Up in Smoke

Declaring youth vaping a public health emergency, Michigan became the first state last week to ban the sale of flavored e-cigarettes that officials believe are targeting children and young adults.

That wasn’t the only new salvo against the industry: The Centers for Disease Control on Friday recommended that the public avoid e-cigarette products altogether while it investigates a multistate outbreak of lung illnesses associated with vaping—more than 450 cases so far.

The announcements follow a skyrocketing rate of youth vaping, with more than 37% of 12th graders in 2018 reporting vaping substances that can come in flavors ranging from menthol and tobacco to bubblegum and watermelon, up from 28% just a year earlier.

Craig S. Fryer, an associate professor for behavioral and community health and associate director for the Maryland Center for Health Equity, spoke to Maryland Today about the impact of the ban, vaping’s health effects and the broader context of drug laws.

How much do we know about vaping and its health effects?
Our understanding of the negative short-term health effects of vaping is growing. There have been recent studies linking vaping to mouth and throat irritation, exposure to heavy metals, and breathing problems. These studies are small and the subsequent health outcomes are relatively new. We need larger and more comprehensive studies to examine long-term effects. Those of us in tobacco control are in a battle with the tobacco industry. We’re playing catchup in our empirical evidence of the detrimental effects because federal systems like the FDA need to have scientific evidence before they can take action with regulatory power to protect the public’s health.

How significant is Michigan’s ban?
It’s very significant. In the absence of current federal laws that restrict flavored e-cigarettes, we need local policy or local government to make these decisions. Other states are looking at whether this is going to work for potential duplication.

Are single-state actions like this an effective way to impact public health?
Yes, they can be, particularly if other states follow suit. There’s always the potential for an unanticipated outcome of policy. You could create sub-markets for products if there’s a ban, and that’s potentially a possibility for e-cigarettes. For me, however, this is about initiation: How do we stop the attractiveness of flavored e-cigarette products for young people who don’t use any other tobacco product? As we think of supply and demand, people can cross borders and jurisdictions if they are really in need. What makes it impactful, though, is that for your general young person, it’s sending a message these products are not good for them and its use is detrimental to their health.

Will policies like this be seen as contradictory when Michigan also recently legalized marijuana, which has often been a long-time focus of anti-drug campaigns?
For the general public, this may be a confusing message. Here again, I say we need a call for more empirical research in these areas in terms of the medicinal aspects of marijuana and the impact on use when a product is legalized. Policy-wise, it may be difficult for Michigan to explain that rationale, because young people can vape marijuana oils. Either way, the focus should remain on why did vaping become popular, particularly among young people as their first tobacco product of choice?  This ban is a good first step, given the amount of current awareness it has garnered at the national level.