully. Unlike the current market for illicit tobacco which hinges on offering customers cheaper cigarettes, a national prohibition would make illicit sources the only option for menthol smokers. As such, those customers might be willing to pay as much or even more for illicitly supplied menthols as they would have paid when they were legal. By increasing both the demand for and the profitability of illicit menthol cigarettes, a ban may have the unintended effect of attracting international drug cartels into the racket. And given the skill with which these cartels continue to evade authorities, it is not clear why the FDA thinks a cigarette ban would be more successful than any other drug prohibition.

Even if U.S. authorities could stop the flow of illicit cigarettes over our national borders, there is little they could do to stop domestic producers from supplying the market with counterfeit menthols. This task would involve little more than purchasing still-legal non-menthol cigarettes and adding menthol flavoring. The government could do even less about individuals who might make their own supply of menthol cigarettes the same way. 

Far from making menthol cigarettes unavailable, as the FDA assumes, a menthol ban could have the perverse effect of making them far more available, particularly for minors, since illegal dealers aren’t exactly sticklers for age verification. Even more perversely, the ban could harm the very group—people of color—it supposedly seeks to help most. 

While there is no credible evidence that menthol cigarettes are more toxic, harder to quit, or more attractive to youth than non-menthol cigarettes, it is true that they are overwhelmingly preferred by people of color with around 85 percent of black smokers choosing menthols compared to just 30 percent of white smokers. The FDA claims this means that black people would benefit most from a menthol cigarette ban since they will be more motivated to quit smoking. But, it also means that many of the smokers who do not quit and instead turn to illicit markets to get the menthol cigarettes they prefer will be people of color. And, as it is with any drug war, it will be people and communities of color that bear the brunt when local authorities attempt to crack down on illicit activity. 

If the FDA is truly interested in promoting smoking cessation and saving lives, there are more effective and certainly less destructive ways to do this than a prohibition. Another approach would be for the FDA to adopt policies grounded in harm reduction, to encourage smokers who cannot or will not quit using nicotine to switch to less harmful options, such as the already FDA-endorsed (but largely ineffective) nicotine patch, gum, and lozenge, as well as e-cigarettes, snus, and heated tobacco. But, for this to work those products must be at least as accessible, affordable, and palatable to smokers as the cigarettes they are used to. Whether the FDA wants to admit it or not, that means allowing them in flavors smokers want, including menthol. 

In other countries, like the United Kingdom and Japan, tobacco harm reduction has been widely embraced and hugely successful. America has already adopted a similar approach to other substance use issues, such as legalizing cannabis, offering clean needles to people who use intravenous drugs, opioid replacement therapy, and naloxone for overdose prevention. There is no reason that tobacco harm reduction would not be similarly successful if the FDA abandoned its unscientific opposition to nicotine and got out of the way of innovation. Such a harm reduction approach may anger prohibitionists in the anti-tobacco industry and Congress, but unlike the current approach, it might actually save lives. 

The post The FDA’s deadly menthol miscalculation appeared first on Reason Foundation.

Dr. Robert Califf
Commissioner, Food and Drug Administration
10903 New Hampshire Avenue
Silver Spring, MD 20993
RE: Docket No. FDA-2021-N-1349 Tobacco Product Standard for Menthol in Cigarettes

Dear Dr. Califf:

Reason Foundation is grateful for the opportunity to submit comments on the proposed rule to prohibit the use of menthol as a characterizing flavor in cigarettes. Reason Foundation’s nonpartisan public policy research promotes choice, competition, and a dynamic market economy as the foundation for human dignity and progress. Reason produces rigorous, peer-reviewed research and directly engages the policy process, seeking strategies that emphasize cooperation, flexibility, local knowledge, transparency, accountability, and results. 

The available evidence suggests prohibition of menthol cigarettes will not present significant public health benefits to the population as a whole and will produce a suite of negative consequences undermining the FDA’s goals. While studied for decades, the evidence is either conflicted or directly contrary as to whether menthol cigarettes pose greater risks for smoking initiation, progression to regular smoking, increased dependence, and reduced cessation, particularly among African Americans, compared to non-menthol cigarettes. 

The FDA has not sufficiently considered the effectiveness of menthol bans and tobacco prohibitions from other jurisdictions, the severe limitations on and public misperceptions of safer alternatives such as e-cigarettes, or the unintended consequences of possible increased cigarette consumption among those menthol smokers who switch to a non-menthol product.

The FDA has also not accounted for the extremely low levels of youth cigarette use, for which menthol remains the least favored option. Furthermore, such a prohibition will result in a host of unintended consequences, including increased tobacco smuggling, burdens on law enforcement, and more frequent interactions between law enforcement and minority communities. 

To read the full published comment, please click here or here (.pdf).

The post Public Comment: Menthol prohibition would come with negative consequences appeared first on Reason Foundation.

The FDA makes three claims as to why menthol is uniquely dangerous. First, FDA contends menthols are especially attractive to kids. Second, the agency suggests menthol prohibition will increase the rate of people quitting smoking among current menthol smokers, who it says are more addicted than regular smokers. Third, FDA asserts the menthol ban will narrow health disparities, particularly among communities of color since 85 percent of black smokers use menthol products.

Unfortunately, none of these claims about the proposed menthol ban hold up. The latest data from the Centers for Disease Control and Prevention’s National Youth Tobacco Survey survey of U.S. middle school (grades 6–8) and high school (grades 9–12) students show only 1.5 percent of young people smoked at least once in the past month and the majority of these youth, 61.2 percent, used a non-menthol cigarette. The percentage of American youth who smoke regularly is just 0.28 percent. Essentially, youth smoking in the United States has nearly entirely been eliminated.

Thus, the FDA’s claims that hundreds of thousands of lives will be saved by cutting off the next generation of smokers are decades out of date. It is also difficult to justify the FDA’s assertion that menthol is more addictive and harder to quit than non-flavored cigarettes. One week before the FDA’s announcement, research from Vanderbilt University Medical Center showed quit rates for menthol and non-menthol smokers were indistinguishable, with no significant difference between black and white smokers.

If the ban is supposed to get adult menthol smokers to quit, the results from similar prohibitions are not encouraging. From 2015 to 2018, menthols were banned across Canada, where menthol sales were just five percent of the market. One study on the ban found that 78.6 percent of menthol smokers still smoked after the ban, with 19.5 percent continuing to use menthol. Worse still, compared to regular smokers, the study found that “menthol smokers did not differ significantly from non-menthol in quit success” between the study’s baseline and follow-up. 

Before the European Union banned menthol cigarettes, Poland had the largest menthol market of all member states, at 28 percent. A preprint evaluation of the Polish experience finds there has been no statistically significant reduction in cigarette sales in Poland after the menthol ban.

The only U.S. state to have banned menthols is Massachusetts. Menthol trafficking in bordering states exploded after the ban, with Massachusetts and its bordering states experiencing an increase in cigarette sales of 1.28 percent. There was also a significant uptick in non-menthol cigarette purchases. 

The most common response to menthol bans is switching to equally dangerous regular cigarettes, buying illicit menthol, or using devices to give non-menthol cigarettes a menthol taste. Because of these substitution effects, the alleged health benefits of prohibition are unlikely to materialize. According to the American Cancer Society, disparities amongst smokers have already narrowed significantly because young black people have been less likely to start smoking than their white peers in.

The FDA insists it will not be involved in any enforcement of a menthol ban when it comes to individual consumers, but federal agencies will need to be used to stop the flow of menthol cigarettes from abroad. Every state penalizes the sale of untaxed cigarettes with punishments ranging from hefty fines to significant jail time. With around 18 million consumers of menthol cigarettes in America and billions of dollars in revenue at stake, believing criminal networks will not look to make money by filling customer demand for menthol products is naive at best.

There is an alternative that would cut smoking rates without the costs of prohibition. The Biden administration has committed itself to a policy of harm reduction when it comes to tackling the opioid epidemic. Extending this logic to smokers who want to quit would avoid the specter of cops hassling people selling Newports or loose cigarettes, which tragically led to the death of Eric Garner in 2014. 

Most Americans are unaware or misinformed about safer nicotine alternatives like vapes, nicotine pouches, and heat-not-burn products. According to the Health Information National Trends Survey, just 2.6 percent of adults correctly believe e-cigarettes are much less harmful than traditional cigarettes. E-cigarettes are more effective than nicotine replacement therapies at helping smokers quit and because there is no burning tobacco in these products, they are also substantially safer than traditional cigarettes. 

Promoting innovation and harm reduction would likely be more effective in achieving public health goals without increasing the carceral state or the unnecessary targeting of minority communities that the FDA’s proposed menthol cigarette ban will likely deliver.

The post The FDA’s proposed ban on menthol cigarettes is based on faulty claims appeared first on Reason Foundation.

Here are some of the common questions about banning menthol cigarettes, the supposed evidence in support of a menthol cigarette ban, and a ban’s possible consequences on public health and minority communities.

Who smokes menthol cigarettes?

According to the FDA, there are nearly 18.6 million American menthol smokers. The FDA says nearly 85 percent of all black smokers use menthol-flavored products, compared to around 30 percent of white smokers who use menthol cigarettes. 

Are menthol cigarettes more dangerous than non-menthols?

Menthol and non-menthol cigarettes are both addictive and can cause smoking-related diseases, but non-menthol cigarettes are not safer than their menthol counterparts. Research published in the Journal of the National Cancer Institute found menthol smokers were somewhat less likely to develop lung cancer than non-menthol smokers. The report found:

“Black men are known to have a higher incidence of lung cancer and are more likely to smoke mentholated cigarettes compared with white men,” said Vanderbilt-Ingram Cancer Center’s William Blot, Ph.D. “It has been hypothesized that menthol in cigarettes influences smoking behavior, perhaps increasing dependency or adversely affecting the biology of the lung. However, our large study found no evidence to support those theories.”

…Among people smoking 20 or more cigarettes a day, menthol smokers were approximately 12 times more likely to develop lung cancer than never-smokers, while non-menthol smokers were about 21 times more likely to have the disease. The differences were mirrored for lung cancer death rates and were found to be statistically significant.

The researchers also found that both white and black menthol smokers reported smoking fewer cigarettes per day than non-menthol smokers. When it comes to the likelihood of quitting smoking, there was no significant difference between menthol and non-menthol smokers.

The authors said the findings suggest mentholated cigarettes are no more, and perhaps less, harmful than non-mentholated cigarettes.

The difference in lung cancer development may be because menthol smokers tend to smoke fewer cigarettes per day and start smoking later in life. If menthols are prohibited, those cigarettes left on the market may be considered safer by consumers, with a possible increase in the number of cigarettes smoked by those menthol smokers who switch to non-menthols. 

Are menthol cigarettes more addictive than non-menthols?

On standard dependency measures, such as the number of cigarettes smoked per day and the time to the first cigarette, menthol smokers are not more dependent than non-menthol smokers. There is also no significant difference in the quit rates between menthol and non-menthol smokers. The most recent evidence published in the Journal of the National Cancer Institute shows that quit rates among menthol and non-menthol smokers are indistinguishable. The study found no significant difference in quit rates between black and white smokers.

Are menthol cigarettes more popular among kids than non-menthols?

Fortunately, youth smoking rates in the United States are at a record low of 1.5 percent, according to the Centers for Disease Control and Prevention. Of that small percentage, more than 60 percent of middle school and high school students who are defined as current smokers use non-menthol cigarettes. Just 0.6 percent of middle and high school students used a menthol cigarette in the past 30 days.

States with the highest menthol consumption rates also have the lowest youth smoking rates. It is true that of the small group of African American middle and high school students who do smoke, most smoke menthol products. However, it should also be noted that black youth have lower smoking rates than other groups of young people, including non-Hispanic whites and Hispanics. 

Have menthol bans been implemented elsewhere? Were they successful?

Supporters of menthol prohibition have been disappointed by lackluster results in other jurisdictions that have banned the products, including Canada, the European Union, and Massachusetts. The most common result of menthol prohibition has been for the majority of menthol smokers to switch to equally dangerous non-menthol cigarettes, continue to buy illicit menthol, or use devices to flavor non-menthol cigarettes. As I noted in a recent piece:

The most optimistic case study for the prohibition of menthols comes from Canada. According to a study of Canada’s menthol ban, while the vast majority continued to smoke after the ban was implemented, a significant portion reported quitting. The study found “59.1 percent of pre-ban menthol smokers switched to non-menthol cigarettes; 21.5 percent quit smoking and 19.5 percent still smoked menthols, primarily purchased from First Nations reserves.” These results might seem somewhat underwhelming but are still impactful. But when we compare the menthol smokers to non-menthol smokers, we see a lackluster result. 

According to the authors of the study, menthol smokers increased their attempts to quit smoking, relative to non-menthol smokers by 9.7 percent. However, overall, just 7.5 percent more menthol smokers quit compared to non-menthol…

The European Union, with its 27 member states and a population of about 450 million, is the largest region to have banned menthol cigarettes. Menthols were already unpopular in Europe. Poland had the largest menthol market in the European Union at 28 percent, closest to America’s market at 36 percent. A preprint study funded by the Norwegian Cancer Society in partnership with the Polish Health Ministry found no statistically significant change in cigarette sales after the ban.

How would the prohibition of menthols likely be enforced?

The FDA says menthol prohibition would be enforced only against “manufacturers, distributors, wholesalers, importers, and retailers.” However, any implication that a ban would only affect big tobacco companies and established retail stores is misconceived. There are already laws on the books that would impose severe penalties on individuals who sell menthols post-prohibition. Anyone selling, importing, or distributing menthol cigarettes would be committing a crime and could land themselves in prison. Thanks to the Federal Cigarette Contraband Trafficking Act (CCTA), smuggling menthol cigarettes across state lines could result in five years in prison. Every state also has laws on the books that criminalize the unlicensed sale and distribution of tobacco products.

Additionally, the possession of untaxed cigarettes is already illegal in 36 states and the District of Columbia. States and localities could enact other laws to clamp down on any increase in the illicit tobacco trade. 

Why are some civil liberties and criminal justice reform groups concerned the ban would negatively impact minority communities?

Aamra Ahmad, senior legislative counsel with the American Civil Liberties Union, said a ban on menthol cigarettes would disproportionately impact minority communities:

“Time and time again, we see encounters with police over minor offenses — for Daunte Wright it was expired tags, for George Floyd it was using a counterfeit bill, for Eric Garner it was selling loose cigarettes — result in a killing. There are serious concerns that the ban implemented by the Biden administration will eventually foster an underground market that is sure to trigger criminal penalties which will disproportionately impact people of color and prioritize criminalization over public health and harm reduction.”

A ban on menthol cigarettes should be expected to hurt communities of color, spur the growth of black markets for methol products, lead to more policing and incarceration, and undermine a variety of criminal justice reforms that cities and states have made in recent years.

Rather than prohibition, what is an alternative harm reduction strategy?

While smoking rates have gradually declined over the last few decades, 12.5 percent of American adults continue to smoke despite the widely known dangers and many smoking cessation resources available. One reason why so many Americans keep smoking traditional cigarettes is that public health officials have mostly failed to let them know that nicotine alternatives like e-cigarettes are substantially safer than combustible cigarettes. 

According to the Health Information National Trends Survey, just 2.6 percent of adults correctly believe e-cigarettes are much less harmful than traditional cigarettes. Since there is no burning tobacco in e-cigarette products, they are substantially safer than traditional cigarettes. Research also shows e-cigarettes are far more effective than nicotine replacement therapies at helping smokers quit.

Rather than resorting to the failed prohibitionist policies of the past, the FDA and Biden administration should apply the harm reduction model to tobacco policy. The federal government could focus on educating the public about safer nicotine delivery products, and the latest smoking cessation products available as part of a pragmatic approach to improving public health as people choose better options than conventional cigarettes. The harm reduction model has been successfully used by governments to reduce sexually transmitted diseases, reduce overdose deaths and treat drug addiction. In the case of smoking and menthols, a harm reduction strategy would be far more effective in reducing smoking than banning menthols.

The post Frequently asked questions about the FDA’s ban on menthol cigarettes appeared first on Reason Foundation.

Case Studies

The most optimistic case study for the prohibition of menthols comes from Canada. According to a study of Canada’s menthol ban, while the vast majority continued to smoke after the ban was implemented, a significant portion reported quitting. The study found “59.1 percent of pre-ban menthol smokers switched to non-menthol cigarettes; 21.5 percent quit smoking and 19.5 percent still smoked menthols, primarily purchased from First Nations reserves.” These results might seem somewhat underwhelming but are still impactful. But when we compare the menthol smokers to non-menthol smokers, we see a lackluster result. 

According to the authors of the study, menthol smokers increased their attempts to quit smoking, relative to non-menthol smokers by 9.7 percent. However, overall, just 7.5 percent more menthol smokers quit compared to non-menthol. It is also unclear whether menthol smokers from before the ban had more quit attempts than regular smokers.

The study notes that between its baseline and follow-up, “[M]enthol smokers did not differ significantly from non-menthol in quit success.” Compared to the U.S., menthol was also just a small part of the Canadian cigarette market, accounting for five percent of Canadian sales compared to menthol products accounting for roughly one-third of cigarette sales in the United States.  

The European Union, with its 27 member states and a population of about 450 million, is the largest region to have banned menthol cigarettes. Menthols were already unpopular in Europe. Poland had the largest menthol market in the European Union at 28 percent, closest to America’s market at 36 percent. A preprint study funded by the Norwegian Cancer Society in partnership with the Polish Health Ministry found no statistically significant change in cigarette sales after the ban. While the EU suffers from illicit trade in menthol cigarettes and most smokers switched to equally unhealthy non-menthol cigarettes, entrepreneurs have also stepped in to offer smokers ways to adulterate regular cigarettes to give them a menthol flavor.

After the ban in the EU, a study of young Danish smokers found that many were still smoking menthols, 20 percent after the ban compared to 29 percent before. One reason is this proliferation of flavor accessories that can effectively give a menthol flavor to non-menthol cigarettes. Alex Liber, the author of the previously mentioned Polish study and a continued supporter of a menthol product ban said of the Danish research: “My takeaway is that any government that moves forward with a menthol ban should temper its expectations on immediate consumption declines. Tobacco companies will protect their cigarette cash cow.” 

Massachusetts is the only state in the US to have implemented a ban on flavored tobacco products as of this writing. One result of Massachusetts’ ban has been a dramatic increase in purchases of non-menthol cigarettes and an increase in the sales of menthol cigarettes in New Hampshire and other neighboring states. According to the Tax Foundation, the ban cost Massachusetts $125 million in lost tax revenue in its first fiscal year. In addition, a forthcoming Reason Foundation analysis finds the region in and around Massachusetts experienced a net increase in cigarette sales of 7.2 million packs.

In the aggregate, the experience of menthol bans in the real world, as opposed to forecasts about them, is that the bans have minimal effects on tobacco consumption but do engender unintended consequences, even in markets where menthol is relatively unpopular. 

A Harm Reduction Alternative to Bans

Banning menthol cigarettes, a product used by up to 18 million Americans, is a radical policy with significant implications for the criminal justice system and personal autonomy. It is worth examining whether less intrusive, costly, or iniquitous measures can help those who wish to quit smoking.

Smoking rates have gradually declined over the last few decades. And they have declined faster since safer nicotine alternatives like e-cigarettes were introduced. 

One reason why so many Americans keep smoking traditional cigarettes is that public health officials have mostly failed to let them know that nicotine alternatives like e-cigarettes are substantially safer than combustible cigarettes. According to the Health Information National Trends Survey, just 2.6 percent of adults correctly believe e-cigarettes are much less harmful than traditional cigarettes.

Since there is no burning tobacco in e-cigarette products, they are substantially safer than traditional cigarettes. Research also shows e-cigarettes are far more effective than nicotine replacement therapies at helping smokers quit.

However, thus far, the FDA has only authorized a handful of e-cigarette products as “appropriate for the protection of public health.” But the most popular vaping products among consumers have been banned or are in regulatory limbo.

The FDA has also taken no action to correct public misperceptions around e-cigarettes or other products like nicotine pouches or snus. Correcting these misperceptions and ensuring a wide range of appealing alternatives to cigarettes could help rapidly decrease smoking rates without imposing the negative consequences and costs of prohibition.

Rather than resorting to the failed policies of the past, the FDA and the Biden administration should apply the harm reduction model to tobacco policy. Educating the public and taking a harm reduction approach has been successful in the fields of sexual health and drug addiction, and it would be far more effective in reducing smoking than banning menthols.

The post Rather than banning menthols, FDA should embrace harm reduction appeared first on Reason Foundation.

Civil rights organizations and criminal justice reformers have been voicing concerns that racial and ethnic minorities will bear the brunt of any potential enforcement action. These fears are well warranted. While black and white smoking rates are similar, black smokers are far more likely to use menthol products. Roughly 85 percent of black smokers use menthol products.

Making menthol cigarettes illegal while leaving the cigarettes favored by white smokers legal is sadly reminiscent of the government’s disparate treatment of, and sentencing rules for, crack cocaine users compared to powder cocaine users. At one point, the distribution of five grams of crack cocaine, which was found more frequently in black communities, carried a minimum five-year federal prison sentence. In contrast, it took the distribution of 100 times that—500 grams of powder cocaine, which was favored in white communities—to trigger the same five-year mandatory sentence. Now, the FDA seems curiously poised to ban the specific cigarettes favored by black smokers while doing nothing about the cigarettes preferred by white smokers.

Last year, Aamra Ahmad, senior legislative counsel with the American Civil Liberties Union, said a ban on menthol cigarettes would disproportionately impact minority communities:

“Time and time again, we see encounters with police over minor offenses — for Daunte Wright it was expired tags, for George Floyd it was using a counterfeit bill, for Eric Garner it was selling loose cigarettes — result in a killing. There are serious concerns that the ban implemented by the Biden administration will eventually foster an underground market that is sure to trigger criminal penalties which will disproportionately impact people of color and prioritize criminalization over public health and harm reduction.”  

Unfortunately, these critiques correctly note that if an illicit market for menthol cigarettes grows as the result of a federal ban, the black market and its impacts are likely to be concentrated in low-income, minority neighborhoods that already suffer from higher crime and policing. And the fact that the FDA itself would not be enforcing the ban on possession or use is a true but trivial point. At no time during alcohol prohibition were individual drinkers criminalized. But organized crime ran rampant, disputes over product and territory abounded, and individual small producers and sellers were prosecuted.

There are currently between 12 million and 18 million menthol smokers in America. If the FDA implements a ban on menthols, it is ludicrous to suggest that organized crime won’t seek to serve this market, especially as menthols remain legal in most of the world. Federal law enforcement agencies would be tasked with interdicting flows of illicit tobacco from abroad.

The U.S. already suffers from some crime spurred by today’s high tobacco taxes, even without prohibition. More than 50 percent of cigarettes sold in New York, for example, come from out of state due in part to the state’s high tax rates. In Massachusetts, which is the only state to have already banned flavored tobacco products, smugglers are being arrested with hundreds of thousands of dollars worth of contraband in their possessions.

There are already laws on the books that will impose severe penalties on those who sell menthols post-prohibition. If the FDA’s rule is enacted, anyone selling, importing, or distributing menthol cigarettes would be committing a crime and could land themselves in prison for a year for each offense. Thanks to the Federal Cigarette Contraband Trafficking Act (CCTA), smuggling menthol cigarettes across state lines could result in five years in prison. Every state also has laws on the books that criminalize the unlicensed sale and distribution of tobacco products. The possession of untaxed cigarettes is already illegal in 36 states and the District of Columbia.

Law enforcement officers frequently pursue minor infractions, such as selling loose cigarettes, as justification for intrusive searches that could lead to more significant busts, such as those for guns or drugs. These searches problematically increase the number of police interactions with the public, especially with minority men. As the ACLU and criminal justice reformers correctly note, Eric Garner was killed by New York City police in an incident that was initially sparked by law enforcement’s overreaction to his minor action of selling loose cigarettes. 

“Giving police officers a reason to detain and engage black smokers to find out where they purchased their menthol cigarettes could lead to encounters that are likely to escalate to the unnecessary use of force and arrests,” writes Major Neill Franklin, a law enforcement veteran of the Maryland State Police and Baltimore Police Department. 

America’s illicit tobacco market is already a multibillion-dollar industry, with profits from the illegal trade funneled into organized crime. A U.S. Department of State report revealed tobacco smuggling to be a ‘low-risk, high-reward’ source of funding for terrorist groups that also drains potential tax revenue from federal and state coffers.

The country has been making a lot of progress on some of these issues. Marijuana is being legalized in many states. Similarly, sports betting legalization is birthing a safer, more successful, and profitable industry in several states. Alcohol prohibition ended long ago and was replaced by regulation.

Why would we rightly recognize the need to end prohibition in these areas but still ban menthol cigarettes?

To believe that prohibition of menthol cigarettes would dramatically improve public health with zero negative consequences concerning disparate law enforcement is to believe in a world that is completely free from trade-offs.

If the FDA bans menthol cigarettes, it will spur the growth of a black market for those products. Law enforcement agencies can then be expected to claim the use and distribution of illegal menthol products as justification for increasing policing actions in minority communities. Thus, the proposed criminalization of menthol cigarettes should be expected to hurt communities of color, spur the growth of black markets, lead to more incarceration, and undermine criminal justice reforms made in recent years.

The post A ban on menthol cigarettes would hurt communities of color and undermine criminal justice reforms appeared first on Reason Foundation.

Thank you for allowing me the opportunity to submit testimony on House Bill 7870. 

My name is Guy Bentley, and I am 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 this bill to limit tobacco use, especially among youth, is to be applauded. However, the evidence of the success of such prohibitions should raise significant concerns that the ban would promote further inequalities in the criminal justice system, push sales and tax revenue to other states, increase the illicit tobacco trade, and fail to improve public health in Rhode Island.

Case Studies: Massachusetts, Canadian Provinces, and the European Union

Massachusetts’ ban on flavored tobacco products went into effect in June of 2020. The Reason Foundation has conducted a yet-to-be-published, preliminary analysis of the ban’s impact which compared cigarette sales in and around Massachusetts the year prior to the ban and the year following the ban’s implementation. We found that there was a net increase in cigarette sales of 7.2 million packs sold within Massachusetts and in its bordering states. 

These figures likely underestimate cross-border trade because they do not also account for lost sales of flavored e-cigarettes, smokeless tobacco, or cigars. Massachusetts also saw a 15.6 million pack increase in non-menthol cigarette sales as consumers switched brands.

According to the Tax Foundation, Massachusetts lost $125 million in tobacco revenue for the fiscal year 2021.

Furthermore, according to a study published by the Journal of Law and Economics, Canadian provinces’ menthol prohibition significantly increased non-menthol cigarette smoking among young people, resulting in no overall net change in youth smoking. As for adult smokers, provincial menthol bans simply shifted smokers’ cigarette purchases away from grocery stores and gas stations. 

The world’s largest experiment in menthol prohibition is the European Union, which includes 27 countries and has a population of 447 million people. The EU ban became effective in May of 2020. Prior to the ban, Poland had the largest menthol cigarette market in the EU, making up 28 percent of total sales. An analysis funded by the Norwegian Cancer Society in partnership with the Polish Ministry of Health found there was no statistically significant decline in cigarette sales after the ban.

These results are important not just because they demonstrate an immediate economic impact on jurisdictions that introduce prohibition but, thanks to cross-border trade and the substitution of non-menthol cigarettes, any predicted public health benefits are likely to be severely limited. In other words, the loss in tax revenue is unlikely to be offset by lower health care costs or improved public health.

Public Health and Disparate Impacts

Advocates for the prohibition of menthol cigarettes correctly observe that a disproportionate number of black smokers choose menthol products. In Rhode Island, some hope the ban would dramatically reduce the state’s smoking rate. While these populations are more likely to use a menthol product while white smokers are more likely to use a non-menthol product, smoking prevalence is, in fact, lower among black youth and adults.

Black non-Hispanic young people are less likely to smoke than their white peers. In Rhode Island, 4.1 percent of white high schoolers smoked in 2019. For black Rhode Island high schoolers, the number was 3.4 percent. These data conform to Reason Foundation’s study published in 2020 showing that states with higher menthol cigarette use tend to have lower, not higher, youth smoking rates.

From a public health standpoint, as black adults and young people smoke at lower rates than non-Hispanic whites, it’s hard to ascertain why non-menthol cigarettes, which are equally dangerous, would not be subjected to prohibition while menthol products would be. 

Because menthol cigarettes are overwhelmingly the choice of minority smokers, prohibition will necessarily lead to a concentration of the illicit tobacco market in minority communities. The American Civil Liberties Union and other civil rights groups warn that the prohibition of menthols could disproportionately negatively impact people of color, trigger criminal penalties, and prioritize criminalization over public health and harm reduction. The National Organization of Black Law Enforcement Executives (NOBLE), Grand Council of Guardians (GCGNY), National Association of Black Law Enforcement Officers (NABLEO), and Law Enforcement Action Partnership (LEAP) have argued that prohibitions of all kinds disproportionately affect communities of color, and this is especially the case when it comes to banning menthol cigarettes.

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 also currently reviewing e-cigarette product applications that contain reams of data on safety, efficacy, and potential threats to youth. If the FDA finds that any product is a net harm to public health, it will be removed from the market. 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 Rhode Island 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. According to a survey conducted by the International Tobacco Control Policy Evaluation Project, 57 percent of vapers said they would continue vaping if flavors were banned and half said they would find a way to get their preferred flavor. Of most concern was the finding that close to one in five vapers said they would stop vaping and smoke instead. 

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 use by a friend or family member. Availability in flavors, such as mint, candy, fruit, or chocolate comes as a very distant third. Banning flavored tobacco products may also induce perverse outcomes contrary to the promotion of public health among adolescents. 

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 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 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. 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 driving vapers back to smoking, fueling illicit markets, and forcing the closure of Rhode Island vape shops. 

The post Testimony: Rhode Island e-cigarette prohibition could create unintended consequences appeared first on Reason Foundation.

A bill in the Colorado state legislature would prohibit the sale of flavored tobacco products, including menthol cigarettes. Only one state has implemented such a ban. In June 2020, Massachusetts implemented its prohibition of flavored vaping and tobacco products and the results have been disastrous. Lawmakers hoped people would stop smoking and vaping, but, instead, people switched products and sought their favored flavors elsewhere. Sales of non-menthol cigarettes, which are equally as deadly, soared by 15.6 million packs a year in Massachusetts. In neighboring states, where flavored products were available, cigarette sales surged 22 percent in New Hampshire and 18 percent in Rhode Island. The New England region saw no reduction in cigarette sales, but Massachusetts lost $125 million in tax revenue for the fiscal year 2021 due to the flavor ban, according to the Tax Foundation.

Advocates claim banning menthol is about protecting young people, particularly African Americans. But according to the last set of data from the Centers for Disease Control and Prevention (CDC), in 2019 the smoking rate amongst Coloradan black high school-aged students was so low as to not be statistically significant. The latest federal data showed that, nationwide, just 1.9 percent of young people smoked at least once a month in 2021, which is significantly lower than the percentages for marijuana or alcohol use in that age group.

Prohibition can also have perverse consequences, as San Francisco experienced after its flavored tobacco ban in 2018. Yale University’s Abigail Friedman found, “San Francisco’s ban on flavored tobacco product sales was associated with increased smoking among minor high school students relative to other school districts.”

Rather than encouraging kids to stop vaping, the flavor ban drove teens to traditional cigarettes. “While neither smoking cigarettes nor vaping nicotine is 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. 

These results are not surprising. CDC surveys of teenagers show that just 13.2 percent of young people who use e-cigarettes say they do so for the flavors. Driving kids away from flavored vaping products toward traditional cigarettes is a terrible trade-off that worsens public health. E-cigarettes are dramatically safer than combustible cigarettes and are more effective in helping smokers quit than nicotine replacement therapies. 

Additionally, since black adults and young people smoke at lower rates than non-Hispanic white adults and youth, it is hard to ascertain why menthol products are being banned while the non-flavored, but equally dangerous, tobacco products used by more Coloradans would not be subjected to the bill’s prohibition. 

Menthol cigarettes are overwhelmingly the choice of minority adult smokers. As a result, a ban on them will likely lead to the growth of illicit tobacco markets and more policing in minority communities. The American Civil Liberties Union and other civil rights groups warn, “Policies that amount to prohibition for adults will have serious racial justice implications. Such a ban will trigger criminal penalties, which will disproportionately impact people of color, as well as prioritize criminalization over public health and harm reduction. A ban will also lead to unconstitutional policing and other negative interactions with local law enforcement.” 

Instead of prohibition, Colorado should apply the harm reduction strategies and logic it has used for legal marijuana and sports gambling. In this case, keeping safer alternatives, like vaping products and nicotine pouches, on the adult market can be a long-term tool to help drive down smoking rates. Rather than creating new black markets and policing problems, driving sales to neighboring states, and losing tax revenues, Colorado should resist misguided calls to ban flavored tobacco products.

The post Colorado’s proposed flavored tobacco ban would worsen public health and criminal justice inequities appeared first on Reason Foundation.

Chair Lontine, members of the committee, thank you for allowing me the opportunity to submit testimony on HB22-1064. 

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 HB22-1064 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 ban will promote further inequalities in the criminal justice system, push sales and tax revenue to other states, increase the illicit tobacco trade, and fail to improve public health in Colorado. 

Case Studies: Massachusetts, Canadian Provinces, and the European Union

Massachusetts’ ban on flavored tobacco products went into effect in June of 2020. A preliminary analysis awaiting publication conducted by Reason Foundation which compared cigarette sales in Massachusetts the year prior to the ban and the year following the ban’s implementation found that, in total, there was a net increase in cigarette sales of 7.2 million packs for Massachusetts and its bordering states. These figures underestimate cross-border trade because they do not account for lost sales of flavored e-cigarettes, smokeless tobacco, or cigars. There was also an increase of non-menthol cigarette sales in Massachusetts of 15.6 million packs as consumers switched brands.

Furthermore, according to a study published by the Journal of Law and Economics, Canadian provinces’ menthol prohibition has significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates. As for adult smokers, the study discovered, provincial menthol bans shifted smokers’ cigarette purchases away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not apply). 

The world’s largest experiment in menthol prohibition is the European Union, which includes 27 countries and a population of 447 million people. The EU ban became effective in May of 2020. Prior to the ban, Poland had the largest menthol cigarette market in the EU, making up 28 percent of total sales. An analysis funded by the Norwegian Cancer Society in partnership with the Polish Ministry of Health found there was no statistically significant decline in cigarette sales. These results are important not just because they demonstrate an immediate economic impact on jurisdictions that introduce prohibition but, thanks to cross-border trade and the substitution of non-menthol cigarettes, any health benefits are severely limited. In other words, the loss in tax revenue is unlikely to be made up of lower healthcare costs.

Public Health and Disparate Impacts

Advocates for the prohibition of menthol cigarettes correctly observe that a disproportionate number of Black smokers choose menthol products. In Colorado, some hope the ban will dramatically reduce the state’s smoking rate. While these populations are more likely to use a menthol product while White smokers are more likely to use a non-menthol product, smoking prevalence is, in fact, lower among Black youth and adults.

Black non-Hispanic youth are less likely to smoke than their White peers. In Colorado, 4.3 percent of White high schoolers smoked in 2019. For Black Coloradan high schoolers, the numbers were so low as to not be statistically significant. These data conform to Reason Foundation’s study published in 2020 showing that states with higher menthol cigarette use tend to have lower, not higher, youth smoking rates. From a public health standpoint, as Black adults and youth smoke at lower rates than non-Hispanic Whites, it’s hard to ascertain why non-menthol cigarettes, which are equally dangerous, will not be subjected to prohibition and menthol products will be. 

Because menthol cigarettes are overwhelmingly the choice of minority smokers, prohibition will necessarily lead to a concentration of the illicit tobacco market in minority communities. The American Civil Liberties Union and other civil rights groups warn prohibition could disproportionately impact people of color, trigger criminal penalties, and prioritize criminalization over public health and harm reduction. The National Organization of Black Law Enforcement Executives (NOBLE), Grand Council of Guardians (GCGNY), National Association of Black Law Enforcement Officers (NABLEO), and Law Enforcement Action Partnership (LEAP) have argued that prohibitions of all kinds disproportionately affect communities of color, and this is especially the case when it comes to banning menthol cigarettes.

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 also currently reviewing e-cigarette product applications that contain reams of data on safety, efficacy, and potential threats to youth. If the FDA finds that any product is a net harm to public health, it will be removed from the market. 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 Colorado 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. According to a survey conducted by the International Tobacco Control Policy Evaluation Project, 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 in five vapers said they would stop vaping and smoke instead.

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 use by a friend or family member. Availability in flavors, such as mint, candy, fruit, or chocolate comes as a very distant third. Banning flavored tobacco products may also induce perverse outcomes contrary to the promotion of public health among adolescents. 

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 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 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. 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 Colorado vape shops, and driving vapers back to smoking.

The post Colorado should rethink potential tobacco prohibitions appeared first on Reason Foundation.

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.

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