Many in Maryland undoubtedly believe that protecting our youth from nicotine addiction and harm ranks as a top priority. Yet parents and teachers at high schools and middle schools continue to wage a battle against multi-billion-dollar tobacco and e-cigarette corporations.
Recently introduced emergency bills (House Bill 3 and Senate Bill 233) in the Maryland House of Delegates and Senate give parents, teachers and the youth they protect a fighting chance.
This legislation provides an opportunity to stop the sale of all flavored tobacco products, including flavored e-cigarettes. Use of e-cigarettes among Maryland high school students has increased 73% since the 2016-2017 time period, with almost one in four students reporting having used an e-cigarette in the last 30 days.
These products appeal to youth with kid-friendly flavors, discreet design and savvy social media marketing. Many pod-based e-cigarettes, like JUUL, have extremely high levels of nicotine that get youth quickly hooked. In fact, JUUL and others chemically modify their nicotine to make it more palatable.
To help combat the youth epidemic, last year the Maryland General Assembly and Governor Larry Hogan passed and signed into law a bill that raised the minimum age to purchase tobacco to age 21. Nevertheless, youth may still acquire tobacco products like e-cigarettes through other means, such as online retailers. Or they can pay a legal age adult to buy tobacco products for them. The evidence also shows retailer compliance with the law is not likely to be 100%. Therefore, we need additional policy actions to prevent youth from using these highly addictive and unsafe products.
Flavors play a prominent role in youth initiation by making e-cigarettes more appealing, especially to first-time users. Approximately 96% of youth who use e-cigarettes say they started with a flavored product. Pro-vaping advocates will likely suggest adults trying to use e-cigarettes to quit smoking also use flavored e-cigarettes. While it is true adult users cite flavors as a primary reason for their use, the role of flavors in helping smokers quit cigarettes remains uncertain.
A decision earlier this year by the Food and Drug Administration to stop the sale of flavored pods or cartridges (small containers filled with e-liquid and a heating coil that are connected to a device’s battery prior to use) might sound like a positive step. However, companies may be able to continue selling refillable pods with e-liquids sold separately, and the flavors currently available are limited only by your imagination.
History suggests pro-tobacco advocates and retailers will seek to exempt tobacco products, like cigars, from H.B. 3 and S.B. 233 on the grounds they do not contribute to the youth e-cigarette epidemic. This would be a mistake. For example, in 2009, the FDA stopped the sale of flavored cigarettes, with an exemption for menthol. The policy succeeded at its primary goal of reducing cigarette use among youth but eventually led to an increase in youth use of other tobacco products known for their flavors, like menthol cigarettes, cigars and pipes.
Moving forward, Maryland has an opportunity to finally put an end to this game of whack-a-mole by prohibiting the sale of all flavored tobacco products.
Despite the body of evidence outlining the likely benefits of H.B. 3 and S.B. 233, pro-vaping advocates and some business owners, who are not able or willing to diversify their product offerings, will likely argue for a retailer exemption that restricts the purchase of flavored products to adult-only tobacco and vape shops. Lessons learned from other states and cities indicate this approach is not wise.
In California, vape shops ranked as the most likely retailer type to sell to those under 21. In Minneapolis, convenience store owners circumvented a law with this retailer exemption by applying for licenses to become adult-only tobacco retailers in order to continue selling flavored products. These cautionary examples suggest an exemption for adult-only shops may not adequately reduce the availability of flavored tobacco products to Maryland youth.
The evidence suggests we need to do more to curb youth vaping and tobacco use. Stopping the sale of all flavors, including menthol, for all retailers may drastically lower youth use of tobacco products, including e-cigarettes. Watering the bill down with exemptions may displace youth tobacco use and/or result in ineffective policy. The time has come to give those on the frontlines a chance and pass H.B. 3 and S.B. 233.
Jeffrey Hardesty (firstname.lastname@example.org) is a public health researcher at the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health. He is lead author of a new report: State of the Evidence — Flavored Tobacco Product Bans or Restrictions. Views expressed are his own.