Despite much of the news we digest on a daily basis, it may come as some surprise that heart disease is still the No. 1 cause of death in our city. It may not come as a surprise that, within the data concerning death and heart disease, many health disparities across race, gender and socio-economic status are readily apparent. For instance, men of color in Baltimore die of cardiovascular disease at a rate that is more than 10 percent higher than the city average and more than 45 percent higher than the state average. Of all the factors that contribute to cardiovascular disease-related deaths, tobacco usage is the leading preventable cause.
As members of the Baltimore City Council representing some of the city’s most socio-economically depressed neighborhoods, we see the prevalence of tobacco usage and regularly grieve the passing of our friends and family from readily preventable disease. Recently, the Maryland General Assembly’s Legislative Black Caucus announced its support for raising the age of tobacco sales to 21, a measure we wholeheartedly support. While this would be a remarkable step toward helping our neighbors, we believe more must be done to protect the residents of Baltimore City, including increased local control over the sale, distribution and packaging of tobacco products.
Knowing some of the practical and legal constraints we face in Maryland, and Baltimore City in particular, we propose three modest steps to help our city:
1. Ban flavored e-liquids, the commonly used term referring to the inhaled vaporized fluids associated with electronic smoking devices, to prevent children and youth from taking up vaping and tobacco;
2. Put up signage to inform residents of the harmful effects of tobacco and resources to help them quit;
3. And require tobacco retailers to carry tobacco cessation aids, specifically nicotine replacement therapy or “NRT” (including gum, patches, lozenges, and inhalers).
With respect to flavored e-liquids, there has been considerable national media attention in recent months concerning the targeted sales of electronic smoking devices, like JUUL, to young people. Even the Food and Drug Administration has come out aggressively against flavored e-liquids, having drawn a direct connection between electronic smoking devices and increased nicotine addiction among teens. A CDC study from 2014 found that more than 250,000 youth who had never smoked a cigarette before used an electronic smoking device in 2013. In 2014, 33 percent of Baltimore high school students reported having used electronic smoking devices, according to the Maryland Youth Risk Behavior Survey that year. Nicotine is toxic, highly addictive and has negative effects on brain development in adolescence. Nicotine addiction developed through the use of electronic smoking devices also greatly increases the likelihood of cigarette and other tobacco product use.
Anecdotally, we have each had countless conversations with teachers and school administrators within our districts who have seen dramatic increases in electronic smoking devices being used in schools. Many devices, such as JUUL, are extremely difficult to detect and are easily concealed. Vaping has glamorized smoking and threatens to reverse the decades of progress that has been made in tobacco control. The use of electronic smoking devices in schools and other public spaces normalizes smoking and undermines smoke-free and tobacco-free laws, sending the wrong message to our youth.
Yet, we acknowledge that many current tobacco users are turning to JUUL and other electronic smoking devices to either quit tobacco or cut down their tobacco usage. Until there is more research and regulation addressing the health consequences of e-liquids, we cannot encourage Baltimoreans to use said devices. Unlike popular nicotine replacement therapies, the amount of nicotine used in electronic smoking devices is not capped at a responsible level intended to help people quit, like NRTs, which have been shown to double the quit rate after one year of use.
Knowing this, we propose having affordable, small packages of nicotine replacement therapy available at every corner store where tobacco is also available, and signs guiding tobacco users to Maryland’s Quitline (1-800-QUIT-NOW) and other helpful cessation resources. According to the Centers for Disease Control, “people of low [socioeconomic status] are just as likely to make quit attempts but are less likely to quit smoking cigarettes than those who are not.” Clearly, we must provide more resources to our communities if they are to succeed in quitting tobacco.
All told, our suite of bills within the Baltimore City Council will help to curb tobacco usage and save lives as a result. Together, we will work to help longtime users of tobacco break their addiction and protect our young people from ever having to experience the harmful effects of nicotine and tobacco products.