Clearing the Cloud on E-Cigarette Regulation

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Scholar calls for regulation to counter cigarette addiction while limiting increased vaping among non-smokers.

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Despite posing serious health and addiction risks, e-cigarettes remain 95 percent safer than traditional cigarettes, according to a 2015 Public Health England study. In balancing combustible cigarette and e-cigarette restrictions, regulators face a difficult choice: they can either help current smokers quit traditional cigarettes and transition instead to e-cigarettes, or they can protect a new generation from e-cigarette vaping addiction.

In a recent working paper, Samuel Hampsher-Monk, Managing Director of BOTEC Analysis, argues that this smoking­­­­–vaping paradox is solvable. He claims that taxation, bans on certain flavors, smoke-free laws, and restrictions on marketing would help e-cigarettes replace traditional cigarettes without attracting new users. According to Hampsher-Monk, if regulators choose to crack down on e-cigarettes, traditional cigarette use among youths may increase, and many former cigarette smokers might turn back to traditional cigarettes.

Hampsher-Monk reports that manufacturers, after creating the e-cigarette, rushed to sell these vape products to young audiences. Policymakers, afraid of addiction risk, responded with restrictions on e-cigarettes.

Hampsher-Monk admits that regulators were right to worry, as scientists have yet to determine the full extent of how vaping can harm health. Hampsher-Monk argues, however, that policymakers must weigh potential harms of vaping against larger public health risks from smoking. Hampsher-Monk acknowledges that nicotine in e-cigarettes causes increased blood pressure and heart rate, and vapor fumes can cause lung problems. Studies also indicate that vaping causes poor immune system response and respiratory disease.

Hampsher-Monk points out, however, that cigarette smokers see improvement in chronic obstructive lung disease symptoms after switching from traditional cigarettes to vaping. In long-term cigarette smokers, switching to e-cigarettes decreases smoking biomarkers in lungs, increases vascular function, and decreases respiratory illness.

In the United States, there are nearly 9 million adult e-cigarette users who smoke cigarettes, approximately 7 million of whom reported using e-cigarettes to help them quit. Hampsher-Monk argues that e-cigarettes serve as a tool to transition traditional cigarette smokers away from smoking altogether.

In addition to concerns over the unknown health risks of e-cigarettes, critics of e-cigarettes fear that young people may become addicted to vaping. Hampsher-Monk notes, however, that although rates of vaping among youth increased in the United States and Canada, teens do not become regular users of e-cigarette products unless they already use tobacco products.

Taking into account these concerns, Hampsher-Monk reports that the number of Americans harmed by policies that discourage the use of cigarettes in favor of e-cigarettes is more than two and a half times greater than the number of Americans hurt by e-cigarette use. Hampsher-Monk proposes several regulatory guardrails that seek to ensure that the benefits of e-cigarette use outweigh the harms.

Hampsher-Monk first proposes that policymakers should set tax rates to keep e-cigarette prices lower than those of cigarettes, then increase prices to create a gap between traditional cigarette and e-cigarette products.

According to Hampsher-Monk, regulators should also increase taxes on both products over time but keep e-cigarettes the lower-priced option amid these price increases. Hampsher-Monk warns that if regulators drive up the price of e-cigarettes too much, smokers, including youths, will return to cigarettes. For example, Hampsher-Monk reports that a $1 tax increase for electronic nicotine delivery systems reduced e-cigarette sales by 29 percent, but increased the sale of cigarettes by 10 percent. Regulators, therefore, must balance these price increases carefully, he notes.

Hampsher-Monk next argues for bans on vape flavors that appeal to children.

Flavored pods are currently banned in the United States, and flavored liquids are restricted in several states. Hampsher-Monk disagrees with general bans on flavored products and instead argues that regulators should exempt flavors that do not appeal to a young audience. Older users prefer tobacco, menthol, and mint flavors that recreate the smoking experience, while younger users prefer sweet candy profiles. These flavor preferences are common across age groups, so targeted bans would be effective, Hampsher-Monk argues.

Hampsher-Monk also recommends that governments establish more smoke-free zones to inconvenience traditional smokers and disrupt smoking normalization.

Following a 2016 World Health Organization recommendation, several United States municipalities adopted laws prohibiting vaping in enclosed public areas. Hampsher-Monk argues, however, that regulators should not treat vaping the same as smoking and instead use a “differentially applied public use ban.”

He proposes that cigarette users should have increased restrictions on smoking, but e-cigarette users should remain able to vape in certain areas. Hampsher-Monk claims that the comparative convenience of vaping will encourage smokers to switch without normalizing vaping for non-smokers.

Hampsher-Monk further encourages regulators to set nicotine limits for regular cigarettes lower than e-cigarettes to encourage users to switch to vaping. Regulators should then continue to lower the limit for all nicotine products over time to phase out the chemical altogether, he argues.

The European Union, United Kingdom, and Canada passed regulations limiting nicotine concentration in e-cigarettes. The United States has yet to follow, as critics claim that such laws would undermine efforts to use e-cigarettes to quit smoking. Hampsher-Monk claims that European studies, however, show that e-cigarettes with lower nicotine levels remain effective quitting aids.

Hampsher-Monk also calls for regulators to require manufacturers to print warnings on cigarette boxes, indicating that e-cigarettes are a safer smoking alternative.

Hampsher-Monk warns that current labeling methods fail to promote vaping as a safer alternative to cigarettes. He explains that, under his recommendation, customers already buying cigarettes would see the warning label, while consumers who purchase e-cigarettes would only see nicotine warnings.

In addition, regulators should ban e-cigarette manufacturers from advertising in stores other than tobacco shops and from using lifestyle messaging that would appeal to younger consumers, Hampsher-Monk argues. According to Hampsher-Monk, advertising is an effective mechanism for diverting smokers to vaping, but if implemented poorly, advertising can lead to unintended youth uptake.

As his final policy proposal, Hampsher-Monk suggests that regulators set the e-cigarette minimum legal sale age to 18 years old but keep the cigarette purchase age at 21. He reports that such laws would reduce youth smoking, while higher minimum age laws for vape products tend to push youth toward cigarettes. Indeed, a U.S. study reveals an 18 percent increase in youth smoking following a 30 percent decrease in youth e-cigarette use as a result of minimum sale age increases.

If teens must smoke something, it should be a vape rather than traditional cigarettes, Hampsher-Monk concludes.