Research & Commentary: Illinois Flavor Ban Unlikely to Reduce Hospitalizations, Youth Use, Disregards Harm Reduction

Published November 5, 2019

In their quick veto session, Illinois Senate Democrats are seeking to outlaw flavors in all tobacco products, including cigarettes, e-cigarettes, smokeless tobacco, and the newly approved IQOS device. An amendment to Senate Bill 668 would create the “Flavored Tobacco Ban Act,” which would prohibit any “characterizing flavor” except tobacco flavor. Unlike other misguided flavor bans, the Illinois bill includes menthol and mint flavors.

According to a press release from Illinois Senate Democrats, lawmakers are “[r]esponding to a wave of [vaping-related] hospitalizations and deaths across the country.” According to Illinois Senate Democrats, SB 668 “is aimed specifically at keeping tobacco out of the hands of children.” Unfortunately, Illinois lawmakers do not seem to understand that recent vaping-related hospitalizations are overwhelmingly linked to illegal, unregulated vaping products containing tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana.

A September 2019 report by the Centers for Disease Control and Prevention (CDC) found 77 percent of patients reported vaping products that contained THC. Further, an October 2019 CDC report linked 78 percent of cases to use of THC vaping devices.

Moreover, flavor bans are unlikely to reduce youth use of e-cigarettes and are more likely to lead adult smokers back to combustible cigarettes, which are far more dangerous than regulated e-cigarettes.

CDC’s findings are similar to several state health departments. The Utah Department of Health noted 94 percent of patients with vaping-related lung illnesses reported use of “any THC cartridges.” On October 11, the Iowa Department of Public Health reported that of 38 cases of possible vaping-related lung injury, 33 patients, or 86 percent, reported vaping THC-containing devices. According to the Texas Department of State Health Services, 87 percent of patients “reported vaping products containing [THC].”

Illegal THC vaping cartridges have been confiscated in Illinois. For example, a 25-year-old was arrested in the fall of 2019 after police found more than $103,000 worth of marijuana and more than $5,000 of LSD at his residence. Law enforcement seized “253 THC vape pen cartridges.”

More notably, law enforcement recently uncovered a massive  “THC vape manufacturing” operation that “produced 4,000 to 5,000 vape cartridges a day.” According to officials, the ring sold THC cartridges “in Wisconsin, Illinois and Minnesota.”

Despite lawmakers’ best intentions, flavor bans do not reduce youth vaping. The Heartland Institute examined the effects of flavor bans, finding these measures to have no impact on youth e-cigarette use. For example, Santa Clara County, California, banned flavored tobacco products to age-restricted stores in 2014. Despite this, youth e-cigarette use increased. In the 2015-16 California Youth Tobacco Survey (CYTS), 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.

Flavors are immensely popular among adult smokers, who have transitioned from combustible cigarettes to vaping. For example, a 2018 survey of nearly 70,000 American adults noted that 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively. Further, only 20 percent of respondents reported using tobacco flavors at point of e-cigarette initiation.

Flavor bans will also likely lead former smokers back to much more harmful, combustible cigarettes. A 2017 study by the National Bureau of Economic Research concluded banning flavors “would result in the increased choice of combustible cigarettes.” Indeed, the authors expect e-cigarette use to decrease by approximately 10 percent if flavors are banned.

Further, a ban on menthol cigarette and smokeless tobacco products is likely to have no impact on tobacco use. In a 2012 study, a quarter of menthol smokers indicated they would find a way to purchase, even illegally, menthol cigarettes, should a ban be enforced.

To understand how a ban on flavored tobacco products would impact Illinois, lawmakers need only look at Cook County, which has some of the highest cigarette prices in the country, and also a very large black market. Cook County, which includes Chicago, also has a Cigarette Tax Reward Program, which offers monetary awards of up to $250 to persons reporting those seeking to avoid paying cigarette taxes, including people who use unstamped or counterfeit packs or even stray cigarettes. It has been reported that Chicago police issue each year, however, only 15–20 percent are actually are paid.

Moreover, Illinois lawmakers are concerned about what they consider a “youth vaping epidemic,” yet data confirms there is no epidemic. According to the 1997 Youth Risk Behavior Survey, 42.7 percent of high school students reported using tobacco products, with 36.4 percent reporting use of combustible cigarettes. According to the 2018 National Youth Tobacco Survey, only 27.1 percent of high school students reported using any tobacco product, with 20.8 percent reporting using e-cigarettes and vaping devices. It is alarming that lawmakers would choose to prohibit adult use of tobacco harm reduction products when youth tobacco use is relatively low compared to 1997.

If Illinois lawmakers truly want to address youth tobacco use, they should divert more of existing tobacco moneys into tobacco control programs. Illinois received an estimated $1.0688 billion in tobacco tax revenue and settlement payments in 2019, yet the Land of Lincoln only “allocated $9.1 million [or 0.008 percent of tobacco moneys] in state funds to tobacco control programs” in the same year. Illinois’ spending on tobacco control is so minimal, the Lung Foundation gave the state an F grade in 2019 for the state’s “tobacco prevention and cessation funding”—or lack thereof.

It is becoming extremely apparent that recent vaping-related hospitalizations are being caused by illicit THC-containing vaping devices. Flavor bans are unlikely to reduce such lung illnesses. Further, flavors are essential in tobacco harm reduction devices including e-cigarette and smokeless tobacco, and such bans are likely to lead former smokers back to combustible cigarettes. A ban on flavored tobacco products will create even bigger black markets. Instead of banning products that have helped millions of adults quit tobacco cigarettes, Illinois lawmakers should allocate more than 0.008 percent of tobacco moneys to programs intended to reduce youth tobacco use.

The following documents provide more information on e-cigarettes and tobacco harm reduction.

Tobacco Harm Reduction 101: A Guidebook for Policymakers
This booklet from The Heartland Institute aims to inform key stakeholders on the much-needed information on the benefits of electronic cigarettes and vaping devices. Tobacco Harm Reduction 101 details the history of e-cigarettes, including regulatory actions on these products. The booklet also explains the role of nicotine, addresses tax policy and debunks many of the myths associated with e-cigarettes, including assertions about “popcorn lung,” formaldehyde, and the so-called youth vaping epidemic.

Podcast Series: Voices of Vapers
In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Policy Tip Sheet: Vaping Hospitalizations Likely Linked to Black Markets
In this Policy Tip Sheet, State Government Relations Manager Lindsey Stroud examines recent headlines, finding vaping-related hospitalizations are likely linked to illegal black market vaping products. Stroud examines reports from January 2019 which found youth were being hospitalized due to marijuana vaping products. Further, in 2018, the U.S. Army warned of the dangers of vaping synthetic marijuana after more than 90 military personnel were hospitalized and two died after vaping such devices. Further, none of the reports on the recent hospitalizations have been able to identify a single product that would have caused adverse health effects.

Research & Commentary: Largest Vaping Survey Finds Flavors Play Important Role in Tobacco Harm Reduction–commentary-largest-vaping-survey-finds-flavors-play-important-role-in-tobacco-harm-reduction
In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines a survey of nearly 70,000 adult vapers in the United States. The survey was completed in response to the U.S. Food and Drug Administration’s recent Advanced Notice of Proposed Rulemaking seeking comment on the role of flavors in tobacco products. The authors found nearly 95 percent of survey respondents were at one time smokers and the majority reported using flavors at the point of e-cigarette initiation. Stroud compares this to other surveys. She concludes, “eliminating flavors will force [vapers] to vape only tobacco-flavored e-cigarettes, which would likely cause them to return to combustible cigarettes.” Stroud also found research has found e-cigarettes are a key tobacco harm reduction product and could help alleviate state budgets by mitigating health care costs.

Want More Black Markets and Less Revenue? Move Forward with Menthol Bans
In this opinion piece featured in Townhall, Heartland State Government Relations Manager Lindsey Stroud examines recent proposals to ban menthol in tobacco cigarettes. Stroud finds data indicate that menthol bans are unlikely to reduce cigarette consumption and many menthol smokers would find ways to purchase menthol cigarettes, even from black markets. Stroud writes that menthol bans “will have dire consequences, including increased illegal activities from black markets and negative health consequences due to unregulated menthol cigarettes.”

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Heartland’s government relations department, at [email protected] or 312/377-4000.