By Justine Fuga
Just last year, one in five high school students and one in 20 middle school students across the country used electronic cigarettes (e-cigarettes). According to the 2018 National Youth Tobacco Survey, more than 3.6 million middle and high school students used electronic cigarettes, more than double the number of youth using e-cigarettes in 2017. This increase is concerning given what is known about the adverse health effects of e-cigarettes. Recent research shows that nicotine has a negative effect on the developing brain. Other chemicals found in e-cigarettes are toxic to cells and have been linked to cardiovascular and lung diseases, including cancer.
Diverse strategies have emerged to curb the youth e-cigarette epidemic, including million-dollar campaigns from CVS Health and school policies implementing random nicotine testing. Most notable is the recent ordinance passed by San Francisco, the first city to institute a large-scale sales restriction. The city-wide ban prevents residents from purchasing any e-cigarettes in stores or online until products have undergone a premarket review by the U.S. Food and Drug Administration (FDA). The ban is motivated in part to decrease youth access to e-cigarettes. From 2016 to 2017, current e-cigarette use among California high school students increased from 8.6% to 10.9%, according to the California Student Tobacco Survey.The San Francisco ban is not the first law implemented to impact youth access to e-cigarettes. California state law sets various online purchasing requirements for e-cigarettes: online purchasers must provide proof of age, distributors must deliver to verified mailing addresses, and online purchaser age must be verified by a third-party service. These laws were in place in 2016 and 2017, but it is unclear whether these state laws had any impact on the 2.3% increase in youth vaping because, problematically, there is no current research exploring the link between the laws and youth e-cigarette use.
As localities pass ordinances, like the San Francisco ban, to regulate e-cigarette use and access, policy surveillance can play an important role in determining the law’s effect on health outcomes. Policy surveillance is the systematic, scientific collection and analysis of laws of public health significance. Policy surveillance produces legal maps that provide data suitable for use in rigorous evaluation studies.
Temple University’s Center for Public Health Law Research (CPHLR) has laid some of the groundwork for policy surveillance in electronic cigarette laws. This legal map provides insight on the number of states that have laws in place that impact youth access to e-cigarettes, particularly online access. As of August 1, 2017, 49 states and Washington, D.C. have laws regulating e-cigarettes, including laws establishing age requirements to purchase e-cigarettes. However, online purchasing requirements for e-cigarettes varied. Nine states had laws requiring an online purchaser to provide proof of age. Twelve states had laws requiring that an online purchaser’s age be verified by a third-party service. Six states had laws requiring that the person signing for delivery of an online purchase be over the minimum legal age. Perhaps even more interesting to the issue of youth access to e-cigarettes is that 37 states did not have any laws including online e-cigarette purchasing requirements as of August 1, 2017. Interestingly, youth use of e-cigarettes nearly doubled from 2017 to 2018. As e-cigarette use continues to rise, state e-cigarette regulation continues to vary. Health outcomes of local e-cigarette laws are not 100% known, but we can use policy surveillance to continue to track and build a foundation of research.
Justine Fuga is a law student at the Thomas R Kline School of Law at Drexel University, and a summer intern with the Center for Public Health Law Research.