WCMS sent the following comments after approval at the October 2020 WCMS Executive Council meeting.
October 23, 2020
Via email (MDHHS-AdminRules@michigan.gov)
Michigan Department of Health and Human Services
Bureau of Legal Affairs
333 S. Grand Avenue, 5th Floor
Lansing, MI 48909
Dear Michigan Department of Health and Human Services:
On behalf of the Washtenaw County Medical Society (WCMS), we write to support the rulemaking efforts to ban flavored tobacco for e-cigarettes. As physicians and public health leaders, we are aptly aware of the danger and health risks these products pose to Michigan’s children, their families, and our communities.
Since 1827, WCMS has been the leading physician medical association for legislative action and community outreach in Washtenaw County. We are comprised of approximately 1,000 physicians of various specialties working at major medical and teaching institutions, including the University of Michigan, Chelsea Hospital, St. Joseph Mercy Ann Arbor; and IHA; community health centers; and small or private practices. WCMS members care for patients across all ages, from a wide-range of socioeconomic backgrounds, representing various health needs.
WCMS appreciates the Michigan Department of Health and Human Services’ commitment to public health and the opportunity to comment on the proposed rules. The most recent 2018 data from the Michigan Profile for Healthy Youth for Washtenaw County reports that 18.3% of 9th-11th graders used e-cigarettes, and that number has likely grown over the past two years. Washtenaw teens’ usage is higher than Michigan’s overall value by nearly 5%, and shows a growth of 11% since the last report. With those statistics in mind, WCMS highlights the real urgency and risk of that usage below:
- Time is of the essence: The COVID-19 pandemic has emphasized the urgency in protecting lung health. Smoking greatly harms overall health and can increase the risk for harm and exacerbate respiratory infections, such as COVID-19. There is growing evidence that vaping can also harm lung health.
- Kids like flavors: The 2020 National Youth Tobacco Survey found that 7% of high school users (2.53 million) and 73.9% of middle school users (400,000) used e-flavored cigarettes. Among high school students who currently used any type of flavored e-cigarettes, the most commonly used flavor types were fruit (73.1%; 1.83 million); mint (55.8%; 1.39 million); menthol (37.0%; 920,000); and candy, desserts, or other sweets (36.4%; 910,000).
- Flavors are an attractive gateway: The FDA’s Population Assessment of Tobacco and Health (PATH) Study found that that 81% of youth and 86% of young adults who had ever used tobacco reported that their first product was flavored, versus 54% of adults aged 25 or older.
- Flavors increase long-term smoking rates: The PATH Study also found that those who said that their first tobacco product was flavored had a 13% higher prevalence of current tobacco use a year later and adults started with a product that was flavored had a 32% higher prevalence of current tobacco use a year later.
WCMS urges MDHHS to consider these concerning statistics which exist beyond the current scope of the proposed rulemaking opportunity:
- Truth Initiative’s Young Adult Cohort Study found that 52% of new young adult smokers (18-34) initiated with menthol cigarettes. Initiation with menthol cigarettes was higher among black smokers (93.1%) compared to white smokers (43.9%).
- The five most popular cigar brands among 12-17-year-olds (Swisher Sweets, Black & Mild, Backwoods, White Owl, and Dutch Masters) all come in flavor varieties (National Survey on Drug Use and Health, 2016).
- In 2015, flavored products made up more than half of all smokeless tobacco sales (Kuiper, NM, et al., “Trends in sales of flavored and menthol tobacco products in the United States during 2011-2015,” Nicotine & Tobacco Research, published online June 1, 2017).
- Kids are successful at purchasing tobacco online 94% of the time (Rebecca S. Williams, MHS, PhD; Jason Derrick, MSW; Kurt M. Ribisl, PhD, "Electronic Cigarette Sales to Minors via the Internet," JAMA Pediatr. 2015;169(3):e1563. doi:10.1001/jamapediatrics.2015.63).
We strongly urge MDHHS to both approve the rules as currently proposed, and work to improve them by banning all flavored tobacco products and requiring online sales to be shipped to a licensed retailer for age verification. WCMS welcomes the opportunity to work together to develop reasonable solutions in pursuit of our mutual goal of optimizing patients’ health and community safety.