HJLR May/Jun 2019

48 MAY / JUN 2019 I  Healthcare Journal of little rock column policy The Arkansas General Assembly convened this year amid reports that electronic cigarette use has skyrocketed among American youth, and that smoking by adults costs the state Med- icaid program hundreds of millions of dollars more each year than the state collects in tobacco taxes. Policymakers recognized a need to act, and while there was significant legislative activity creating more awareness, a good portion of it was stifled by the vaping and tobacco lobby. The Centers for Disease Control and Prevention reported earlier this year that 20.8 percent of high school stu- dents said they had used an e-cigarette in the past 30 days, up from 11.7 percent in 2017. The CDC also found that high school stu- dents were using e-cigarettes more often. Among e-cigarette users in that age group, 28 percent said they had vaped on more than 20 of the past 30 days in 2018, up from 20 percent in 2017. These statistics are especially troubling to public health advocates because cigarette use has been declining among young people. In 2018, 1.8 percent of American middle and high school students said they were current cigarette smokers, down from 4.3 percent in 2011, according to the CDC. Decades ago, the numbers were far worse. In 1989, 15.7 percent of children ages 12–18 reported be- ing current smokers. Remember “smoking areas” in high school? The reduction in cigarette smoking by young people has been a great public health success story, but the manufacturers of e- cigarettes are luring kids back to nicotine with flavors, advertising, and other mar- keting practices aimed squarely at this age group. Young people may not think smok- ing cigarettes is cool anymore, but the vap- ing industry is successfully convincing vast numbers of them that vaping is cool. Make no mistake—an e-cigarette is a nic- otine-delivering product. Not only are ado- lescents susceptible to nicotine addiction, theymay even be more susceptible than new smokers of adult age because their brains are still forming. While it is plausible that e- cigarettes may have a role to play in helping adults reduce or quit tobacco consumption, the health effects of inhaling vaporized dilu- ents and flavorings are completely untested. And for young people, vaping can be an in- troduction to a lifelong addiction. Vaping often leads to cigarette smoking. A recent study found that young people who use e- cigarettes before trying any other nicotine products are four times more likely to be smoking cigarettes within two years than young people who have not tried vaping. A report late last year showed Arkansas continues to rank near the bottom among states in overall health, in part because of smoking by adults. The United Health Foun- dation’s annual America’s Health Rankings placesArkansas at No. 46, and the single big- gest adverse factor in the ranking is that 22.3 percent of adults in the state are smokers, compared to the national rate of 17.1 percent. In January, theArkansas Center for Health Improvement published an infographic il- lustrating smoking’s financial impact on Arkansas’s Medicaid program. We looked at the numbers of Arkansans with health conditions that can be attributed to smoking, estimated how many of them likely devel- oped those conditions because of smoking, looked at those individuals’Medicaid claims, and concluded that smoking costs the state Medicaid program at least $795 million a year. Arkansas’s tobacco taxes have been generating about $230 million a year. Smoking, Vaping Get Arkansas Lawmakers’Attention