Nicotine has been a major public health issue for hundreds of years. Cigarettes have been the most common form of nicotine for a long time. E-cigarettes have been around for decades but more recently gained popularity in the early 2000s. They were advertised as alternatives to smoking and as “potential cessation devices” (National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health). Popularity of e-cigarettes spiked in the early 2000s when more information about the negative health effects of smoking cigarettes became more widespread. E-cigarettes and other vaping products are deemed as “safer” alternatives to regular cigarettes but that is not necessarily the case. There are still many negative health issues that can arise as a result of vaping. Vaping may cause very serious health outcomes
like asthma, lung scarring, organ damage, and possibly even death (Cleveland Clinic). Some of the liquids within vaping devices have been shown to cause cancer. To attempt to combat these issues, the State of Massachusetts passed a bill that restricted the sale of “flavored nicotine, e-cigarettes, and other vaping products” (Act Modernizing Tobacco Control, 2020). These products can now only be sold to “licensed smoking bars where they may only be smoked on-site.” By restricting the sale of these products to specific locations, they are hoping to decrease the overall use of these products and thus decrease the negative effects of them as well. E-cigarettes and vaping devices are considered public health problems because they contribute to negative health outcomes within society that are completely preventable.
Charlie Baker, then Governor of Massachusetts, declared a public health emergency when there was an outbreak of severe lung disease related to the usage of vaping devices. The vaping epidemic was especially troubling because the fruity-flavored vaping products were very appealing to the younger generations. Of the 18-24-year-old age group, 7.8% reported that they regularly used vaping devices in 2017, prior to the introduction of this bill. Concerningly, high school students are six times more likely to use flavored vapor products than adults. After instating a four-month ban on all vaping products in the state of Massachusetts from September 2019 to January 2020, the restriction to the sale of vaping products for on-site consumption at smoking bars went into action in June 2020. There were many people and organizations that were outspoken in their support for this bill. For example, Massachusetts State Senator John F. Keenan published his thoughts on the vaping epidemic and voiced his support for the passing of the bill. He calls the nicotine industry, “an industry that has always sought to protect profits over all else” (Keenan, 2020). He expresses his support for the bill, hopeful that cigarettes and other nicotine products will not cause severe health issues in future generations as they did for his and his parents' generations.
Another example of a stakeholder with unwavering support for this bill is an organization called “Fight All Flavors”. This group was created with the sole purpose of supporting the proposed bill and fighting for its passing. Several stakeholder organizations banded together to create one large and powerful group. “Fight All Flavors” is the combination of groups like Campaign for Tobacco Free Kids, Health Resources in Action, Tobacco Free Mass., the African American Tobacco Control Leadership Council, and many other local, state, and federal stakeholder organizations. Their message is “We are fighting against the tobacco and vaping industries tactics to addict youth. Join us” (Fight All Flavors, 2019). They are passionate about fighting against addiction within the younger generations and more specifically fighting against the way the African American community has been disproportionately affected by the tobacco industry. They argue that “Big Tobacco” unjustly markets their products toward the African American youth. This group is extremely proud of the fact that Massachusetts was the first state to restrict the sale of vaping products. They also have the option on their website for people in other states to contact them and gain support for “Fight All Flavors” in their home states. The Fight All Flavors” team worked tirelessly to mobilize their partners, oftentimes disadvantaged communities, to educate the masses and reach out to state legislators who had the power to make this change.
Additionally, Harold Wimmer, President and CEO of the American Lung Association, showed his support for the passage of this bill. He argued that since the federal government has failed to address this public health crisis, it was the job of the state to address it. He also urges “states and localities to follow Massachusetts’s lead” (NPR, 2019).
Though the public showed overwhelming support for this bill due to the numerous proposed benefits, many retailers that made profits off of the sale of vaping products were not in favor of this bill. Many of them argued that if vaping products were no longer available for purchase at convenience stores and gas stations, people would resort to buying these products from illegitimate sellers. Jon Shaer, executive director of the New England Convenience Store & Energy Marketers Association, said, “The people that were applauding the governor the loudes were the criminals and gangs that already operated in the state's illegal black market” (NPR, 2019). He is arguing that there are people in favor of the bill who use or sell vaping products illegally, to begin with. Hence, they are in favor of the bill because it will make no difference to them. Of course, it makes sense that people who benefit financially from the sale of vaping products would be opposed to the restriction of their sale.
Governor Charlie Baker was able to pass the bill restricting the sale of vaping products because he declared a public health emergency due to the 500+ cases of severe lung disease related to vaping and at least 9 deaths from vaping-related injuries. By declaring a public health emergency he was able to instate the four-month temporary ban on vaping products. During that period he was able to garner support from multiple different organizations and politicians, which allowed for the state legislature to eventually vote on Baker's proposed bill and pass it. After signing the passed legislation into law, the Public Health Council eventually approved further regulations on vaping products. The bill was enforced at the state and local levels and any businesses found breaking this law and selling banned products at unapproved locations were fined $1000 for the first offense. The bill makes it clear that they are not prosecuting the possession, use, or purchase of the products, just the sale of them. It cannot be argued that they are taking away a person's liberties by passing this bill because the use of the products is not criminalized, just the sale.
Unsurprisingly, the sale of tobacco products greatly decreased following the implementation of the bill. As the sale of products decreased in Massachusetts, they increased in the neighboring state of New Hampshire (The Commonwealth of Massachusetts, 2022). They spiked for a few months, until around the end of 2020, and have since started to return to their pre-bill levels. Overall, youth vaping and e-cigarette usage declined from 32% in 2019 to 17.6% in 2021. Additionally, in 2022, black smokers were 25% more likely than white smokers to attempt quitting, which addresses the prior concern that “Big Tobacco” targeted the African American communities more heavily. It is estimated that for every 1% decrease in adult smoking rates, there are 56,000 fewer smokers, and $477 million dollars saved in healthcare costs for long-term health conditions. With less smokers and tobacco users in general, the rate of severe lung disease will likely not increase in the state of Massachusetts. Smoking kills over 6 million people each year and about half of its longtime users. By reducing the levels of smoking by creating a barrier to purchase, Massachusetts is protecting its people from becoming addicted to tobacco or continuing their addiction to tobacco which in turn protects them from the health consequences that are associated with long-term smoking and vaping.
The Massachusetts’ ban on the sale of tobacco products except in specified locations has drastically reduced the sale of tobacco products within the state. This has led to increased numbers of people attempting to quit and prevented from purchasing to begin with. This bill was targeted directly at protecting the youth by ending the marketing of fruit-flavored vaping products to young people. It has helped immensely in preventing the new generation from becoming youth addicts.
References
National Center for Chronic Disease Prevention and Health Promotion (US) Office on
Smoking and Health. (1970, January 1). Introduction, conclusions, and historical
background relative to e-cigarettes. E-Cigarette Use Among Youth and Young Adults: A
Report of the Surgeon General [Internet].
Anonymous. (2024, June 21). Vaping (e-cigarettes): What it is, side effects & dangers.
Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/21162-vaping
105 CMR 665.00: Minimum standards for retail sale of tobacco and electronic nicotine
delivery systems. Mass.gov. (n.d.).
Massachusetts’ Flavored Tobacco Products Policy. (2022, September).
Keenan, John. (2020, January 29). An act modernizing tobacco control. State Senator John
Flavors hook kids NYC. (n.d). https://fightallflavors.org/
Romo, V. (2019, November 27). Massachusetts governor signs law severely restricting
flavored tobacco, vape products. NPR.
Report to the FDA on the use of Menthol Cigarettes. (2022, August 2). The
Commonwealth of Massachusetts
Impact Of Restricting The Sale Of Flavored Tobacco Products: The Massachusetts
Experience. (2024, June 12). Campaign for Tobacco-Free Kids.
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