The Western War On Vaping Is Harming Public Health

Most people who work on the topic of tobacco harm reduction are aware of the potential advantages of e-cigarettes in helping adults who smoke break their deadly smoking habit. Experts in the field often repeat the conclusions from Britain’s top public-health agency (Public Health England), which found that vaping is at least 95 percent less harmful than smoking combustible cigarettes. Nevertheless, in the West Coast states in particular, policymakers are trying to stamp out vaping to protect teens—and leaving adults who smoke with fewer, less-dangerous options.

Policymakers do this in several ways. The most obvious is a direct ban on flavored tobacco sales. In California, for instance, Gov. Gavin Newsom signed Senate Bill 793 in 2020, which banned the retail sale of tobacco and nicotine products that have a non-tobacco flavor. Because state law describes nicotine-infused vape liquids as tobacco products, the net result is a ban on most vaping products—except those that mimic the flavor of tobacco. Opponents qualified a 2022 referendum on the general election ballot, but voters overwhelmingly supported the new law.

No other Western state has taken such a draconian approach, but other states—and some localities—have embraced other counterproductive policies. Whereas California’s flavored tobacco ban still allows residents to buy online vaping products, Oregon passed a new law that bans online vaping sales. Oregon hasn’t passed a statewide ban on retail sales, but its most populous county, Multnomah (home to Portland), has done so. If the state follows California’s lead, then vapers won’t even have that online loophole to secure these less dangerous products.

States also have embraced two other main policies designed to battle vaping: capping the amount of nicotine in e-liquids and levying state excise taxes on vaping products—in most cases bringing them up to or beyond the level of comparable combustible products. The nicotine caps are almost nonsensically counterproductive, given that people will simply increase the amount of vaping to satisfy their craving. The trend toward boosting excise taxes also is problematic.

Lawmakers’ goal, obviously, is to discourage vape use, but raising prices via tax rates serves only to make more dangerous cigarette smoking a likely alternative. Pricing is a top determinant in one’s decision about which product to buy. Western policymakers are committed to discouraging the use of e-cigarettes—and other lower-risk smokeless tobacco products such as snus or Zyn—so they think it promotes public health to increase their cost.

But they’re not looking at it from the perspective of someone who is reliant on nicotine. The issue isn’t the overall price of e-cigarettes so much as it is their overall price in comparison to combustible cigarettes. It’s poor public health policy to use taxation in a way that incentivizes use of the latter. All of these policies—flavored-tobacco bans, nicotine caps and higher excise taxes—mainly discourage people who smoke from switching to less-dangerous products.

Harm Reduction and the Importance of Allowing E-cigarettes

E-cigarettes are widely recognized as a useful tool for reduced usage of traditional combustible tobacco products. Although e-cigarettes are still nicotine-delivery products, the way in which they function significantly reduces the physical harm done  compared to combustibles. While products like cigarettes burn tobacco in order for users to consume nicotine, e-cigarettes heat nicotine-infused liquids for inhalation. The result is significantly less chemical and carcinogenic exposure for users. As noted previously, a study from the United Kingdom’s Royal College of Physicians concludes that the “hazard to health arising from long-term vapor inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.”

Ever since e-cigarettes emerged as a potential alternative for conventional tobacco usage, debate has turned to their appeal to first-time tobacco users. These products may be less detrimental to the health of users than combustibles, but they still involve consumption of an addictive, unhealthy agent. Lawmakers across the country have raised concerns about e-cigarettes introducing younger generations to nicotine addiction. As a result, states and localities have moved to tax and regulate the e-cigarette industry, in the hopes of driving youth away from the market.

An unintended consequence of this heavy-handed regulatory approach is pushing former combustible users away from e-cigarettes and back to tobacco-burning products. Given the wealth of data that proves the value of e-cigarettes as a smoking-cessation tool, this is a distinctly undesirable outcome. A critical element in harm-reduction policy is to allow for credible alternatives to the most harmful behaviors, since it is impossible to eliminate detrimental behaviors in society. Policymakers interested in reducing the risks of nicotine addiction should focus on transitioning users to less damaging alternatives, like e-cigarettes. To deal with underage vapers, states should strictly enforce age-21 laws.

A Review of Nicotine Caps

Lawmakers have floated the possibility of reducing the addictiveness in both combustible products and e-cigarettes. While nicotine is what makes tobacco products addictive, chemical compounds and carcinogens are the most dangerous elements of cigarette usage in terms of their direct impact on user health. Nicotine caps are a regulatory strategy meant to reduce the risk of users developing nicotine addiction.

While these caps sound sensible at first blush, they are actually counterproductive. “People considering a transition from smoking to vaping require a product yielding enough nicotine to satisfy their craving,” according to a column published last year in the Financial Post. “Under a nicotine cap, some smokers will not transition to vaping while some high-nicotine vapers will go back to smoking; others will vape more nicotine at lower concentrations, although they will have to spend more to get the same amount of nicotine.”

By restricting the amount of nicotine in e-cigarette liquids, policymakers inadvertently encourage people who smoke to: a) continue smoking combustible cigarettes; and b) encourage vapers to vape even more to reach the desired nicotine level. Once again, we see that such regulations are counterproductive. Nevertheless, the U.S. Food and Drug Administration is moving forward with such caps.

As articulated in testimony opposing Utah’s effort to impose a maximum nicotine concentration of 36 milliliters (ml) in vaping liquids, “The ability to achieve a similar nicotine delivery profile to that of combustible cigarettes is likely one reason that e-cigarettes are more effective cessation devices than pharmaceutical nicotine replacement therapy treatments.”

The Impact of Higher Vaping Tax Rates

As mentioned previously, higher excise taxes boost the cost of e-cigarettes and reduce the economic incentive to switch to lower-risk products. The following chart details the comparative tax rates in the Western states:

Western State Taxation on Vapors, Tobacco, Combustibles and E-cigarettes

Alaska
Vaping tax: No tax
Cigarette tax: $2.00/pack
Other tobacco product tax rate: 75 percent of wholesale price
E-cigarettes classified as a tobacco product: No

Arizona
Vaping tax: No tax
Cigarette tax: $2/pack
Other tobacco product tax: 33 percent of wholesale price
E-cigarettes classified as a tobacco product: No

California
Vaping tax: 61.74 percent of wholesale; 12.5 percent of retail
Cigarette tax: $2.87/pack
Other tobacco product tax: 51 percent of wholesale price
E-cigarettes classified as a tobacco product: Yes

Colorado
Vaping tax: 35 percent of manufacturing price
Cigarette tax: $0.84/pack
Other tobacco product tax rate: 40 percent of manufacturing price
E-cigarettes classified as a tobacco product: Yes

Hawai’i
Vaping tax: No tax
Cigarette tax: $3.20/pack
Other tobacco product tax: 57 percent of wholesale price
E-cigarettes classified as a tobacco product: Yes

Idaho
Vaping tax: No tax
Cigarette tax: $0.57/pack
Other tobacco product tax rate: 40 percent of wholesale price
E-cigarettes classified as a tobacco product: Yes

Montana
Vaping tax: No tax
Cigarette tax: $1.70/pack
Other tobacco product tax rate: 50 percent of wholesale price
E-cigarettes classified as a tobacco product: No

Nevada
Vaping tax: 30 percent of wholesale
Cigarette tax: $1.80/pack
Other tobacco product tax: 32 percent of wholesale price
E-cigarettes classified as a tobacco product: Yes

New Mexico
Vaping tax: 12.5 percent of wholesale price; $0.50/cartridge
Cigarette tax: $1.66/pack
Other tobacco product tax rate: 25 percent of product value
E-cigarettes classified as a tobacco product: Yes

Oregon
Vaping tax: 65 percent of wholesale
Cigarette tax: $3.33/pack
Other tobacco product tax: 59 percent of wholesale price<
E-cigarettes classified as a tobacco product: Yes

Utah
Vaping tax: 56 percent of wholesale price
Cigarette tax: $1.70/pack
Other tobacco product tax rate: 86 percent of manufacturing price
E-cigarettes classified as a tobacco product: Yes

Washington
Vaping tax: $0.09 per ml open; $0.027 per ml closed
Cigarette tax: $3.025/pack
Other tobacco product tax: 54 percent of wholesale price
E-cigarettes classified as a tobacco product: No

Wyoming
Vaping tax: 15 percent of wholesale price
Cigarette tax: $0.60/pack
Other tobacco product tax rate: 20 percent of wholesale price
E-cigarettes classified as a tobacco product: No

Conclusion

Policymakers’ concerns about nicotine addiction may be admirable, but targeting e-cigarettes for cumbersome regulation only furthers the use of combustible tobacco products. The fear that e-cigarettes may promote combustible cigarette use among youth is not supported by data. Research shows that youth who vape are not more likely to start smoking in the long term, although youth should not ever vape or smoke. Period. Similarly, the percentage of teen vapers who never smoked cigarettes prior to vaping is extremely small. Most young people who vape have smoked combustible products prior to vaping.

While vaping does not generally lead to smoking among teens, it does lead to less smoking among adults. Studies have shown that cigarette use in the general population has continued to decline, as it has for decades. Among young adults (18-29 years old), the decline in smoking is even more pronounced, falling by 23 percent in the last 20 years. These positive shifts come as vaping has gained traction in the United States. E-cigarette usage is not a gateway to combustible cigarette usage. It is a preferable, far less damaging alternative to traditional combustibles even though abstinence from nicotine products always remains the safest choice.

In fact, some studies show that as officials clamp down on the availability of e-cigarettes, youth smoking rates have increased. Research from an updated 2021 JAMA Pediatrics report concluded: “San Francisco’s partially implemented flavor ban was associated with higher odds of recent smoking among underage high school students relative to concurrent changes in other districts.”

If the overarching goal of these polices is to reduce the negative health effects of nicotine addiction, policymakers should focus on transitioning people who smoke to products like e-cigarettes. Multiple studies have shown the value of e-cigarettes as a smoking-cessation tool. The British National Health Service now licenses physicians to provide prescriptions for e-cigarettes as an alternative for people who smoke. Instead of recognizing the potential of these products, too many lawmakers in the United States and especially in Western states insist on new regulations, the downstream effects of which can push people back to combustible cigarettes. This will lead to worse health outcomes, despite the good intentions.

Western lawmakers must recognize that harm reduction must focus on risk mitigation, not solely risk elimination. E-cigarettes provide a promising off-ramp for nicotine-addicted combustible cigarette users, and overregulating the e-cigarette will not reduce nicotine addiction in the United States.