Testimony in Opposition to Flavor Bans for ENDS Products in Golden, Colorado
Testimony from:
Stacey McKenna, Senior Fellow, Integrated Harm Reduction, R Street Institute
In OPPOSITION to Ordinance 2216, banning the sale of flavored tobacco products in Golden, Colorado
July 25, 2023
Golden City Council
City Manager Varga, City Clerk Mendoza and City Councilmembers:
My name is Stacey McKenna, and I am a long-time Colorado resident and a senior fellow in Integrated Harm Reduction at the R Street Institute (RSI), a nonprofit, nonpartisan think tank engaged in policy research and outreach to promote free markets and limited, effective government in many areas, including tobacco harm reduction. That is why we are interested in Ordinance 2216.
In an effort to reduce youth vaping and smoking, Ordinance 2216 would ban the sale of “characterizing flavors” in nicotine and tobacco products, including electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes or vapes. While RSI applauds the council’s goal of preventing youth use of nicotine-containing products, we are concerned that prohibiting sales of flavored tobacco and nicotine products will do little to protect young people, while unintentionally harming adult smokers and Golden’s public health. This is because e-cigarettes are much less harmful than combustible cigarettes, and as such represent a safer alternative for people who are unable or unwilling to quit using nicotine. Furthermore, flavors can play an important role in helping adult smokers make the switch from cigarettes to reduced risk products, but do not represent the primary motivator for youth uptake.
Smoking and Vaping in Colorado
The rates of smoking among Colorado adults have been declining in recent years. According to the Colorado Department of Public Health and Environment (CDPHE) Vision database, in 2012 more than 17.8 percent of Coloradans smoked cigarettes. As of 2021, that percentage had dropped to 11.9 percent. During roughly the same period – from 2016 to 2021 – the proportion of Colorado adults using ENDS products climbed from just over 5 percent to nearly 7 percent. Similarly, in Jefferson County, adult smoking rates fell (from 15.5 percent in 2016 to 11.6 percent in 2021) as the use of ENDS products increased (from 4.8 percent in 2016 to 6.2 percent in 2021).[1]
The trends are encouraging in Colorado’s underage population as well. The Healthy Kids Colorado Survey reports that in 2015, 8.6 percent of Jefferson County high school students had smoked one or more cigarettes in the last 30 days. By 2021, that number had dropped to just 3.3 percent. And while youth do continue to use ENDS products, those numbers are falling: In 2021, 16 percent of Jefferson County high-schoolers reported vaping, a huge decline from the high of 27 percent in 2017.[2] It is noteworthy that research demonstrates that using ENDS products does not lead to the use of combustible cigarettes. Thus, while the use of reduced risk nicotine products like ENDS by underage individuals should be continually monitored and efforts made to provide accurate prevention education and reduce youth access, it is unlikely that youth vaping will lead to youth smoking.[3]
The fact that combustible cigarette use is on the decline in Colorado, and may be accelerated among adults by uptake of vaping, supports the need to ensure that access to e-cigarettes does not face more barriers than access to combustibles. Furthermore, the fact that youth vaping has also declined in recent years points to the effectiveness of existing policies and efforts – such as federal and state minimum age requirements – that exclusively target young people.[4] We describe the research driving these connections and conclusions below.
ENDS Products as a Smoking Cessation and Harm Reduction Tool
Research shows e-cigarettes are a valuable tool for smokers looking to transition away from combustible tobacco products to less harmful nicotine delivery methods. Combustible cigarette smoke, the result of burning tobacco, contains more than 7,000 chemicals, some of which are highly carcinogenic. Because e-cigarettes do not burn tobacco, but heat a nicotine-containing liquid, they do not release this same volume of dangerous chemicals.[5] In fact, a number of public health agencies – including Public Health England; The Royal College of Physicians; The National Academies of Science, Engineering and Medicine; and the U.S. Food & Drug Administration (FDA) – have noted that nicotine products exist on a continuum of risk, with e-cigarettes and traditional nicotine replacement therapies at the lower end of that spectrum and combustible cigarettes carrying the most significant risks.[6] The Royal College of Physicians has estimated that e-cigarettes are unlikely to have more than 5 percent of the risk associated with combustibles.[7]
As more public health experts recognize and understand the risk continuum, e-cigarettes have become an important tool for smoking cessation in many parts of the world. At the population level, models suggest that as e-cigarettes become more available, they have contributed to steeper declines in smoking rates compared to prior years.[8] In the United States and the United Kingdom, e-cigarettes are among the most popular tools for smoking cessation, and have more successful outcomes when compared to traditional quit methods such as nicotine replacement therapies or talk therapy.[9]
In the United Kingdom, the National Health Service has endorsed the use of e-cigarettes and actively encourages smokers to make the switch.[10] Even the U.S. Centers for Disease Control and Prevention (CDC) acknowledges that smokers who use e-cigarettes more frequently tend to smoke fewer combustible cigarettes.[11]
Flavors Encourage Adult Smokers to Switch
For many adult smokers, flavors play a critical role in smoking cessation. For example, in a study of 4,515 current and former smokers who had transitioned to e-cigarettes, the vast majority (91 percent) of e-cigarette users had transitioned completely away from combustible cigarettes. Among those individuals, more than two-thirds said they used multiple flavors within a single day.[12] Perhaps not surprisingly, all of the participants in the study said that this variety of flavors was thus “very important” in their decision to switch to e-cigarettes, while 40 percent indicated that they would have been less likely to switch from combustibles to e-cigarettes if flavor options had not been available.[13]
Flavors Do Not Drive Youth Vaping
The council has used prevention of youth e-cigarette initiation to justify its introduction of Ordinance 2216. As one of the first national think tanks to advocate for raising the tobacco purchase age to 21 years, RSI shares these concerns about youth uptake of vaping. However, research demonstrates that flavors do not drive youth uptake of vaping, and banning flavored e-cigarettes is not an effective way to prevent initiation.
A CDC study found that in 2021, only 13.5 percent of e-cigarette users under 18 years of age cited flavors as the primary reason they tried e-cigarettes, whereas nearly hald expressed general “curiosity” as their main motivator.[14] Furthermore, recent research shows that in cities that have instituted flavor bans, the prevalence of combustible cigarette use increases among both underage and adult community members.[15] Taken together, these data do not support the banning of flavors as an effective way to prevent or reduce youth e-cigarette use.
In addition, Colorado’s recent declines in both youth vaping and combustible cigarette smoking – which are similar to what is seen at the national level – indicate that age restrictions on tobacco and nicotine products can be an effective deterrent.[16] In 2019, the U.S. federal government raised the minimum age to purchase tobacco products to 21 with Tobacco 21 (T21). The following year, Colorado became the 30th state to pass its own T21 law. Research indicates that these age restrictions are quite effective at reducing youth perceptions that tobacco is easy to access. [17] However, enforcement can be improved – a nationwide survey found that only 17 percent of underage youth who attempted to buy tobacco after the federal Tobacco 21 (T21) law went into place were turned away due to age.[18]
Conclusion
The preponderance of evidence demonstrates that flavored e-cigarettes benefit adult smokers by providing a safer way to consume nicotine. Furthermore, research suggests that access to flavors does not lead to increased youth use. As such, flavor bans are an ineffective mechanism through which to curb youth initiation of nicotine consumption, and come with the risk of causing unintentional harm to adult smokers. As such, RSI urges councilmembers to oppose Ordinance 2216.
Stacey McKenna
Senior Fellow, Integrated Harm Reduction
R Street Institute
[email protected]
[1] Colorado Department of Public Health & Environment, “VISION: Visual Information System for Identifying Opportunities and Needs,” Colorado Department of Public Health & Environment. https://cdphe.colorado.gov/vision-visual-information-system-for-identifying-opportunities-and-needs
[2] Colorado Department of Public Health & Environment, “Healthy Kids Colorado Survey (HKCS),” Colorado Department of Public Health & Environment. https://cdphe.colorado.gov/healthy-kids-colorado-survey-dashboard
[3] David J.K. Balfour, et al., “Balancing Consideration of the Risks and Benefits of E-Cigarettes,” American Journal of Public Health, 111: 9, (Sept. 22, 2021), pp. 1661-1672. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2021.306416.
[4] “Colorado Governor Signs Strong Tobacco 21 Legislation,” TOBACCO twenty-one, July 17, 2020. https://tobacco21.org/colorado-governor-signs-strong-tobacco-21-legislation; U.S. Food and Drug Administration. “Tobacco 21,” Accessed July 18, 2023. https://www.fda.gov/tobacco-products/retail-sales-tobacco-products/tobacco-21.
[5] “Harms of Cigarette Smoking and Health Benefits of Quitting,” National Cancer Institute, Dec. 19, 2017. https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet.
[6] 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; See, e.g., 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; See, e.g., 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.
8 Tobacco Advisory Group. https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0.
[8] 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://www.ncbi.nlm.nih.gov/pubmed/30459182.
[9] Health & Wellbeing Directorate. 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; Shu-Hong Zhu et al., “E-cigarette use and associated changes in population smoking cessation: evidence from US population surveys,” BMJ 358 (July 26, 2017). https://www.bmj.com/content/358/bmj.j3262; Peter Hajeket 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] “Using e-cigarettes to stop smoking,” National Health Service, March 29, 2019. https://www.nhs.uk/live-well/quit-smoking/using-e-cigarettes-to-stop-smoking.
[11] Centers for Disease Control and Prevention, “Adult Smoking Cessation—The Use of E-Cigarettes,” Department of Health and Human Services, Jan. 23, 2020. https://www.cdc.gov/tobacco/data_statistics/sgr/2020-smoking-cessation/fact-sheets/adult-smoking-cessation-e-cigarettes-use/index.html.
[12] Konstantinos E. Farsalinos et al., “Impact of Flavour Variability on Electronic Cigarette Use Experience: An Internet Survey,” International Journal of Environmental Research and Public Health 10:12 (Dec. 17, 2013), pp. 7272-7282. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881166.
[13] Ibid.
[14] Adrea S. Gentzke et al., “Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021,” Surveillance Summaries 71:5 (March 11, 2022), pp. 1-29. https://www.cdc.gov/mmwr/volumes/71/ss/ss7105a1.htm.
[15] Michael Siegel and Amanda Katchmar, “Effect of flavored E-cigarette bans in the United States: What does the evidence show?” Preventive Medicine, 165: Pt B, (April 20, 2022). https://pubmed.ncbi.nlm.nih.gov/35452711.
[16] Monica E. Cornelius, et al., “Tobacco Product Use Among Adults–United States, 2021,” Morbidity and Mortality Weekly Report, 72: 18, (May 5, 2023), pp. 475-483. https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a1.htm; U.S. Food and Drug Administration, “Tobacco 21,” Accessed July 18, 2023. https://www.fda.gov/tobacco-products/retail-sales-tobacco-products/tobacco-21.
[17] Israel T. Agaku et al., “A Rapid Evaluation of the US Federal Tobacco 21 (T21) Law and Lessons From Statewide Policies: Findings From Population-Level Surveys,” Preventing Chronic Disease, 19, (June 2, 2022). https://www.cdc.gov/pcd/issues/2022/21_0430.htm.
[18] Ibid.