Testimony in Opposition to Preemption Repeal Concerning Tobacco Control in Rhode Island
Mazen Saleh, Integrated Harm Reduction Policy Director, R Street Institute
R Street Testimony in Opposition to RI H 6091 “AN ACT RELATING TO TOWNS AND CITIES — ORDINANCES.”
House Committee on Municipal Government & Housing
March 28, 2023
Chairman Casey, Vice Chairwoman Fogarty, Vice Chairwoman Speakman and members of the committee,
My name is Mazen Saleh, and I am the policy director for Integrated Harm Reduction at the R Street Institute. The R Street Institute is a nonprofit, nonpartisan public policy research organization. Our mission is to engage in policy research and outreach to promote free markets and limited, effective government in many areas, including tobacco control. Our efforts to promote all forms of harm reduction are why we have a particular interest in H 6091.
The proposed legislation represents an effort to undermine state-level control of tobacco and nicotine products in Rhode Island by granting localities the authority to regulate and limit the sale of these goods. Should this legislation come to pass, Rhode Island should anticipate negative outcomes that will arise from uneven implementation of tobacco control across the state. These outcomes are not only economic in nature, but also include the health of the 140,000 Rhode Islanders that smoke who will likely experience reduced access to less harmful alternatives to combustible cigarettes.
E-cigarettes are a harm reduction and smoking cessation tool
Over the past several decades, public health has made great strides to decrease smoking initiation and promote smoking cessation interventions. However, no cessation or prevention program is 100 percent successful. R Street’s ultimate goal is to bring harm reduction approaches into equal standing as a third pillar of tobacco control alongside demand reduction (increased cessation and prevention measures) and supply reduction (shifting to economies that do not rely on tobacco production).
Although there are a number of U.S. Food and Drug Administration-approved smoking cessation nicotine products, their low success rates necessitate that the public health community consider expanding the cessation toolbox to include electronic nicotine delivery systems (ENDS), such as e-cigarettes. The simple truth is that e-cigarettes are fast becoming one of the most effective tools smokers use to quit and are a far better alternative than combustible cigarettes. In fact, according to Public Health England, e-cigarettes are 95 percent less harmful than combustible cigarettes. It is perhaps unsurprising that the Cochrane Library, the gold standard in research analyses, found high-certainty evidence that e-cigarettes are a more effective cessation tool than nicotine replacement therapies, such as the patch or gum. Given this strong evidence, the General Assembly should be pleased when more smokers consider switching to less harmful e-cigarettes. However, e-cigarettes’ reduced harm profile alone may not be enough to encourage smokers to quit for good, but that is where flavored vapor products prove useful.
Flavors help smokers transition away from combustible cigarettes
The availability of non-tobacco flavors assists smokers with the transition from combustible cigarettes. The International Journal of Environmental Research and Public Health reports that limitations in flavor choices negatively impact user experience. About 40 percent of e-cigarette-using, former and current adult smokers predict that removing their ability to choose flavors would make them less likely to remain abstinent or attempt to quit. In fact, data suggests that current smokers are partial to the flavor of traditional tobacco, while fruit and sweet flavors are preferred by former smokers.
Moreover, it has recently been demonstrated that e-cigarette users who use non-tobacco flavors, including menthol and non-menthol (fruit, sweet or dessert) flavors are more likely to switch completely from combustible cigarettes than those who choose tobacco flavors. Flavored e-liquids are yet another way that e-cigarettes can help smokers disassociate combustible cigarettes—and their characteristic flavor—from the pleasurable effects of nicotine. It stands against reason when localities prohibit flavors and regulate that non-cigarettes must taste like cigarettes in order to remain on the market.
Studies show that adults greatly prefer non-tobacco flavors. If localities elect to ban all flavored vapor products—as this bill would facilitate—it is less likely that current smokers will make the switch to less harmful products. This is something that Rhode Island cannot afford to risk.
Losing momentum against reducing the rate of smoking
By repealing preemption in Rhode Island, the state runs the very real risk of introducing a patchwork of laws governing the sale of tobacco and nicotine products that is confusing, decreases tax revenues, reduces access to less harmful alternatives for adult smokers and spurs the formation of illicit markets. In Massachusetts—the first state to ban flavored tobacco—the Multi-Agency Illegal Tobacco Task Force recently concluded that the statewide ban resulted in “cross-border smuggling of untaxed flavored ENDS products” and found that “inspectors and investigators are routinely encountering or seizing menthol cigarettes, originally purchased in surrounding states, and flavored ENDS products and cigars purchased from unlicensed distributors operating both within and outside the Commonwealth.” If this was the experience at the state level, it is not hard to imagine a similar scenario across local jurisdictions with mismatched tobacco and nicotine control legislation in Rhode Island. It is with these concerns in mind that we oppose efforts that could subvert the consistency of tobacco control policy in Rhode Island.
I respectfully urge the committee to reject H 6091.
Integrated Harm Reduction Policy Director
R Street Institute
 Centers for Disease Control and Prevention, “Tobacco-Related Mortality,” U.S. Department of Health and Human Services, April 28, 2020. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm; Centers for Disease Control and Prevention, “Map of Current Cigarette Use Among Adults,” U.S. Department of Health and Human Services, Oct. 22, 2021. https://www.cdc.gov/statesystem/cigaretteuseadult.html.
 See, e.g., Office of the Surgeon General, Smoking Cessation: A Report of the Surgeon General, U.S. Department of Health and Human Services, 2020. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf.
 Shu-Hong Zhu et al., “E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys,” BMJ 358 (July 26, 2017). https://www.bmj.com/content/358/bmj.j3262.
 Ann McNeill et al., “Evidence review of e-cigarettes and heated tobacco products 2018: executive summary,” Public Health England, March 2, 2018. https://www.gov.uk/government/publications/e-cigarettes-and-heated-tobacco-products-evidence-review/evidence-review-of-e-cigarettes-and-heated-tobacco-products-2018-executive-summary.
 Jamie Hartmann-Boyce et al., “Electronic cigarettes for smoking cessation,” Cochrane Database of Systematic Reviews 11 (Nov. 17, 2022). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub7/full.
 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 (December 2013), pp. 7272-7282. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881166.
 Christopher Russell et al., “Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA,” Harm Reduction Journal 15:33 (June 28, 2018). https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-018-0238-6#Abs1.
 Multi-Agency Illegal Tobacco Task Force, “Annual Report of Multi-Agency Illegal Tobacco Task Force,” Commonwealth of Massachusetts, Feb. 28, 2023. https://www.mass.gov/doc/task-force-fy23-annual-report/download.