Testimony from:
Pritika C. Kumar, Resident Senior Fellow, Integrated Harm Reduction, R Street Institute
In OPPOSITION to
California Assembly Bill CA AB 1690

March 28, 2022

Chair and members of the committee,

I am writing on behalf of the R Street Institute (R Street) to oppose Assembly Bill 1690, which would prohibit “a person or entity from selling, giving, or furnishing to another person of any age in this state a single-use electronic cigarette.”

R Street is a nonprofit public policy organization focused on advancing limited, effective government in a variety of policy areas, including tobacco harm reduction. We do not advocate for the use of deadly, combustible tobacco products such as cigars and cigarettes. However, Assembly Bill 1690 includes a prohibition on reduced-risk tobacco products, such as electronic cigarettes (e-cigarettes). We recognize and support the science and public health utility behind the exclusive use of e-cigarettes as harm reduction tools for adult smokers who are unwilling or unable to quit smoking cigarettes.

Cigarette Smoking in California
In California, 8.9 percent adults smoke cigarettes, which amounts to nearly 3 million adult smokers. More than 25 percent of the cancer deaths in the state are attributable to smoking. Given these statistics and the burden of disease and death attributable to use of combustible cigarettes, it would be counterproductive to discard less harmful alternatives such as e-cigarettes. Quitting combustible cigarettes is extremely difficult, with almost 70 percent wanting to quit, 55 percent indicating an attempt to quit in the past year and only 7.5 percent of smokers quitting successfully in the past year. When used exclusively for cessation efforts, e-cigarettes improve population health by enabling adult smokers to transition from deadly combustible products.

Public Health Utility of Electronic Cigarettes as a Harm Reduction Tool for Adult Smokers
At R Street, we believe in harm reduction, which means meeting people where they are in their journey of health improvement. Harm reduction—for a variety of risky behaviors—has proved to be not only a viable public health strategy, but also reduces costs in the U.S. healthcare system. While we acknowledge that the use of e-cigarettes is not risk-free, it is much less harmful than smoking combustible cigarettes. Leading authorities such as the Royal College of Physicians, U.S. Food and Drug Administration, and the National Academies of Sciences, Engineering, and Medicine have all confirmed this fact. Because e-cigarettes do not burn tobacco, they do not release the 7,000 chemicals found in combustible cigarette smoke. Given this research, e-cigarettes are at the lower end of the risk spectrum, near traditional nicotine-replacement therapies, whereas combustible cigarettes are at the highest end. According to a recent review, e-cigarettes are 95 percent less harmful to health compared to smoking. It is perhaps unsurprising that in the United Kingdom, vaping is popular among adult smokers as the U.K.’s National Health Service endorses e-cigarettes as a smoking cessation tool.

Indeed, randomized controlled trials indicate that e-cigarettes may be almost twice as effective as traditional nicotine replacement therapies at helping former smokers sustain abstinence from combustibles. Public health models show that e-cigarettes have helped accelerate the decline in smoking.

The Impact of Single-Use E-Cigarettes on the Environment
While R Street supports sensible efforts to address climate change, it is hard to believe that banning single-use e-cigarettes will provide enough of an environmental benefit to outweigh the potential harms in the protection of public health. As with a myriad of other products that have significant public health impacts but also contribute to littering—such as disposable face masks, food packaging and sterile gloves—electronic cigarettes hold a significant harm reduction value for adult smokers. We acknowledge the waste generated by e-cigarettes and believe that waste management—not full-scale prohibition—is the appropriate solution to reducing the environmental footprint while simultaneously helping to improve population health.

Recommendations
Rather than withhold the benefit for adult smokers of transitioning from much more harmful products like combustible cigarettes to reduced-risk products like e-cigarettes, we recommend the following measures to address the issue of effectively managing the waste generated by these less harmful alternatives:

  1. Request that manufacturers provide retailers with clear instructions on how to handle e-cigarette waste properly.

  2. Incentivize manufacturers and retailers to develop “take-back-and-recycle” programs, product deposit systems, deposit refund systems and in-store recycling bins.

  3. Establish an educational campaign targeted to e-cigarette users for the proper disposal of single-use electronic cigarettes, akin to campaigns on battery disposal.

Through various supply- and demand-side mechanisms, Californian policymakers hold a range of suitable options to address e-cigarette waste. R Street strongly urges the examination of these options and the public health utility of e-cigarettes as harm reduction tools that complement other tobacco cessation strategies. Through more targeted public policy interventions, addressing the climate and improving health need not be mutually exclusive. We respectfully oppose Assembly Bill 1690, which would cut off a valuable and less harmful alternative for adult smokers.

Thank you for your consideration.

Pritika C. Kumar
Resident Senior Fellow
Integrated Harm Reduction
R Street Institute
[email protected]

[1] America’s Health Rankings, “Smoking,” United Health Foundation, 2022. https://www.americashealthrankings.org/explore/annual/measure/Smoking/state/CA.

[2]  Joannie Lortet-Tieulent et al., “State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States,” JAMA Internal Medicine 176:12 (Dec. 1, 2016), pp.1792-98. https://pubmed.ncbi.nlm.nih.gov/27775761.

[3]  Centers for Disease Control and Prevention, “Smoking Cessation: Fast Facts,” Department of Health and Human Services, Sept. 20, 2021. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/smoking-cessation-fast-facts/index.html.

[4]  David P. Wilson et al., “The cost-effectiveness of harm reduction,” International Journal of Drug Policy 26:1 (Feb. 1, 2015) pp. S5-11. https://www.sciencedirect.com/science/article/pii/S0955395914003119.

[5]  See, e.g., Health & Wellbeing Directorate, “E-cigarettes: a new foundation for evidence-based policy and practice,” Public Health England, August 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/454517/Ecigarettes_a_firm_foundation_for_evidence_based_policy_and_practice.pdf; Tobacco Advisory Group, “Nicotine without smoke: Tobacco harm reduction,” Royal College of Physicians, April 28, 2016. https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0; Kathleen Stratton et al., eds., Public Health Consequences of E-Cigarettes, (The National Academies Press, 2018). http://nationalacademies.org/hmd/reports/2018/public-health-consequences-of-e-cigarettes.aspx; U.S. Food and Drug Administration, “FDA announces comprehensive regulatory plan to shift trajectory of tobacco-related disease, death,” Department of Health and Human Services, July 27, 2017. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm568923.htm.

[6]  Tobacco Advisory Group. https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction.

[7]  Ann McNeill et al., “Evidence review of e-cigarettes and heated tobacco products 2018,” Public Health England, 2018. https://www.jesuisvapoteur.org/wp-content/uploads/2021/10/Evidence_review_of_e-cigarettes_and_heated_tobacco_products_2018.pdf.

[8]  National Health Service, “Using e-cigarettes to stop smoking,” Department of Health and Social Care, March 29, 2019. https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking.

[9]  Peter Hajek et al., “A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy,” The New England Journal of Medicine 380 (Feb. 14, 2019), pp. 629-637. https://www.nejm.org/doi/full/10.1056/nejmoa1808779.

[10]  David T. Levy et al., “Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check,” Tobacco Control 28:6 (November 2019), pp. 629-635. https://pubmed.ncbi.nlm.nih.gov/30459182.

[11]  Keiron P. Roberts et al., “Increased personal protective equipment litter as a result of COVID-19 measures,” Nature Sustainability (Dec. 9, 2021). https://www.nature.com/articles/s41893-021-00824-1.

[12]  Division of Waste and Hazardous Substances, Compliance and Permitting Section, “Vape Shop Hazardous Waste Management,” Department of Natural Resources and Environmental Control, last accessed March 23, 2022. https://documents.dnrec.delaware.gov/dwhs/SHWMB/Hazardous/Fact-Sheets/Vape-Shop-Hazardous-Waste-Management-Fact-Sheet.pdf.

[13]  Kari Paul, “Vaping’s other problem: are e-cigarettes creating a recycling disaster?,” The Guardian, Aug. 27, 2019. https://www.theguardian.com/society/2019/aug/26/vapings-other-problem-are-e-cigarettes-creating-a-recycling-disaster.

[14]  U.S. Food and Drug Administration, “Tips for Safe Disposal of E-Cigarettes and E-Liquid Waste,” Department of Health and Human Services, Sept. 23, 2020. https://www.fda.gov/tobacco-products/products-ingredients-components/tips-safe-disposal-e-cigarettes-and-e-liquid-waste.