DENVER — The nicotine landscape in Colorado is likely to change in the near future, but how much depends on what lawmakers do in the final days of this year’s legislative session.
Late last month, the U.S. Food and Drug Administration proposed banning menthol in cigarettes and all non-tobacco flavors in cigars. A bill in the Colorado legislature would go further, prohibiting retailers from selling any tobacco product that’s flavored, and outlawing products made with lab-created nicotine.
That wider definition would include e-cigarette liquid and most products, other than “premium cigars” and hookah tobacco.
Both proposed bans would apply to manufacturers, distributors and retailers. Possession and use of flavored tobacco products wouldn’t be a crime.
There’s widespread agreement in the public health community that banning flavors from cigarettes and cigars would save lives, but applying the same rules to e-cigarettes is more controversial.
Ted Wagner, director of the Center for Tobacco Research at Ohio State University’s Comprehensive Cancer Center, said a ban on flavors in cigarettes and cigars is a clear public health win, but when it comes to e-cigarettes, the benefits of reducing kids’ exposure to nicotine has to be balanced against the risk the vapers will turn to combustible cigarettes.
“It’s a little more complicated,” he said.
Menthol cigarettes are easier to start, harder to quit
In 2009, the FDA banned almost all flavors from cigarettes. It allowed menthol cigarettes and flavored cigars to stay on the market, though. Both menthol cigarettes and flavored cigars are disproportionately used by young people and African Americans.
One study estimated that removing menthol from cigarettes and cigars could prevent up to 650,000 tobacco-related deaths by 2060, because fewer people would start smoking and some menthol smokers would quit.
The problem isn’t that menthol is more dangerous, but that the cooling effect makes cigarette smoke less harsh, so young users are more likely to keep lighting up, said Dr. Rachel Villanueva, president of the National Medical Association, a group representing Black physicians.
Some research suggests menthol also influences the way the body processes nicotine, making cigarettes more addictive.
“It’s easier to smoke… but just as risky,” she said.
About 85% of Black smokers use menthol products, compared to about 30% of white smokers, and tobacco companies disproportionately advertised menthol cigarettes in locations and publications popular with Black people. Some people have argued that banning those cigarettes would be discriminatory and encourage police to harass users.
Excessive policing is a concern, Villanueva said, but so is the increased risk of cancer and heart disease in smokers, as well as asthma in kids exposed to secondhand smoke. Black smokers are more likely to report they want to quit than white smokers, but have lower odds of success, and the tendency to use menthol cigarettes may be a factor, she said.
Sondra Young, president of the NAACP Denver, said at a rally Wednesday that stopping the sale of menthol cigarettes and flavored cigars is a top priority for the organization.
“There is no greater risk to the health and wellbeing of thousands than the health impacts caused by these deadly products,” she said.
E-cigarette flavors appeal to kids and adults
The Colorado proposal that would ban flavored e-cigarettes, House Bill 1064, passed the House and is waiting to be assigned to a Senate committee. But time is running short, since the legislature is scheduled to adjourn Wednesday.
State Sen. Rhonda Fields, an Aurora Democrat who is shepherding the ban through the Senate, said it’s not uncommon for big bills to linger until the last days of the session. It will likely face amendments as it works through the Senate, and if it changes, go back to the House for concurrence.
“I’m expecting rich dialogue about it,” she said. “Most people don’t like the idea of smoking trending up, especially when it comes to flavors and getting our kids hooked on it.”
It’s not clear how youth smoking and vaping has trended since 2019, the last year with data from the Youth Risk Behavior Surveillance survey. Between 2017 and 2019, the percentage of high school students reporting they vaped on at least 20 days in the past month rose from 5.6% to 9.9%. The percentage reporting they used cigarettes that often ticked up from 1.3% to 1.4%, but the difference was within the margin of error.
If the Colorado bill is passed, nonpartisan fiscal analysts with the state warned it would take a chunk out of the state budget because fewer people would buy highly taxed tobacco and nicotine products. The universal preschool program approved by voters in 2020 is heavily reliant on tobacco taxes, though lawmakers could find another funding source.
Bans have faced a difficult road. In cities that considered them, including Denver, the tobacco industry lobbied heavily, sometimes through agents who didn’t declare who was paying them. Denver Mayor Michael Hancock vetoed a proposed citywide ban on menthol cigarettes and flavored e-cigarettes in December, saying it would be ineffective as long as those products remained available in surrounding counties, and would put vape shops out of business.
Nyla Pollard, a senior at Aurora’s Smoky Hill High School and officer of the African Student Association, asked lawmakers to support a ban at the rally Wednesday.
“It is too easy for kids to try vaping. These products are easy to hide and young people don’t realize the damage they are doing by using them,” she said. “They seem cool and they taste good. By the time kids realize they are addicted to tobacco, it’s too late.”
Theoretically, any e-cigarette product that hasn’t gone through the FDA’s premarket process can’t be sold, but no one is enforcing that. So far, the FDA has only allowed a handful of tobacco-flavored nicotine liquids to be sold, and hasn’t made a decision on the most popular brands.
Flavored nicotine clearly appeals to youth, but adults who are switching from cigarettes also tend to prefer it, Wagner said. When smokers start using e-cigarettes, they replace the nicotine, but miss other parts of the “sensory experience.” The flavors offer a different experience with its own appeal, rather than an incomplete cigarette experience, and they may reduce the brain’s association between the taste of tobacco and pleasure, he said.
When cities have banned flavored nicotine liquid, youth use went down, suggesting fewer teens were trying e-cigarettes, Wagner said. But use of regular cigarettes, which are a more dangerous product, went up among kids who have risk factors that make them more likely to become nicotine users, he said.
“It’s a tricky subject, because both products seem to be substitutes for each other,” he said. “You’re trying to thread the needle.”
Policies specifically targeted at youth use might be more effective, such as only allowing the sale of flavored nicotine liquid at stores that only serve customers 21 and up, Wagner said. Another option would be to restrict or ban “nicotine salts,” a less-harsh version of the chemical that’s used in some vape products that are most popular with youth, like Puff Bar.
“Smokers are kind of used to that (harshness),” he said. “Kids aren’t.”
