UVM Medical Center physicians play role in new laws on cigarette and e-cigarette use
For public health advocates concerned about rapidly increasing electronic cigarette use among Vermont’s youth, 2019 may turn out to be a watershed year.
Motivated by a desire to curtail teen vaping, state officials enacted statutes imposing a new wholesale tax on e-cigarettes; restricting online sales of such devices; and raising the legal age to purchase and possess tobacco and e-cigarettes from 18 to 21.
Several University of Vermont Medical Center physicians were on the front lines of that effort. They included George Till, MD, a state legislator who has long pushed for smoking-related reforms.
Without taking immediate action on e-cigarettes, Till says, “we were about to lose a war we had been winning for decades.”
Till is referring to the fact that, even as youth use of traditional cigarettes continues to decline, there has been alarming growth in e-cigarette use among teens.
E-cigarettes, which use heated liquid to deliver vaporized nicotine and other additives, first hit the market more than a decade ago and have been “the most commonly used tobacco product among U.S. youth” since 2014, according to the U.S. Surgeon General.
E-cigarettes winning popularity among teens
Featuring a wide variety of delivery devices and flavors, e-cigarette popularity has skyrocketed in recent years. Federal officials noted a 78 percent increase in vaping among high school students from 2017 to 2018, and they say more than 3.6 million youth now use e-cigarettes.
In an effort to slow the growth of youth vaping, President Donald Trump’s administration is considering a federal ban on the sale of flavored e-cigarettes.
In Vermont, a 2017 Youth Risk Behavior Survey showed the number of high school students who had ever tried an electronic vapor product increasing from 30 percent to 34 percent since 2015.
In that same survey, current e-cigarette use among Vermont high school students decreased from 15 percent to 12 percent. But that number didn’t match up with the growing concern among educators, who noted “huge problems” with vaping in testimony before the Legislature.
Legislating a solution to teen vaping and e-cigarette use
All of that led to a push for legislative action at the Statehouse. Till was the lead sponsor on two bills that became law: Act 22 says only wholesalers and retailers can engage in the online sale and shipment of e-cigarettes, and Act 28 places a 92 percent wholesale tax on e-cigarette liquids and devices.
Lawmakers also threw their support behind a concept Till had been promoting for more than a decade – boosting Vermont’s legal smoking age to 21.
“The first year I brought it up, I couldn’t even get people to consider it in the House,” said Till, leader of the generalist division within the Department of Obstetrics, Gynecology and Reproductive Sciences.
This year, the so-called “Tobacco 21” measure won approval and became Act 27, with an effective date of Sept. 1. The law also applies to “tobacco substitutes” – meaning e-cigarettes.
Vermont joins 17 other states that have raised their legal smoking age to 21. Ten of those states’ laws have taken or will take effect in 2019.
Changing the smoking age is expected to pay long-term public health dividends. A 2015 Institute of Medicine report projected that, if Tobacco 21 was implemented nationally, there would be a 12 percent decrease in tobacco use by the time current teenagers became adults.
Extrapolated to Vermont, that could mean 11,000 fewer adult smokers, said Rebecca Bell, MD, a pediatric critical care physician at UVM Medical Center. Bell also told lawmakers that raising the smoking age could lead to at least 500 fewer premature deaths among Vermont children born between 2000 and 2020.
Preventing addiction, reducing risk
Bell said the new law is less about 18 to 21-year-olds than it is about ensuring that youth aged 14-17 don’t start smoking or vaping. The idea is to eliminate “social overlap” between younger students and 18-year-old high school seniors who, until the new law took effect, could get tobacco or e-cigarettes legally.
“We know that, the younger someone starts smoking, the more difficult it is for them to then later quit smoking,” Bell said.
Beyond nicotine addiction, e-cigarettes are spurring other concerns nationwide.
The federal government is investigating widespread cases of serious lung illness from nearly every state – as well as dozens of deaths – that have been associated with vaping. The Centers for Disease Control and Prevention advised that “people should consider not using e-cigarette products” during the investigation. In connection with the federal investigation, the Vermont Department of Health asked providers to be on the lookout for and report any significant respiratory illness among those who have recently vaped or smoked.
Additionally, research released earlier this year at an American College of Cardiology conference showed associations between adult e-cigarette use and elevated risks of heart attack, coronary artery disease, depression and anxiety.
That research is “an early signal that these things are not safe,” said Prospero Gogo, MD, a cardiologist who directs UVM Medical Center’s Cardiac Catheterization Lab.
At the same time, Gogo said it’s not yet possible to know the cardiovascular risks of vaping. “That’s another big problem that we have,” he said. “We just don’t have enough data on these things that millions of kids are starting to use.”
Gogo lobbied Vermont legislators to approve Tobacco 21. In his presentation, he included e-cigarette marketing campaigns from JUUL – the market’s major player – that featured eye-catching colors and images of smiling young people.
“My main problem with JUUL and vaping is that, it’s not something that a 17-year-old should start using,” Gogo said.
This story was reported by Mike Faher, with the UVM Health Network.