The Effect of Online Sales Bans on E‑Cigarette Use

From Jeffrey Miron.

"Despite reports that they are less harmful than regular cigarettes, legislators have targeted e-cigarettes and vapes via crackdowns and online sales bans, citing a desire to protect young people.

A new study examines the effect of online sales bans on use of electronic nicotine delivery systems (ENDS). The study

used data from five national surveys conducted between 2013 and 2023 and leveraged the staggered adoption of the bans across states … [to] reveal no evidence that prohibiting online sales reduced youth e‑cigarette use. … Furthermore, these bans had a minimal effect on the frequency of use among continuing users.

The legislation was ineffective because

young people rarely used the internet to obtain ENDS products before the bans. … Although the bans significantly reduced online purchases of ENDS products, the overall reduction in youth use was less than 1 percentage point.

Indeed,

online purchases fell by 40–50 percent on average, suggesting that young people continued to obtain ENDS products online through illegal shipments … [and] shifted from online to in-person purchases and obtained more ENDS products from family and friends.

The bans also did not stop adults from using ENDS; the study shows

no evidence that online sales bans reduced e‑cigarette or cigarette use among adults, even though adults use these products at higher rates than young people."

High-Tax California Is the Nation’s Cigarette-Smuggling Capital

A levy of nearly $3 a pack has spawned a lucrative black-market trade in out-of-state smokes

By Michael LaFaive and Todd Nesbit. Mr. LaFaive is senior director of fiscal policy at the Mackinac Center for Public Policy. Mr. Nesbit is an assistant professor of economics at Ball State University. Excerpts:

"The Golden State has banned some popular cigarettes while jacking up taxes on the smokes that remain."

"More than half of cigarettes smoked in California—53%, to be exact—evaded or avoided the state’s cigarette mandates and levies. That’s a stunning rise from a decade ago, when 28% of cigarettes were smuggled into the Golden State."

"A 2017 California law raised the cigarette tax from 87 cents to $2.87"

"California then banned menthol cigarettes, which make up roughly a third of the nation’s cigarette sales"

"In May, Customs and Border Protection officials in Southern California confiscated 150,000 illegal cigarettes from cruise-ship passengers disembarking from Mexico. In April the state attorney general charged five people with a $24 million tax fraud for allegedly illegally importing untaxed cigarettes."

"A 2022 study found that even before the menthol ban and $2 tax hike, 36% of respondents said they had brought cigarettes into California from elsewhere in the previous year. A 2023 study of discarded cigarette packs conducted across California found that of 15,000 cigarette packs collected, 45% didn’t bear the state’s tax stamp."

"heavy-handed cigarette policies have led to delivery-truck heists, armed retail thefts, and even a murder-for-hire plot."

"Last year a former prison guard was indicted for his role smuggling tobacco into Solano State Prison, near Sacramento."

"Lower-taxed states are a major source of cigarettes to high-taxed ones. Wyoming’s smuggling export rate is 55%. Idaho’s is 28%." 

FDA Deregulation of E-Cigarettes Saved Lives and Spurred Innovation

By Alex Tabarrok.

"What would happen to drug development if the FDA lost its authority to prohibit new drugs? Would research and development boom and lives be saved? Or would R&D decline and lives be lost to a flood of unsafe and ineffective drugs? Or perhaps R&D would decline as demand for new drugs faltered due to public hesitation in the absence of FDA approval? In an excellent new paper Pesko and Saenz examine one natural experiment: e-cigarettes.

The FDA banned e-cigarettes as unapproved drugs soon after their introduction in the United States. The FDA had previously banned other nicotine infused products. Thus, it was surprising when in 2010 the FDA was prohibited from regulating e-cigarettes as a drug/device when a court ruled that Congress had intended for e-cigarettes to be regulated as a tobacco product not as a drug.

As of 2010, therefore, e-cigarettes were not FDA regulated:

…e–cigarette companies were able to bypass the lengthy and costly drug approval process entirely. Additionally, without FDA drug regulation, e–cigarette companies could also freely enter the market, modify products without approval, and bypass extensive post–market reporting requirements and quality control standards.

Indeed, it wasn’t until 2016 that the FDA formally “deemed” e-cigarettes as tobacco products (deemed since they don’t actually contain tobacco) and approvals under the less stringent tobacco regulations were not required until 2020. For nearly a decade, therefore, e-cigarettes were almost entirely unregulated and then lightly regulated under the tobacco framework. So, what happened during this period?

Pesko and Saenz show that FDA deregulation led to a boom in e-cigarette research and development which improved e-cigarettes and led to many lives saved as people switched from smoking to vaping.

The boom in research and development is evidenced by a very large increase in US e-cigarette patents. We do not see a similar increase in Australia (where e-cigarettes were not deregulated) nor do we see an increase in non e-cigarette smoking cessation products (figure 1a of their paper not shown here).

 

Estimating the decline in smoking and smoking-attributable mortality (SAM) is more difficult but the authors assemble a large collection of data broken down by demographics and they estimate that prohibiting the FDA from regulating e-cigarettes reduced smoking attributable mortality by nearly 10% on average each year from 2011-2019 for a total savings of some 677,000 life-years.

The authors pointedly compare what happened under deregulation of e-cigarettes–innovation and lives saved–with what happened to similar smoking cessation products that remained under FDA regulation–stagnation and no reduction in smoking attributable mortality.

A key takeaway on the slowness of FDA drug regulation is that it took 9 years before nicotine gum could be sold with a higher nicotine strength, 12 years before it could be sold OTC, and 15 years before it could be sold with a flavor. Further, a recent editorial laments that there has been largely non–existent innovation in FDA–approved smoking cessation drugs since 2006 (Benowitz et al., 2023). In particular, the “world’s oldest smoking cessation aid” cyctisine, first brought to market in 1964 in Bulgaria (Prochaska et al., 2013), and with quit success rates exceeding single forms of nicotine replacement therapy (NRT) (Lindson et al., 2023), is not approved as a drug in the United States.

The authors conclude, “this situation raises concern that drugs may be over–regulated in the United States…”. Quite so.

Addendum: A quick review on the FDA literature. In addition to classic works by Peltzman on the 1962 Amendments and by myself on what we can learn about the FDA from off-label pricing we have a spate of recent new papers including Parker Rogers, which I covered earlier:

In an important and impressive new paper, Parker Rogers looks at what happens when the FDA deregulates or “down-classifies” a medical device type from a more stringent to a less stringent category. He finds that deregulated device types show increases in entry, innovation, as measured by patents and patent quality, and decreases in  prices. Safety is either negligibly affected or, in the case of products that come under potential litigation, increased.

and Isakov, Lo and Montazerhodjat which finds that FDA statistical standards tend to be too conservative, especially for drugs meant to treat deadly diseases (see my comments on their paper and more links in Is the FDA Too Conservative or Too Aggressive?)

See also FDA commentary, for much more from sunscreens to lab developed tests."

Vaping Around Kids Is Far Safer for Them Than Smoking

By Kiran Sidhu. Kiran is a tobacco harm reduction fellow for Filter.

"Children absorb far less nicotine from people vaping around them indoors than they do from secondhand smoking, researchers found, suggesting that any secondhand absorption of other components of vapor is also likely to be very low.

Countries with substantial uptake of vaping have seen accelerated declines in the cigarette smoking which costs millions of lives each year. Yet valid concerns about passive smoking have often morphed into largely media-driven alarm over passive vaping—despite no good evidence that it is harmful.

Such fears have fueled debates over where vaping should be permitted, and they’ve been particularly pronounced when it comes to the potential impact on children. An Alabama law passed in 2023, for example, made it illegal to vape (or smoke) in a car with a child under 15 present, with a potential fine of up to $100.

The new study—conducted by researchers at University College London (UCL) and the SPECTRUM Consortium, and published in JAMA Network Open—set out to compare nicotine absorption levels in three groups of children in the United States: those exposed to secondhand smoke only, those exposed to secondhand vapor only, and those exposed to neither.

Children were categorized based on interviews with their parents or guardians. Those reportedly exposed to both smoke and vapor were excluded.

Blood samples from 1,777 children, aged 3-11, were then sent for analysis at a Centers for Disease Control and Prevention laboratory. There, concentrations of serum cotinine in the samples were measured—long regarded as a “precise and accurate marker of recent absorption of nicotine,” the researchers noted.

“Compared with children exposed to secondhand smoke, nicotine absorption was 83.6% lower in those exposed to secondhand vapor.”

Nicotine absorption was found to be “highest among children who were exposed to secondhand smoke only, followed by those exposed to secondhand vapor only,” the authors wrote.

The difference between those two groups was actually much bigger than the difference between the vapor-exposure group and the no-exposure group.

“[C]ompared with children exposed to secondhand smoke only, nicotine absorption was 83.6% lower in those exposed to secondhand vapor only and 96.7% lower in those exposed to neither,” the researchers found.

“Our study shows, using data from the real world rather than an artificial lab setting, that nicotine absorption is much lower from secondhand vapor than from secondhand smoking,” lead author Dr. Harry Tattan-Birch said in a press release. 

“Nicotine itself is of limited risk, but it shows what the highest possible exposure might be from secondhand vaping,” he continued. “Exposure to harmful non-nicotine substances present in vapor will likely be substantially lower still.”

Still, the research found that children exposed to secondhand vapor do absorb more nicotine than those exposed to neither smoke nor vapor. Is their exposure to nicotine and other substances something we should be at all worried about?

“The results show that the level of secondhand exposure to nicotine (and other harmful constituents) from being indoors while other people are vaping appears to be minimal,” Tattan-Birch, of the UCL Institute of Epidemiology & Health Care, told Filter.

From his perspective as researcher based in the United Kingdom, he noted that “this means there isn’t the same impetus to ban vaping indoors (e.g., in bars and workplaces) on health grounds alone as there was for smoking.”

Tattan-Birch and his colleagues don’t say that secondhand vapor is totally risk-free, however.

“[A]s secondhand vaping still exposes children to more harmful substances than no vaping or smoking exposure at all, it is best to avoid indoor vaping around children,” UCL’s Professor Lion Shahab, another of the authors, said in the press release.

But Shahab’s much stronger language about smoking in that situation—“should be avoided at all costs”—makes clear that parents or caregivers who switch from cigarettes to vapes are taking a big step forward. Most adults who vape in the UK and other countries previously smoked, and many people who smoke find that vaping is the only way they can quit.

“‘Passive vaping’ is unlikely to pose any health risks.”

Other experts go a little further.

“‘Passive vaping’ is unlikely to pose any health risks,” said Dr. Peter Hajek, professor of clinical psychology and director of the Health and Lifestyle Research Unit at Queen Mary University of London.

Hajek, who was not involved in the new study, publicly commented that it “confirms that, as expected, the amount of nicotine exhaled by vapers, that children and other bystanders are exposed to, is negligible.”

While cigarettes “release …  a number of more serious toxicants into the environment,” he noted, vapes release “no combustion products.”

Dr. Roberto Sussman, a physicist at the Institute of Nuclear Sciences, National Autonomous University of Mexico, is also among scientists who say that risks of secondhand vapor are grossly exaggerated.

Sussman previously explained to Filter how exhaled vaping aerosol rapidly evaporates and disperses, and how particulate matter from air pollution, even in indoor environments, is a far more valid concern. Globally, almost 2,000 children under 5 die because of air pollution each day.

The study authors seem to agree that secondhand vapor is not a substantial threat.

“This paper suggests that concerns about secondhand vaping may be somewhat overstated, with secondhand exposure to toxic substances likely to be very low,” Prof. Shahab said in the release."

Debunking the myth that vaping causes popcorn lung

There is no evidence that e-cigarettes cause popcorn lung. In fact, all of the evidence points to the contrary.

By Michelle Minton of Reason. Excerpt:

"The persistence of the idea that vaping is directly linked to popcorn lung has prompted several health bodies, including Health Canada, the New Zealand Ministry of Health, and the UK Health Security Agency, to clarify that no evidence exists for such a link. Independent charities and research institutions, like Cancer Research UK and Action on Smoking and Health, have made similar statements. Yet, the myth continues to appear in news headlines around the world. (Credit where credit is due: The Washington Post, at least, published an article in 2019 debunking the myth.)  

These misleading headlines are being published at the same time anti-tobacco organizations are continuing to promote the mythical link between vaping and popcorn lung as a reason to support more restrictive policies on e-cigarettes. But, contrary to what frightening headlines would have you believe, there is no evidence that e-cigarettes cause popcorn lung. In fact, all of the evidence points to the contrary. 

For one thing, with the rise in popularity of e-cigarette use over the last 15 years, one would expect a concurrent increase in popcorn lung cases where the two are related. The news media periodically reports on individuals suffering from alleged vaping-induced popcorn lung, but none have been confirmed. Health authorities report no increase in bronchiolitis obliterans. Some countries’ health departments, such as Canada’s, have even admitted that there has never been a confirmed case of e-cigarette-associated popcorn lung in their country’s history. 

More importantly, if vaping nicotine e-cigarettes increases the risk of popcorn lung, one should expect an even clearer connection between popcorn lung and traditional smoking. Conventional combustible cigarettes contain diacetyl—significantly more than what was found in even early-generation e-cigarettes before voluntary industry changes and governmental prohibitions on diacetyl in e-cigarettes. 

The 2015 Harvard study, for example, found an average of nine micrograms of diacetyl per e-cigarette cartridge in the samples that tested positive for the chemical. Combustible cigarettes, meanwhile, contain approximately 336 micrograms of diacetyl per cigarette. This means that a cartridge-per-day vaper would be exposed to just nine micrograms of diacetyl, while pack-per-day smokers are exposed to more than 6,700 micrograms of diacetyl every day—750 times more diacetyl exposure than vapers. Yet, a link between smoking and popcorn lung has yet to materialize. In fact, during the initial studies of popcorn factory workers, researchers observed that those employees who reported smoking showed fewer signs of bronchiolitis obliterans than their non-smoking counterparts. 

If smokers are at no greater risk of popcorn lung because of the diacetyl in cigarettes, why would nicotine vapers be at risk of the disease when their exposure to diacetyl is several hundred times less than smokers? The answer: They aren’t."