Testimony from:
Chelsea Boyd, Integrated Harm Reduction Research Fellow, R Street Institute


Senate Committee on Emerging Issues

April 17, 2023

Chairman Brown, Vice Chairman Moon and members of the committee,

My name is Chelsea Boyd, and I am a research fellow for Integrated Harm Reduction Policy at the R Street Institute (R Street). R Street 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 S 522.

The proposed legislation represents an effort to preserve state-level control of tobacco and nicotine products in Missouri by limiting localities’ authority to regulate and limit the sale of these goods. This will prevent negative outcomes from arising due to uneven implementation of tobacco control across the state. These outcomes are not only economic in nature, but also include the health of the roughly 817,000 Missourians that smoke who will likely maintain better access to less harmful alternatives to combustible cigarettes.[1]

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.[2] 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.[3] In fact, according to Public Health England, e-cigarettes are 95 percent less harmful than combustible cigarettes.[4] 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.[5] Given this strong evidence, the Senate 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.[6] 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.[7] 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.[8]

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.[9] 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.[10] 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.[11] If localities elect to ban all flavored vapor products—as this bill would prevent—it is less likely that current smokers will make the switch to less harmful products. This is something that Missouri cannot afford to risk.

Losing momentum against reducing the rate of smoking 

By protecting the state’s authority to regulate tobacco products, the state will prevent the very real risk of introducing a patchwork of laws governing the sale of tobacco and nicotine products that 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.”[12] 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. It is with these concerns in mind that we favor efforts that prevent the subversion of consistent tobacco control policy in Missouri.

I respectfully urge the committee to support S 522.


Chelsea Boyd

Chelsea Boyd
Research Fellow, Integrated Harm Reduction
R Street Institute
[email protected]

[1] Centers for Disease Control and Prevention, “Extinguishing the Tobacco Epidemic in Missouri,” U.S. Department of Health and Human Services, Oct. 13, 2022. https://www.cdc.gov/tobacco/stateandcommunity/state-fact-sheets/missouri/index.html; 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.

[2] 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.

[3] 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; 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

[4] 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.

[5] Hartmann-Boyce et al. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub7/full.

[6] 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.

[7] Ibid.

[8] Ibid.

[9] 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.

[10] Ibid.

[11] Ibid.

[12] 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.