Arkansas Attorney General Leslie Rutledge launched an offensive against youth vaping on Monday -- the same day researchers in New York published the first study linking e-cigarette vapor to cancer in mice.
The Republican attorney general issued an "enforcement advisory," warning online retailers that they stand to be fined up to $10,000 under the Arkansas Deceptive Trade Practices Act for selling or shipping e-cigarette products to minors.
She also wrote to the president and CEO of online marketplace eBay urging the website to ensure no vaping products can be purchased there.
Monday was also the first day that a public service announcement featuring Rutledge warning about the risks of vaping was to air on television across the state.
Rutledge announced the initiatives at the start of her office's youth vaping conference at Arkansas Children's Hospital on Monday morning. She'll hold a second meeting on the issue in Bentonville on Wednesday.
"Misinformation and opportunities for youth to illegally buy vaping products online have contributed to the vaping epidemic across the nation and our state," Rutledge said."It is my responsibility to educate our youth on the dangers of vaping and hold those accountable who break the law. With more children and teens becoming sick and addicted to nicotine, we cannot stand idle and watch a health crisis fester within our state. If you are selling illegal products to Arkansas children, prepare to face consequences."
The public meetings come as government and public health officials scramble to address the rising prevalence of e-cigs, particularly among teens.
As of last week, the U.S. Centers for Disease Control had reported about 1,080 cases of acute illnesses associated with vaping in the U.S, including 18 deaths. About 70% of those patients have been males, with 80% being younger than 35.
CANCER IN MICE
Billed as a safer alternative to traditional cigarettes because they don't involve the burning of tobacco leaves, vaping products' long-term health consequences have been largely unknown.
But that picture became bleaker on Monday after researchers at New York University published a study in the Proceedings of the National Academy of Sciences showing that e-cigarette vapor caused lung cancer in 22.5% of mice tested. It also showed that 57.5% of the mice in the study had bladders that showed rapid cell growth, an early sign of cancer.
"Our current results show that [e-cigarette smoke]-exposed mice developed lung adenocarcinoma and bladder urothelial hyperplasia, indicating that ECS is a lung carcinogen and a potential bladder carcinogen in mice," the study said.
The New York University researchers concluded that vaping is the likely cause of a variety of chronic diseases in humans as well, but that further study is needed on the potential threat to humans. It was the first study to link vaping to cancer.
E-cigarettes consist of nicotine contained in a liquid that is aerosolized and inhaled. The heating devices range in size and shape, and vaping companies offer a variety of flavors that are often marketed toward minors.
The devices have become increasingly problematic in schools because they often resemble common items such as computer memory drives and pens.
Rutledge said Monday that she organized the vaping events largely because she's been hearing constantly from school administrators about the "youth vaping epidemic" during her annual tour around the state.
In a large meeting hall at Arkansas Children's Hospital, physicians discussed the negative health consequences of nicotine addiction; law enforcement officials warned of the perils of selling products to minors and adding illicit substances such as cannabis to e-liquid; and public officials contemplated potential policy solutions to address youth vaping.
Arkansas' surgeon general, Dr. Greg Bledsoe, said he's often asked if e-cigs are safer than regular cigarettes, but he said that's a flawed question.
"It's like being asked, 'Would it be better if I jumped out of a third-story window or a 10th-story window?'" Bledsoe said.
STATES' SOLUTIONS
Other states have been grappling with the same issues, and they've approached the same problem with a variety of solutions.
Michigan, for instance, banned the sale of flavored e-cigarettes and e-liquid; the U.S. Food and Drug Administration last month also announced that it would soon implement regulations banning non-tobacco-flavored e-liquid.
Fifteen states, including Kansas and Louisiana, have levied excise taxes on vaping products in recent years.
In Arkansas, those products carry only the standard sales tax, whereas tobacco cigarettes carry an excise tax of $1.15 per pack.
While the Arkansas General Assembly approved an eventual increase of the tobacco and e-cig buying age to 21 earlier this year, lawmakers didn't approve any legislation to address youth vaping.
The House and Senate Public Health, Welfare and Labor committees have adopted a study on the matter, and Senate President Pro Tempore Jim Hendren, R-Sulphur Springs, publicized a draft bill on the issue that he described as a "starting point."
The draft proposes levying an excise tax on vaping products similar to cigarettes. It would also place additional restrictions on the places where e-cigarettes can be used or advertised.
Taxing vaping products has split the General Assembly, but Hendren has said he hopes that it can find common ground before the next regular legislative session in 2021, perhaps convening for a special session before then to consider vaping legislation.
MARKETING BLAMED
Rutledge said she convened the public meetings to bring stakeholders together to ensure everyone wasn't "spinning the same wheels."
Participants on several different panels encouraged parents and school officials to have honest, direct conversations with children about vaping. The products are easily hidden and can be purchased online, so no one should assume that they're not being used.
Dr. Tamara Perry, an associate professor of pediatrics at the University of Arkansas for Medical Sciences and Arkansas Children's Hospital researcher, said that children shouldn't bear the brunt of the blame.
"These children are victims of marketing," she said.
Similarly, first lady Melania Trump said Monday that companies "must stop" marketing vaping products to teens, The Associated Press reported.
Trump said, "It is important to me that we all work to educate children and families about the dangers associated with this habit."
The first lady promotes an anti-drug message through the "Be Best" youth initiative she launched in May 2018, the AP reported.
Perry and other doctors noted that children often think they're only inhaling flavored water vapor, unaware of the nicotine and other chemicals contained in e-liquid.
Additionally, e-cig companies have developed a variety of flavors targeting minors such as sweetened cereal milk, gummy bears and other fruity flavors.
BRAINS REWIRED
Dr. Matthew Steliga, a thoracic oncologist at UAMS, said Monday that nicotine use in children can "rewire" their developing brains, making them more susceptible to addiction in the future.
Several doctors on the panels said that the idea that vaping is the best way to stop smoking should be dispelled because there's already highly regulated nicotine cessation products that are used under the supervision of a physician. Those products -- ranging from patches and lozenges to even inhalants -- also slowly decrease the amount of nicotine being delivered to eventually wean patients completely off nicotine.
Rutledge on Monday also issued a warning to online retailers that the Arkansas Tobacco Products Tax Act of 1977 (Arkansas Code Annotated §§ 26-57-201 et seq.) requires tobacco and e-cig transactions to be conducted in person, not online.
She provided a list of 100 online retailers that are "potential targets" for fines from her office. Those retailers, like Direct Vapor and Juice Man USA, ship e-liquids and vaping products across the U.S.
SALES STOPPED
Also Monday, The Associated Press reported that two retailers -- Supermarket chain Kroger and drugstore chain Walgreens -- announced they would stop selling e-cigarettes.
Walmart Inc. announced last month that it would stop selling e-cigarettes at its stores nationwide.
Kroger said it would stop selling e-cigarettes as soon at its current inventory runs out at its more than 2,700 stores and 1,500 fuel centers. The Cincinnati-based company operates the Ralphs, Harris Teeter and other stores.
Walgreens, based in Deerfield, Ill., operates more than 9,500 stores in the U.S.
As for eBay, Rutledge asked the company to adhere to its own policies, which prohibit the sale of vaping products. Vaping products are hard to find on eBay, but some were available for purchase on Monday afternoon.
"While eBay's policy toward these highly addictive and potentially dangerous products is a laudable policy, it appears no sincere effort is being made to monitor compliance of the policy," Rutledge wrote. "I am greatly concerned about the lack of enforcement."
Rutledge's office is also spending about $45,000 to air public service announcement about e-cigs across the state, according to spokesman Rebecca Jeffrey.
Rutledge said she hopes this week's events provide parents, children and schools with awareness about the pitfalls of vaping. E-cig use in teens, she said, can lead to experimentation with other drugs and substance abuse.
After the Little Rock meeting, Rutledge said she was surprised by the consensus that many adults aren't aware of how prevalent e-cigs are.
"Most people are trying to get through the day, or trying to take care of their jobs, or run to soccer practice, go to a second job, or take care of an ailing parent," Rutledge said. "So for someone to say, 'Oh well, your kid is vaping,' when all of the advertisements they've seen are that vape products are used to get people off cigarettes, they think, 'Great, it's better than cigarettes,' when in fact it's not safe."
A Section on 10/08/2019