HJAR Nov/Dec 2019

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2019 31 Joseph W. Thompson, MD, MPH President and CEO Arkansas Center for Health Improvement cease certainmarketing practices, andmake annual payments to the states. Over the first 25 years of the agreement, the industry was to pay $206 billion. 2000s In a 2000 referendum, Arkansas voters ap- proved a measure mandating that all of the state’s tobacco settlement funds be used for health initiatives. No other state placed this requirement on its settlement money. Recognizing the harmfulness of exposure to secondhand smoke, in 2006 the Arkan- sas General Assembly passed the Clean Indoor Air Act, which prohibits smoking statewide in most workplaces and indoor public spaces. Increases in excise taxes have been shown to reduce initiation of tobacco use by teens. In 2009, theArkansas General As- sembly nearly doubled the tobacco excise tax to fund a statewide trauma system and other health programs. Also in 2009, Congress approved the larg- est-ever increase in the federal cigarette tax and gave the Food and DrugAdministration authority to regulate tobacco products. Con- gress also imposed new restrictions, effec- tive in 2010, on advertising tobacco prod- ucts, limiting marketing and sales to youth, and prohibiting marketing with misleading health descriptors such as mild, light, and low. 2010s In 2016, the FDA extended its regulatory power to include e-cigarettes, which had entered the American market in 2007. In 2019, the Arkansas General Assembly raised the legal minimum age for purchas- ing tobacco and vaping products from 18 to 21, with exceptions for members of the military and people who will turn 19 before January 1, 2020. When this column went to press, Arkansas was one of 18 states that had adopted 21 as the legal minimum age for purchasing tobacco and vaping products. Policymakers here and in other states are seeking to combat an epidemic of teen vaping driven by marketing that has successfully targeted young people. Ac- cording to the Centers for Disease Control and Prevention, more than 20 percent of American high school students were cur- rent users of e-cigarettes in 2018, meaning they reported in a survey that they had used e-cigarettes at least once in the previous 30 days. That represents a 78 percent increase from 2017. The regulation of tobacco has been a slow process, playing out over many decades as awareness of the long-term effects of smok- ing and secondhand smoke has grown. In contrast, it has not taken decades for the harmful effects of vaping to become appar- ent. The CDC has been investigating hun- dreds of cases of vaping-related lung illness, and a number of deaths. Most of those be- coming ill have been teenagers. Importantly, most of these illnesses were detected in patients who required hospital- ization. No surveillance is in place to detect less severe, and likely far more frequent, minimal-to-moderate health effects. As it often does, technology has outpaced public policy, but policymakers are working to catch up. Several states have imposed bans on flavored e-cigarette products, which appeal to young people, and numerous cit- ies have imposed similar bans or other re- strictions. Unfortunately, in Arkansas, the General Assembly has prohibited local government from regulating tobacco and vaping products, so regulations can only occur at the state or federal level, unless the pre-emption law is repealed. During the interim between legislative sessions, the Arkansas House and Senate Public Health, Welfare and Labor commit- tees have initiated a study on vaping. Senate President Pro Tem JimHendren has drafted a bill that would impose several restrictions on vaping, and other lawmakers will likely have rival proposals. We must move quickly in response to this public health crisis; we don’t have decades to wait. n