Lindsey Stroud joins the podcast to discuss November’s Policy Focus: E-Cigarettes and Public Health. Tragically, 480,000 Americans die each year from smoking-related diseases and illnesses. Many want to stop but struggle to do so and instead have transitioned from combustible cigarette use to safer e-cigarettes and vaping products. Despite the good news of harm reduction products, there is a large effort by health organizations and lawmakers to eliminate their use. In this episode, we’ll look at the data behind e-cigarettes and vaping products, the regulations imposed on them, and the best policies and products to reduce tobacco harm, especially among young people.
Lindsey Stroud is a visiting fellow at Independent Women’s Forum. She is the director of the Taxpayers Protection Alliance’s (TPA) Consumer Center, which provides data and analysis to inform and assist policymakers when addressing consumer products. Stroud’s main focus is on providing up-to-date information on adult access to goods including alcohol, tobacco, and vapor products, as well as regulatory policies that affect adult access to other consumer products. In her role, Stroud manages the team at the Consumer Center and has testified before state and international lawmakers, led coalition efforts, authored state analyses, and hosts a monthly webinar featuring international guests.
TRANSCRIPT
Beverly Hallberg:
And welcome to She Thinks, a podcast where you’re allowed to think for yourself. I’m your host Beverly Hallberg, and on today’s episode, it is our Policy Focus entitled E-Cigarettes and Public Health. And this is an important focus because, tragically, almost 500,000 Americans die each year from smoking-related diseases and illnesses. Many of them want to stop but struggle to do so, and instead have transitioned from combustible cigarette use to safer e-cigarette and vaping products, which are shown to reduce the harms of tobacco use. But despite this good news of harm reduction products, there is a large effort by health organizations and lawmakers to eliminate their use.
In this episode, we’re going to look at the data behind e-cigarettes and vaping products, the regulations imposed upon them, and the best policies and products to reduce tobacco harm, especially among young people. And we have a wonderful guest to break it all down. She is the author of this month’s Policy Focus. Her name is Lindsey Stroud. Lindsey Stroud is a visiting fellow at Independent Women’s Forum, and she is also the director of the Taxpayers Protection Alliance’s consumer center, where her main focus is on providing up-to-date information on adult access to goods including alcohol, tobacco, and vapor products, as well as regulatory policies that affect adult access to other consumer products.
She has testified before state and international lawmakers and led coalition efforts, and it’s a pleasure to have her on the program today. Lindsey, thank you so much for being here.
Lindsey Stroud:
Thank you, Beverly, for having me on here. You make me sound a lot fancier than what I feel.
Beverly Hallberg:
Well, one of the questions I had for you is how does somebody get into this policy focus, studying combustible cigarettes versus e-cigarettes, vaping products? How did you decide to not only work in the policy field but go into this specific area?
Lindsey Stroud:
My old job, actually — I worked at the Heartland Institute, and when I signed up, I was still smoking and they were like, “Oh hey, you can work on vaping,” and I fell in love with it. Went to this newfangled technology that came out and these people who were able to quit smoking, these adults that were able to quit smoking using this product, and seeing just the nightmare of regulatory action that they were dealing with, especially just at the local, state, federal levels. And then you have the legislatures brought in here, you got courts brought in here, and it’s kind of really fascinating to look at the evolution of adult access to new tobacco products in the United States. And as we’ll probably talk about more in this podcast, is how increasingly difficult it’s getting.
Beverly Hallberg:
And people can find this Policy Focus on IWF’s website, iwf.org, so if they want more information. We’re going to break it all down here, and I thought we would start by talking about just the history of cigarette use and also what we’ve learned about its use over the years. So, I know probably like many people, most of my grandparents smoked decades ago before we realized it did cause health harm, and many people tried to get off of it, some people couldn’t. And now we have these other products that aren’t as damaging that do have harm reduction. But can you give us a little history lesson about the origins of cigarettes, when we learned that they could cause things like lung cancer and the evolution to the innovation we find ourselves in today?
Lindsey Stroud:
Yeah, absolutely. Tobacco, if you know your history, the south and the Civil War, tobaccos have been a staple crop of the United States for years. It wasn’t actually until the early 1900s that actually combusted tobacco…. What most people tended to actually chew their tobacco back in the day. Then the cigarettes weren’t a thing until really the last hundred years and everything. But it wasn’t until the 1950s, 1960s that you started seeing the health community coming out and kind of studying the effects of cigarettes. And so in 1964, which was two years after England had done their report — you had this surgeon general report on smoking, which linked combustible cigarettes with a cancer — so that was pretty much when you started to see this big anti-cigarette smoking [inaudible 0:04:20]. I don’t want to call it an anti-push; it was a push for more information is what I like to call it, like “Hey, these products probably aren’t that good for you, and you probably shouldn’t be advertising them as such.” But since then, you’ve seen the trying to reduce the cigarette rates because they are very harmful for you. It’s one of the only consumer goods that, if you use it as intended, you are going to die by using this product. And in the years since then, because it’s such a hard addiction, you’ve seen people trying to quit smoking and not being able to. The pharmaceutical companies have kind of come in with nicotine replacement therapies. A lot of the public health people will be like, “Hey, cold turkey.”
But researchers kind of started to look at the nuances of why people are smoking. And it was said in 1975, by Michael Russell who, “People smoke for the nicotine but they die from the tar.” It’s the combustion of cigarettes which causes the most harm. You can chew tobacco, even cigars have a very less-risk profile on them. But it’s the whole lighting it up, smoking that part, that’s what… Cigarettes have about 700 ingredients in them. When you light them on fire, it comes into like 6,000 chemicals. So, you’ve had modern products that come out, whether it’s smokeless, heat-not-burn, or e-cigarettes, which allow you to get this nicotine without that tar.
Beverly Hallberg:
And I know people who have a history of smoking understand the addiction and the connection to it. I read an article years ago that I thought was really insightful, and it was somebody who was a smoker talking about a cigarette as a relationship. It’s always there; when you need a break, it’s there. What do you find from the psychological side and the addiction side, why is stopping cigarette smoking such a hard thing for people to do?
Lindsey Stroud:
Well, I think you just said it best. I think that cigarettes are… You equate them with so many things. People will have a meal and then they have a cigarette or there’s a Sam Cooke song “Cigarettes and Coffee.” You’re driving these little… Just it’s a habit that you, “Hey, I have my cigarette, this is how I do it.” And I think that’s a big part of it. And I think it’s also why vaping has been such a really big phenomenon on getting people off of cigarettes because it’s that hand-to-mouth function versus all the other nicotine replacement therapies that you get, whether it’s patch or gum, it doesn’t mimic what you’re used to being able to do. It is a relationship. And by the way, I did just quit smoking a week ago actually, and I’m on my —
Beverly Hallberg:
Congratulations.
Lindsey Stroud:
And when you bring with this habit, I just flew into DCA today and that’s what I was worried about was like, “Okay. You get off the plane, you go immediately to go get your Uber and you smoke a cigarette.” And so it’s that habit. And I did okay, I vaped instead of smoking a combusted cigarette, but I think that’s really difficult because it is a consumer good that you do. Most people smoke a pack a day, that’s 20 cigarettes a day. There’s a lot of instances that they use that in.
Beverly Hallberg:
Well, let’s talk about the innovation of e-cigarettes and vaping products. Break it down to how these products actually work and really why they’re healthier. What is it about them that makes them less harmful to people?
Lindsey Stroud:
Okay. So, e-cigarettes aren’t even that new. Actually, it was one of the bigger tobacco companies in the ’80s or ’90s that actually introduced and had actually sold what would’ve been like a modern e-cigarette. It had really lukewarm approval, but it was in 2007 with Hon Lik who came up with what’s considered the modern e-cigarette and the device that we all now see that, and it was actually 2003 in China that he kind of invented it, brought it to market. Wasn’t until 2007 when they were introduced into the States. So those are the Cigalikes, the old school ones. I think people would probably remember watching the Blue commercials with the black little cigarette people were smoking that you could smoke inside.
And the advent of like, it really is a consumer-driven good. You had Hon Lik, this inventor who kind of came out with this technology, and people were able to actually use it and been able to quit smoking. So the technology of an e-cigarette: it consists of a battery and then it consists of a liquid that you then heat, you will use that battery to heat up that liquid, and it produces an aerosol. And that liquid, it’s about usually five ingredients, mostly for nicotine, flavoring, propylene glycol, and vegetable glycerin. All of those are actually found in combustible cigarettes, maybe not the glycerin or anything, but the combustible cigarette has a heck of a lot more other chemicals added to it that you light on fire. And you don’t light this on fire.
So the aerosol that’s produced is significantly less harmful. A Cochrane review just came out about a month ago actually that did find that e-cigarettes are more helpful in nicotine replacement therapies, the FDA-approved ones, in helping adults quit smoking. So they have been beneficial in reducing cigarette smoking rates among adults, and it’s very limited data, but they’re pretty amazing. It’s unfortunate that the regulatory playing field in the States, there’s been a lot of hindrance on being able to, I guess, tweak and evolve this technology in order for you to be able to market your product in America, you have to go through the pre-market tobacco product application process. Millions of dollars going in there, and if you want to… Say there’s a problem with your product or years down the road, you’d have to go do another application in order to address that. So we’re kind of stunted in tobacco harm reduction in the States just through the regulatory process.
Beverly Hallberg:
Well, one of the things I think is interesting is when you think about other ways people try to stop smoking — Nicorette gum is what pops into mind. That’s never thought of as a negative thing. If somebody is using Nicorette to stop smoking, you think that’s a positive step. Do people not feel the same way about e-cigarettes for a certain reason, do you think?
Lindsey Stroud:
They hate e-cigarettes. Well, it’s Nicorette gum, I like to call it the battle between the tobacco companies and the pharma companies. Nicorette is produced by one of the larger pharmaceutical companies. There’s this wonky notion that e-cigarettes are this newfangled device to get this next generation hooked. And actually, if you look at the history of e-cigarettes and even “big tobacco” being involved with it, e-cigarettes first came into America in 2007. It wasn’t until 2012 with one of the larger tobacco companies purchasing one of the then-existing e-cigarette brands. So they kind of looked at it like it was a gimmick. But when you compare it to any other consumer good, we’re not stopping Volkswagen from making an electric vehicle.
If anything, we’re trying to tell them that, if you look at California, which has banned flavored tobacco and e-cigarette products and by 2035, all of their vehicles have to be electric vehicles. We get this, ‘well cars can be safer,’ but nobody’s banning combustible cigarettes.
Beverly Hallberg:
Now is the argument that there’s enough science that shows that still e-cigarettes are harmful to you, that it causes lung cancer among other things, vaping products are harmful to you so that’s why it needs to be regulated? Now, whether or not that’s a good argument or not, is that their perspective that these are still extremely harmful, and is that accurate? Does the science back that up?
Lindsey Stroud:
There is no science to back it up. The big argument is the what if. The long-term, that seems to be now… We have over 10 years of research on the immediate health effects of e-cigarettes, and they are significantly less harmful. Government public health agencies have actually studied this unbiasedly and they’re finding, when you compare it to a combustible cigarette, the aerosol that’s produced from an e-cigarette is tremendously less harmful. The big thing now that we don’t know these long-term damage, which is this stupid argument when you think of it. It’s like, well, if there’s no short-term damage, where’s this long-term damage going to come out of? And that’s the kind of argument. But I think it just comes back to that “big tobacco,” they had their day in court, they got found guilty and they just have a stain on their back and we’d rather destroy them. But you’re seeing a lot of these flavor bans pop up across the country and it was mentioned in the Westchester County, New York the other night just had it, why aren’t we banning all cigarettes if we understand that these are harmful? But there’s a lot of money in cigarettes. There still isn’t a lot of money that comes from e-cigarettes. The FDA center for tobacco products is completely funded by user fees, which tend to be paid for by the consumers of those tobacco products, and it’s only on six product categories. It’s not any of these newer devices. So, e-cigarettes are not included on that, but cigarettes are. So, when you look at the regulatory playing field, it’s kind of like a business, why would I sit here and authorize a product if I’m making no money off of that product?
Beverly Hallberg:
One of the things I have found very fascinating about even the vaping side of things is, at the same time there have been these increase in regulations against e-cigarettes and vaping products, you have an increased interest and support and states making changes to law on marijuana usage. And so why is marijuana usage looked at as “oh that’s good and people can use that,” but then when you get into the nicotine side, the tobacco side, that’s thought of as evil? What do you make of the dichotomy of this thinking?
Lindsey Stroud:
It’s pretty amazing. I’m glad that you brought that up. Especially when you…. I’ve actually done a little bit of work behind the scenes on some federal cannabis reform stuff, and my big thing is make sure that the FDA does not regulate it because you’re only going to have the big companies. A lot of it, I know, the big thing is the racial issue that comes in. What’s amazing with the marijuana issue is that you’re not seeing the youth issue, but youth use of any products is going down on all of them. Like the drugs, alcohol, tobacco, if you look at the numbers, they’re not as fun as kids as they used to be 10 years ago — I’m joking about that, people. But there is that interesting thing that you are…. New York, I think, is the best example. You banned flavored e-cigarette products and then signed the bill the next day to recreational marijuana.
I think it all comes back to this idea that it’s big bad tobacco just coming after your kids, which is unfortunate because it’s not. Big tobacco is actually forced to change because their consumers forced to change them. But it is going to be interesting to see over the next two years to see what are the policies… if you’re going to see an increase in youth use of these products that you did legalize and what’s the repercussions of banning flavored e-cigarettes.
You have already seen in some localities, for example, San Francisco when they banned flavored e-cigarettes back in like 2018 and you saw an increase in youth using combustible cigarettes. I know I’ve been tracking 18- to 24-year-old data on smoking rates. And three out of the four states with flavored e-cigarette bans did see an increase in smoking rates among their 18- to 24-year-olds through young adults. Yet when you look at all of the states on average, it decreased by 20% between 2020 and 2021.
Beverly Hallberg:
Well, I want to take a brief moment to talk to you, our listeners. You may know that Independent Women’s Forum is a leading national women’s organization dedicated to enhancing people’s freedom, opportunities, and wellbeing. But did you know that we are also here to bring you, women and men on the go the news? You can listen to our High Noon podcast, an intellectual download featuring conversations that make free society possible. Hear guests like Ben Shapiro or Dave Rubin discuss the most controversial subjects of the day. Or join us for happy hour with At The Bar, where hosts Inez Stepman and Jennifer Braceras chat on the latest issues at the intersection of law, politics, and culture. You can listen to past episodes at iwf.org or search for High Noon or At The Bar in your favorite podcast app.
Now Lindsey, I do want to focus just a little bit on young people there. You were just mentioning that regulations on e-cigarettes and vaping products don’t necessarily make your child not smoke, not use them. And I think so many people when they hear about regulations on vaping products, e-cigarettes, they think, “Well, I don’t want my child to smoke, so this is a good thing to do.” What is your main argument to people on why regulations won’t necessarily help your children and definitely don’t help those who are trying to quit smoking?
Lindsey Stroud:
Well, the e-cigarette regulations don’t take into account that flavors are very important to adults. You always see politicians, “Oh, the flavors are only there to attract children.” But no, flavors act as both getting people…. They help people quit smoking cigarettes because they taste so much better. And then also, once they’re used to sucking that flavor, and sucking a combustible cigarette doesn’t feel as good. But also you see time and time again on these youth surveys because they do ask youth, recently too, in the 2021 one they asked among kids who had ever even tried an e-cigarette and ones that were currently using e-cigarettes. And overwhelmingly, they’re not citing flavors as a reason for using them. Among youth who have just tried an e-cigarette, overwhelmingly they tried it because of a friend. Among kids that were currently using e-cigarettes, over 50% of them cited feeling anxious, depressed, or stressed, and that’s why they use them. And that’s where I think it’s really unfortunate there’s something going on with our youth right now, and we’re all kind of I guess throwing out this tobacco-vaping issue where there’s more things, and now kids aren’t using these products because of the flavors, they’re using it because they’re anxious, stressed, or depressed. Let’s go and talk about that because it’s more than them just using tobacco. There’s a whole slew of other things that happen with that one.
The big thing too with the youth is that you did see… After suing the tobacco companies in the 1990s, federal cigarette taxes, state cigarette taxes, you were seeing gradually youth cigarette use was declining. So then you started in 2015, seeing an uptick in kids using e-cigarettes. Now when you look at the numbers, it looks like youth vaping kind of peaked in 2019. And that’s when you had about one in five kids were “current” e-cigarette users, which current is defined as having used an e-cigarette or tobacco product on at least one occasion in the 30 days prior to the survey, so it’s not like they were doing it every day. They could have just been at a party, and they would be defined as a current user.
But you’ve seen that decrease, even, I want to say it’s like 11% now so it’s great. We should be celebrating those policies that have seen already a decrease with this newfangled device. Of course kids were going to use it; show me a product that no kids never get their hand onto it. But I think the flavor bans are just a little bit hard hitting. I don’t think they address why kids are using these products. And I think a lot of it’s just fear mongering and it goes back to this, “oh, it’s big tobacco coming after your kids.” And it’s like, no, it’s not but you can get back to why are kids using these products.
Beverly Hallberg:
And so when we look at what policies should look like on the state level and on the federal level, what is it that you think people should be supporting? I know that it’s a big broad question.
Lindsey Stroud:
If you’re going to regulate tobacco products, they should be regulated on their harm, the continuum of harm. Even the former FDA commissioner, Scott Gottlieb, had the tobacco products are on this continuum of harm. You’ve got combustible cigarettes that are the most harmful, and then nicotine replacement products, which are the least harmful. And that’s the regulations should be reflective of how much harm that they’re doing to a person, to a consumer that uses them. I work at the Taxpayers Protection Alliance, I ain’t going to sit here and say go tax them. But I know right now you have over half the states that do tax electronic cigarettes and other novel tobacco products, and there’s a few states that they tax them, where I want to say it’s Kentucky that actually has a higher tax rate on that than combustible cigarettes.
If you’re going to tax them, once again, the continuum of harm, the tax rate… We use excise taxes to deter people from using these products. If you have a cigarette smoker and you know that this alternative’s going to be safer for them to use, well, you should be encouraging them to go to that safer product, not taxing that product the same way that you would tax a cigarette. And it’s a gimmick. When you look at the youth vaping issue, it’s a lot of anecdotes and not a lot of substance.
I mean, when you start breaking down some of these numbers and the way that you’re even seeing that, you can go look at the FDA, you can go look at the CDC, they conflate the numbers all the time. So when it’s like 11.5% of youth that are current, but they’re all talking about, well, that percentage of youth, the ones in that little, that 11.5% that are using it every day. And so then you have these news media sources that are like, “Oh, 24% of kids are daily e-cigarette users.” Well, it’s no, it’s 24% out of that 11.5%, which is like 3% when we do these numbers. But trying to do math with both lawmakers and media, oh, fun.
Beverly Hallberg:
Well then a final question for you on this, and maybe you won’t even answer this from a personal perspective, I’ll leave that up to you. But when many people do switch from combustible cigarettes to e-cigarettes or vaping products, are they hoping that they stop altogether, or do they view this as something that is less harmful and they’re willing to take on some sort of health risk because they enjoy it so much? Or what are we finding as people’s health, what do they expect when they do make this transition?
Lindsey Stroud:
Me, I was accidental. I was just like, “Hey, you didn’t smoke in a day. Let’s see if you could just do it.” And it’s been fine, except the airport and where you really want a cigarette. The vape shops have been really good at being able… They’re not technically allowed to actually talk about the health benefits of e-cigarettes, but a lot of people do actually because vaping with the open system in liquids, you can actually taper down your nicotine level so that at some point you’re vaping zero nicotine so now it’s just like a hand-to-mouth thing and you don’t really have that I guess “physical addiction.” But I mean all of the anecdotes from people, their lungs are better. I’ve heard stories from people, I’ve seen some lung scans actually from people that their lungs look like they never smoked, and they’ve been vaping for the past decade.
So, this alarmism with the harm, it’s just not there with the people that you’re seeing, but they are taking control of their life, and I think it’s one of probably the coolest things about vaping. At least right now that there is some control over it. You can kind of still pick your device, you’re not supposed to be able to have access to it, but yah, you could still pretty much get some e-liquids in certain states and everything. And you can choose your nicotine level and you can choose how you do it. And it’s very personal versus going to a C-store and getting a pack of Marlboros or Newports.
Beverly Hallberg:
Well, I think it’s such a fascinating topic and often one that people don’t talk about too much because it is one of those hot-button issues. And I think it’s important as we look at regulations and policy to know the facts of what’s going on. So, thank you so much for your research and also putting out this Policy Focus. Again, it is called E-Cigarettes and Public Health. You can find it at iwf.org. Lindsey Stroud, thank you so much for being here.
Lindsey Stroud:
Thank you.
Beverly Hallberg:
And thank you all for joining us. Before you go, I do want to let you know that IWF does want you to know that we rely on the generosity of supporters like you. An investment in IWF fuels our efforts to enhance freedom, opportunity, and wellbeing for all Americans. So please consider making a small donation to IWF by visiting iwf.org/donate. And last, if you enjoyed this episode of She Thinks, do leave us a rating or review on iTunes, it does help. And we’d love it if you shared this episode so your friends know where they can find more She Thinks. From all of us here at Independent Women’s Forum, thanks for watching.
