Indiana Doctor: Taxing E-Cigarettes Is the Right Move

The use of e-cigarettes is at an epidemic level. Most concerning is the exponential increase in youth usage. Although there has been a recent decline in e-cigarette use among high school students, from 2017 to 2019, usage increased by 135%. Currently, nearly 20% of high school students are using these electronic nicotine delivery devices. The current youth e-cigarette usage is actually higher than tobacco usage.

In 2019, 4.5% of adults regularly used e-cigarettes, and 37% of adult e-cigarette users also smoked traditional cigarettes. Unfortunately, Indiana is one of the regions with the highest rates of e-cigarette use in the country.

E-cigarette devices typically contain tobacco-derived nicotine and other components in the liquid. When inhaled, the heated liquid evaporates into a white aerosol similar to smoke. Because there is no combustion, there is no actual smoke.

Industry practitioners often claim that e-cigarettes are safe. However, it is more accurate to say that the toxicity of e-cigarettes may be lower than that of burning tobacco. They contain fewer quantities and types of carcinogens, toxins, and particulates than tobacco smoke, as these compounds are released in higher amounts during combustion. Unfortunately, too many young users still believe that e-cigarettes are safe.

Acute adverse pulmonary effects have been well documented. However, due to the lack of long-term studies on e-cigarettes, the risks of long-term adverse health effects, including lung cancer, remain completely unknown.

Although e-cigarettes have failed to become an effective smoking cessation aid, the potential for harm reduction for stubborn smokers who completely switch to e-cigarettes instead of regular cigarettes is reasonable. However, switching to e-cigarettes often leads to dual usage of smoking. Non-smokers should never start using e-cigarettes and risk addiction and harm to their health.

The FDA has long delayed exercising its full regulatory authority over e-cigarettes (although it has recently begun to reject industry flavor applications), and state regulatory efforts are still in relatively early stages. Bans on sales to minors and inclusion of e-cigarettes in smoke-free air laws; some states have banned flavored e-cigarettes. Thirty states have enacted e-cigarette taxes to deter usage by raising prices.

Public health experts primarily support taxing e-cigarettes as a percentage of price (wholesale or retail) as the best way to link the cost of e-cigarettes to the cost of traditional cigarettes. However, state taxes based on percentage of price vary from 7% to 95%.

While some may oppose taxing e-cigarettes, I support imposing a certain amount of tax to keep e-cigarette prices relatively high. This would encourage adult smokers to switch to e-cigarettes as a potentially less toxic alternative, while not encouraging young people to use e-cigarettes, as they are most sensitive to price.

Indiana has finally imposed a tax on e-cigarettes this year. The new regulations align with the minimum best practices advocated by public health tobacco policy advocates; unusually, the legislature did the right thing. For open systems, the e-liquid tax is set at 15% of retail, while for closed systems like Juul, the e-cigarette tax is set at 25% of wholesale.

Sometimes, the Indiana Assembly does some decent things to promote the public health of Indiana residents. This is a good start to addressing the e-cigarette epidemic among Indiana youth and its future health consequences for our children.