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E-Cig Regulation Likely to Burn Low-Income Americans

27 Sep 2018

Vanessa Brown Calder

The FDA is tied in knots over e-cigarette use. On the one hand,
the FDA does not want people to smoke. But, on the other hand, the
FDA does not want people to use smoking alternatives that could
help them quit, such as e-cigarettes. To that end, the FDA recently
signaled its interest in increasing regulation of e-cigarettes
including Altria’s MarkTen and British American Tobacco’s Vuse,
with an eye towards protecting teens from potential health

As FDA Commissioner Scott Gottlieb put it:

[Some say] in order to protect kids, [the FDA] is going to
encumber adult smokers by putting in place restrictions that make
these products less attractive, or harder to purchase by adults.
These things may all be true.

But although the commissioner recognizes new regulation could
negatively impact adult e-cigarette consumers, he does not consider
that new restrictions may disproportionately affect the poor.

This is likely for three reasons. First, low-income and
low-skill Americans are more likely to smoke traditional
cigarettes, and more likely to smoke traditional cigarettes
heavily. For example, the CDC finds the prevalence of smoking is around two
times as high for smokers below the U.S. poverty line as for
smokers at twice the poverty level. Likewise, adults with less than
a high school education are more than 2.5 times as likely to smoke
as adults with a college degree.

Second, when it comes to quitting smoking, poor and
less-educated Americans have the hardest time. A CDC report suggests that smokers with less than
a high school degree are less than half as likely to report
recently quitting smoking as smokers with graduate degrees. And
adults at or above the poverty level are more likely to report
recently quitting than those below the poverty level.

Evidence suggests
e-cigarettes are an easy way for poor American smokers to improve
their health. Unfortunately, future restrictions may change

Third, poor and less-educated Americans are more likely to use
e-cigarettes. According to a recent study, 10.2 percent of individuals in households with
between $0-$20,000 of income have used e-cigarettes, whereas about
half as many individuals in households with $75,000 of annual
income or more have used e-cigarettes. Education levels break the
same way: Around twice as many individuals with less than a high
school degree have ever used an e-cigarette, compared to
individuals with a college degree or more.

Why does this matter? Low income and less-educated Americans
report lower levels of access to health care and poorer health
outcomes along a variety of metrics. E-cigarettes ostensibly
provide an affordable avenue to improve health for smokers that
can’t afford professional help quitting or reducing cigarette use.

According to a variety of studies, smokers commonly use
e-cigarettes with an intention of substituting them for tradition
al cigarettes or quitting smoking. Indeed, the most common reason
cited for using e-cigarettes is smoking cessation or improving health, and
research finds e-cigarettes are an effective substitute or
“quit aid”: Randomized control trials suggest e-cigarettes
are as effective as other methods and some survey research indicates e-cigarettes are more
effective than over-the-counter nicotine replacement therapies or
trying to quit “cold turkey.”

Smokers who use e-cigarettes also report improved health. In a
2014 longitudinal study of regular smokers who purchased e-cigarettes,
the majority of participants reported improved health (65.4
percent), reduced smoker’s cough (57.7 percent), improved
sense of smell (53.8 percent) and taste (50.0 percent) within 8
weeks’ time of e-cigarette use.

Of course, e-cigarettes are neither guaranteed safe nor lacking
in health risks of their own. Because e-cigarettes are relatively
new, long-term effects are still unknown and evidence on outcomes
is limited.

Still, most everyone agrees that e-cigarettes are a safer option
than cigarettes and that e-cigarette vapor is safer than
second-hand smoke. As the National Academy of Sciences mentions in
a consensus study, cigarette smoke is estimated to
contain “approximately 1,500 times more harmful and
potentially harmful constituents” than e-cigarette vapor and
there is “substantial evidence” that “exposure to
potentially toxic substances … is significantly lower” with
e-cigarettes. In other words, when used the way most smokers
intend, e-cigarettes constitute improvement over traditional

It also bears mentioning that a non-trivial portion of Americans
report using e-cigarettes for cost reasons. Taken together, this
suggests e-cigarettes are an affordable and accessible way for poor
American smokers to voluntarily improve their health.

The FDA is ostensibly committed to protecting Americans from
harmful substances. However, the commissioner should also consider
whether the FDA is interested in protecting poor Americans from
regressive regulation. Evidence suggests e-cigarettes are an easy
way for poor American smokers to improve their health.
Unfortunately, future restrictions may change that.

Vanessa Brown
is a policy analyst at the Cato Institute.

Click here to view the full article which appeared in CATO Journal