A study by Yale Professor Abigail Friedman and Georgia State University Professor Michael Pesko has found higher vaping taxes boost sales of combustible cigarettes.
The researchers examined the impact that tax increases on vaping products had on both e-cigarette usage and traditional combustible cigarette smoking, specifically researching the impact on young consumers (ages 18-25), according to Fee.org.
The study found that as taxes increase on vaping products, vaping decreases. It also shows that higher taxes on vaping products leads to an increase in traditional cigarette smoking among young people.
“A one dollar increase in [vaping] taxes yielded significant reductions in young adults’ daily vaping alongside increases in recent smoking,” the authors find.
The researchers ultimately conclude that “higher taxes on electronic nicotine delivery systems (ENDS) are associated with decreased ENDS use but increased cigarette smoking among 18-25 year-olds.”
This is what’s known as the “substitution effect,” defined by Investopedia as “the decrease in sales for a product that can be attributed to consumers switching to cheaper alternatives when its price rises.”
Use of e-cigarettes vaping devices dropped during the first year of the Covid-19 pandemic, according to a new study.
Researchers from Johns Hopkins University in Baltimore, Maryland, found that usage of vaping products dropped seven percent overall from 2018 to 2020 – including a 17 percent drop among people aged 18 to 20.
Researchers published their findings Friday on the JAMA Network Open after gathering data from the U.S. Centers for Disease Control (CDC) and Prevention’s Behavioral Risk Factor Surveillance System for the study, according to media reports.
The survey included a total of 994,307 respondents. In 2017, the CDC reported 4.4 percent of U.S. adults reported use of an e-cigarette. The figure climbed 25 percent to 5.5 percent in 2018.
‘This increase, primarily observed in younger age groups, was associated with the concurrent rise in the availability of flavored products and high nicotine–concentration pod mod devices (modular vaping devices with refillable or replaceable nicotine cartridges, or pods, such as JUUL brand devices),’ the researcher’s wrote in the study.
Data from 2019 was not gathered. In 2020, overall usage of e-cigarettes fell to 5.1 percent, a seven percent drop from two years earlier. The most dramatic shift was seen among people aged 18 to 20 years old – the youngest group included in the study.
An FDA-funded study falsely claims that e-cigarette use negatively impacts health and increases utilization and cost.
By VV staff
Misinformation is incorrect or misleading information. It is different from disinformation, which is deliberately deceptive. Both are rampant in the vaping industry; however, it is difficult to distinguish between them.
Complicating the issue, it’s impossible to tell if researchers of disproven or flawed anti-vaping studies conducted defective studies intentionally or if they were just bad at their jobs. Many vapor industry advocates claim researchers are intentionally coming to conclusions that fit the U.S. Food and Drug Administration’s “supposed goal” of eventually banning all nicotine products, especially when the studies are being funded by the FDA.
In one recent study, researchers found that the use of electronic cigarettes costs the United States $15 billion annually in healthcare expenditures—more than $2,000 per person a year. The study, published on May 23 in Tobacco Control, is the first to look at the healthcare costs of e-cigarette use among adults aged 18 and older, according to researchers at the University of California San Francisco School of Nursing.
“Our finding indicates that healthcare expenditures for a person who uses e-cigarettes are $2,024 more per year than for a person who doesn’t use any tobacco products,” said lead author Yingning Wang of the University of California San Francisco Institute for Health and Aging.
According to the U.S. Centers for Disease Control and Prevention, combustible cigarette smoking-related illness in the United States costs more than $300 billion each year, including more than $225 billion for direct medical care for adults. With an estimated 30 million smokers, that is $10,000 a year more than for a person a who doesn’t use tobacco products.
The researchers based their estimates of healthcare costs and utilization on data from the 2015–2018 National Health Interview Survey. Healthcare utilization included nights in the hospital, emergency room visits, doctor visits and home visits. “Healthcare costs attributable to e-cigarette use are already greater than our estimates of healthcare costs attributable to cigar and smokeless tobacco use,” said Wang. “This is a concerning finding given that e-cigarettes are a relatively new product whose impact is likely to increase over time.”
The results of the study appear to be based on two key assumptions, according to Jamie Brown, professor of behavioral science and health and director of the Tobacco and Alcohol Research Group at University College London.
“First, that the identified associations between e-cigarette use and poor health status are caused by e-cigarettes. The majority of people who use e-cigarettes are also former or current cigarette smokers. Despite the attempts at adjustment, it is likely that at least some of the association is actually caused by cigarettes,” said Brown. “The second assumption appears to be that the alternative is simply that these people would not be using e-cigarettes. However, we know that e-cigarettes help people to quit smoking cigarettes and that cigarette smoking causes enormous healthcare expenditure. Therefore, the key question is: What is the net impact on healthcare utilization when trying to account for how e-cigarettes affect how many people smoke cigarettes? These types of models have tended to suggest net benefits are likely.”
Credit: Adrian_ilie825
Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary University of London, called the study a “baffling” piece of work. “The authors report that people who use e-cigarettes have poorer health and incur higher health costs than nonsmokers, but it is not clear why they assume that the excess health expenditure incurred by smokers who are trying to limit their smoking by using e-cigarettes—often because of acute health problems—is caused by their recent vaping rather than by their lifetime smoking,” said Hajek. “This is like claiming that the extra health expenditure incurred by people with broken legs is caused by using crutches.”
Researchers for the study sought to put a price tag on the health costs of e-cigarette use, certainly a reasonable component in the policy trade-offs over the use of e-cigarettes, according to Chuck Dinerstein, director of medicine at the American Council on Science and Health (ACSH), who has over 25 years of experience as a vascular surgeon.
He stated that in order to get their data, researchers developed a model using the National Health Interview Survey (NHIS), a household survey of the general population in the U.S. that includes detailed questions on health and use of tobacco products. “The researchers point to a study using NHIS data that per smoker—meaning combustible—attributable healthcare expenditures are $5,602,” explained Dinerstein. “The finding of this study, for both those exclusively using e-cigarettes and the dual users, is roughly a third as much. E-cigarettes reduce healthcare utilization and costs.
“The researchers point out that exclusive e-cigarette users had ‘higher odds of reporting poor health status than never tobacco users.’ That would be no surprise; no one is claiming e-cigarettes do no harm; they are less harmful than the alternative. Just like the prescription of buprenorphine is less harmful than the free-market acquisition of fentanyl … E-cigarettes have been marketed for 15 years and have been the tobacco product of choice for young adults for eight years. I find the assumption that e-cigarettes alone have manifested increased health costs at this point debatable.”
Cameron English, director of bio-sciences at ACSH, believes that the study had several critical flaws, with the most serious being the assumption that e-cigarette use would negatively impact an individual’s health and that this negative impact would increase utilization and cost. “The authors assumed what they should have demonstrated,” stated English. “That’s especially troublesome because existing evidence suggests that vaping is far less harmful than smoking. Instead of boosting healthcare expenditures, e-cigarette use probably reduces the amount of money spent to treat sick smokers. In sum, the Tobacco Control paper is terrible.”
While the research itself is scientifically suspect, two other troubling details should also be highlighted, according to English. “First, FDA paid for this low-quality study—then publicly denied any involvement until the paper was published. Second, the agency’s actions appear to reflect a broader effort to shape the peer-reviewed vaping literature then use it to justify excessive e-cigarette regulations.”
It should also be noted that while the FDA’s primary concern is saving youth from the dangers of vaping, researchers in the FDA-funded study’s opening cite concerns about the increased use of e-cigarettes by youth, especially those aged 15 to 24. “The Truth Initiative, an anti-smoking group funded by money from the Tobacco Settlement, reports that those [aged] 15 to 17 are ‘16 times more likely to vape than people aged 25 to 34,’” explains English. “Among the limitations of the study, the researchers indicate that the young, those we should be most concerned about, were not included in the study. ‘We did not include youth in the analysis due to their low healthcare utilization,’ [the researchers said].”
EVALI caused chaos
Whether it’s misinformation or disinformation, it’s costing lives. It’s keeping combustible cigarette smokers from switching to less harmful products. Another recent study led by researchers at the American Cancer Society shows that perceptions of e-cigarettes as being “more harmful” than cigarettes by adults in the United States more than doubled between 2019 and 2020, and perceptions of e-cigarettes as “less harmful” declined between 2018 and 2020.
Credit: andriano_cz.
The study also found that an increase in cigarette smoking prevalence (2019–2020) was restricted to those who perceived e-cigarettes as “more harmful” than cigarettes while increases in prevalence of e-cigarette use were restricted to those who perceived e-cigarettes as “less harmful” than cigarettes, according to a press release.
Prevalence of dual use of both products increased only among those who perceived these products “as harmful.” The results coincide with the e-cigarette or vaping use-associated lung injury outbreak (EVALI) and the Covid-19 pandemic. The data was published in the American Journal of Preventive Medicine.
“While all tobacco products, including e-cigarettes, pose a risk to the health of the user, major health events, such as the EVALI epidemic in late 2019 and the Covid-19 pandemic in 2020, paved the way to new smoking/e-cigarette health risks,” the release states. “During this time, the quality and type of information individuals were exposed to may have shaped how they compare the potential harms of tobacco products, which, in turn, may have altered tobacco use behaviors.”
How individuals perceive the harm of e-cigarettes versus traditional cigarettes can predict their individual decision to use tobacco products, but according to the study authors, this is the first study to provide evidence that this relationship translates to population-based prevalence changes.
“While this study showed sharp changes in public perceptions of e-cigarette versus cigarette harms during EVALI and Covid-19, the more relevant finding for public health is that increases in cigarette smoking and e-cigarette use prevalence occurred primarily in individuals who perceived their preferred product as relatively less harmful,” said Priti Bandi, principal scientist of risk factors and screening surveillance research at the American Cancer Society and lead author of the study. “This suggests that public perceptions of e-cigarette versus cigarette harms influence population tobacco use patterns.”
In this study, researchers analyzed data from the National Cancer Institute-sponsored Health Information National Trends Survey collected from more than 10,000 U.S. adults from 2018 to 2020. The results showed that perceptions of e-cigarettes as “more harmful” than cigarettes doubled each year, increasing most between 2019 and 2020 (2018: 6.8 percent; 2019: 12.8 percent; 2020: 28.3 percent) while uncertainty (responses of “don’t know”) in relative harm declined (2018: 38.2 percent; 2019: 34.2 percent; 2020: 24.7 percent).
“Less harmful” relative perceptions declined (2018: 17.6 percent; 2019: 15.3 percent; 2020: 11.4 percent) while “as harmful” perceptions remained steady (2018: 37.4 percent; 2019: 37.7 percent; 2020: 35.6 percent). Exclusive cigarette smoking increased between 2019 and 2020 among those who perceived e-cigarettes as relatively “more harmful”(2018: 18.5 percent; 2019: 8.4 percent; 2020: 16.3 percent), exclusive e-cigarette use increased linearly among those who perceived them as relatively “less harmful” (2018: 7.9 percent; 2019: 15.3 percent; 2020: 26.7 percent), and dual use increased linearly in those who perceived them “as harmful”(2018: 0.1 percent; 2019: 1.4 percent; 2020: 2.9 percent).
“It is challenging for individuals to make conclusions about the short[-term] and long-term health effects of tobacco products without clear, effective and ongoing communication from public health authorities, especially when new contextual events that change health harms happen,” said Bandi in a statement. “There is a need for behavioral interventions to encourage individuals to be informed consumers of available scientific findings and appreciate that while no tobacco product is safe, there are inherent differences between relative and absolute harms between tobacco products that can influence behavior. In turn, public health education campaigns must facilitate informed decision-making by translating emerging scientific evidence accurately to appropriate audiences.”
Many people also mistakenly believe that the most dangerous thing about smoking is nicotine. Many falsely believe that nicotine causes cancer. “When people who smoke perceive nicotine-replacement therapy or nicotine vapor products to be as harmful or more harmful than smoking, they are less likely to use less harmful products when attempting to quit smoking,” says Kim Murray, a research fellow with the Taxpayers Protection Alliance.
Murray believes that the widespread misperception about nicotine is due to misinformation. The misinformation is rampant in media and government messaging. This can have damaging impacts on public health.
Credit: Wachiwit
“Unfortunately, the number of people believing the misinformation about nicotine vapor products is rising,” she wrote in an opinion piece. “One of the biggest sources of misinformation is fake news shared on social media. There is a real need for informative and accurate information about smoking and nicotine, but most people don’t know where to find the information,” states Murray. “A logical resource should be their healthcare provider. However, most of the time, that would be the wrong choice because 60 percent of nurses incorrectly perceive nicotine as carcinogenic, and 72 percent believe that nicotine patches could cause heart attacks.”
In April, researchers concluded that more than 60 percent of all doctors incorrectly believe all tobacco products are equally harmful, making them less likely to recommend e-cigarettes for people trying to quit smoking, according to a study published in JAMA Network Open.
The authors of the study, led by Rutgers University, asked more than 2,000 doctors in the U.S. in 2018 and 2019 how they would advise patients on using e-cigarettes as a method of combustible smoking cessation. One in four physicians discouraged all use of e-cigarettes and were more likely to advise against e-cigarettes if the hypothetical smoker they were counseling were a younger, light smoker compared to an older, heavy smoker.
Although no associations were found between harm reduction beliefs and being asked about e-cigarettes by patients, the association between physicians’ harm reduction beliefs and their e-cigarette recommendation practices was significant.
“It will take a lot to change minds and dispel the now entrenched, and largely mistaken, mistrust of nicotine. As in many areas of public life, urban myths and half-truths, which are ingrained over time, are often easier to believe than the truth for many in society. It is difficult to persuade people that the beliefs that they hold are wrong,” states Murray. “Consumers deserve accurate information to enable them to make informed choices. The country won’t achieve health equity and social justice if we continue to misinform those who choose to use nicotine in a safe manner.”
This article first appeared in Vapor Voice 3, 2022.
A claim in the British Dental Journal that found vaping to cause tooth damage was made by two food science lecturers at the Cardiff Metropolitan University School of Sport and Health Science. That study has now been shown to be rife with errors.
A letter has since been published in the British Dental Journal by Newcastle University vaping and dentistry experts Richard Holliday, Elaine McColl, Anthony Weke and Zella Sayeed debunking the claims out of Cardiff.
The four wrote they “were disappointed to see several basic errors and misrepresentations” and went onto correct five major errors in the “erosive potential of vaping” paper.
Newcastle’s experts say the study authors cite a World Health Organization poster and incorrectly claim that nicotine causes a “high risk of oral and whole-body health complications.”
In reality, nicotine has been used in the form of NRT for over 30 years, including in pregnant women, and is regarded as extremely safe, even for long-term use, according to Scoop.
Also significantly, the authors wrongly claim that e-cigarettes are associated with cancer. The supporting reference does not make this claim and instead states “no long-term evidence related to oral and systemic health effects exist.”
The Newcastle experts then “point UK dental professionals to the well-considered public health guidance which basically concludes that, for the best chances of quitting smoking, one should use support and pharmacotherapy and that e-cigarettes can be part of that package.”
Nancy Loucas, executive coordinator of the Coalition of Asia Pacific Tobacco Harm Reduction Advocates (CAPHRA), said the food science lecturers’ biggest mistake was “one made by so many – that is talking up the WHO’s anti-vaping stance” as the official public health position.
“Tellingly, all UK public bodies, including the NHS, ignore the WHO’s advice. They support vaping, knowing it does not erode teeth nor lead to gum disease,” said Loucas. “Once again science and human evidence have trumped another untenable ideological lie about vaping.”
Current vaping among U.K. children aged 11-17 was up from 4 percent in 2020 to 7 percent in 2022, according to the annual YouGov youth survey for Action on Smoking and Health (ASH) carried out in March and published on July 7. The proportion of children who admit ever having tried vaping has also risen from 14 percent in 2020 to 16 percent in 2022.
Disposable e-cigarettes are now the most used product among current vapers, up more than seven-fold from 7 percent in 2020 and 8 percent in 2021, to 52 percent in 2022. Elf Bar and Geek Bar are overwhelmingly the most popular, with only 30 percent of current users having tried any other brands.
Over the past year there has been growing concern about the increasing popularity of disposable vapes with young people, but this is the first time national figures have been available to show the scale of the change. ASH said the increase in vaping shown by the survey is a cause for concern, and needs close monitoring. However, 92 percent of under 18s who’ve never smoked, have also never vaped, the organization pointed out—and only 2 percent have vaped more frequently than once or twice.
“Just to give it a try” is still the most common reason given by never smokers for using an e-cigarette (65 percent). For young smokers the most common reason for using an e-cigarette was “because I like the flavors” (21 percent) followed by “I enjoy the experience” (18 percent) then “just to give it a try” (15 percent), but they also said, “because I’m trying to quit smoking” (11 percent) or “I use them instead of smoking” (9 percent). Fruit flavors remain the most popular (57 percent).
Vaping behavior is strongly age related, with 10 percent of 11-15 year olds ever having tried vaping, compared to 29 percent of 16 and 17 year olds (the figures for those currently vaping are 4 percent and 14 percent respectively). And while underage vaping has risen, underage smoking is lower than it was in 2020 (14 percent in 2022 compared to 16 percent in 2020).
For the first time this year the survey asked about awareness of promotion of e-cigarettes. Over half (56 percent) of 11-17 year olds reported being aware of e-cigarette promotion, most frequently in shops, or online, with awareness highest amongst those who’d ever vaped (72 percent). Tik Tok was the most frequently cited source of online promotion (45 percent) followed by Instagram (31 percent).
In response to the survey results, the U.K. Vaping Industry Association (UKVIA) called for a range of get-tough measures to crack down on unscrupulous retailers who sell vapes to young people.
“The UKVIA understands the need for the right balance between supporting adult smokers to quit without encouraging take up amongst under-18s and ‘never-smokers,’” said UKVIA’s Director General John Dunne in a statement.
In a letter to the Department for Health and Social Care, the UKVIA proposed a set of recommendations to come down hard on those who sell vapes to minors while maintaining vaping’s critical role for helping smokers to quit, including fines of £10,000 ($11,897) and a national retail licensing scheme.
A new University of Washington study shows smokers who switch to e-cigarettes may have more opportunities for healthier choices. That does not mean vaping is safe, researchers say, but for people who smoke combustible tobacco and are trying to quit, vaping can be associated with healthy routines.
The study was funded by the National Cancer Institute, the National Institute on Aging and the National Institute on Drug Abuse.
The co-authors of the study stressed e-cigarettes have substantial public health downsides, including popularity among young people, particularly those not previously addicted to nicotine. The study, however, focused on asking whether vaping can be beneficial to existing smokers unable to to quit.
For the study, Kosterman and his co-authors, Marina Epstein, Jennifer Bailey and David Hawkins, connected with a group of 800 Seattleites who are part of a landmark study that began in 1985 when they were elementary school students.
The UW study focused on 156 of those participants. This subsample reported smoking combustible cigarettes at age 30 and smoking or vaping at age 39.
The research team surveyed participants, when they were 30 and 39, about nine measures of healthy aging and well-being and how often they engaged in certain activities, according to Seattle Times.
Of the 156 participants, 64 percent smoked only combustible cigarettes at age 39, 28 percent smoked and vaped, and 8 percent only vaped. The roughly one third of the group that shifted to vaping some or all the time by age 39 reported better physical health, exercised more and had more active social engagement, the study found.
“Although the study cannot show a causal relationship, we think that because e-cigarettes have less stigma, less odor and are less physically harmful, they may increase health-promoting opportunities among smokers.” Kosterman said. People who use e-cigarettes may be more likely to be in settings that promote physical activity and to interact more with nonsmokers, he said.
“What we’re saying is that e-cigs do have a positive role to play for existing adult smokers who continue to use nicotine,” he said.
The “real world” public-health effects of BAT’s Vuse e-cigarette is the subject of a new study.
The study is “designed to assess and provide insights” into the growing role of the e-cigarette brand. Vuse has been market momentum in since some of its branded products received marketing approval from the U.S Food and Drug Administration.
The study involves a cross-sectional confinement study of exclusive Vuse users in the United Kingdom over at least a six-month period, according to a press release.
“This innovative study demonstrates our commitment to researching the reduced-risk potential of our New Category products. What makes it particularly relevant and exciting is that the results generated will be from people who have been using Vuse as they normally would for more than six months prior to testing,” Sharon Goodall, BAT’s Group Head of Regulatory Sciences, said. “The results will provide important new insights and show us the differences between Vuse users, smokers and former smokers across a range of important biomarkers thought to be predictive of disease development. We look forward to sharing the data once available.”
Also participating were current or former smokers of traditional cigarettes and people who have never smoked. Former smokers would have had to quit for at least six months to qualify. Study participants were between 19 and 55 years old, and in good general health.
“It is hoped that the results, which are currently being analyzed and will be published later this year, will provide further supportive evidence that using Vuse can reduce relative risk for certain diseases among adult consumers compared to smoking,” BAT said in a news release.
Unlike longitudinal studies where participants attend multiple clinic visits over an extended period of time, participants in this study made a single clinic visit where samples of blood, urine and other measurements were collected. These samples were then tested for “biomarkers of exposure” (to selected cigarette smoke toxicants) and “biomarkers of potential harm”. Differences between the groups were assessed, rather than changes from baseline.
In addition, to ensure compliance, the Vuse and former smoker groups were tested for the biomarker, CEVal, which indicates if they have recently smoked cigarettes.
Results from the completed study will be published in due course.
Nearly half (49 percent) of Malaysian smokers choose to vape to cut down on cigarette consumption or quit smoking completely, reports The New Straits Times, citing a 2021 survey of 500 people carried out by Kantar Group
“This appears consistent with mounting scientific evidence that smokers prefer vaping and is effective to help them kick the habit,” said Delon Huma, president and CEO of Health Diplomats, a health, nutrition, and wellness consulting group.
“Available evidence so far shows that most smokers want to quit the habit. For example, in the United Kingdom, around two-thirds of smokers, regardless of their social group, want to stop smoking, and vaping has become the method of choice to quit smoking in that country,” Human said.
The survey also found that 52 percent of Malaysian smokers perceive vaping to be less harmful than smoking cigarettes. Eighty-six percent said that vaping should be made available to smokers as a less harmful product, and 90 percent believed that vaping should be actively promoted as a less harmful alternative to smoking cigarettes.
This study shows vaping in Malaysia has great potential to help the government reduce smoking prevalence as it is a popular tool used by smokers to cut down and quit smoking.
“Studies on the use of e-cigarettes have pointed to the fact that vaping is not risk-free but significantly less harmful than smoking cigarettes,” said Human. “Interestingly, the rate of Malaysian smokers understanding this fact is high compared to other countries,” he said.
In the U.K., by contrast, only 29 percent of smokers believe vaping was less harmful than smoking, despite the country’s adopting a harm reduction approach in encouraging cigarette smokers to switch to vaping, according to Human.
Malaysia is currently contemplating new rules for e-cigarettes.
Most of the Malaysians surveyed support regulations for e-cigarettes and believe they should be regulated as consumer products instead of medicinal products.
At the same time, 81 percent believe regulations must be put in place to ensure the products are not defective and meet product and quality standards and are not sold to minors or underage children.
“This study shows vaping in Malaysia has great potential to help the government reduce smoking prevalence as it is a popular tool used by smokers to cut down and quit smoking,” said Human.
The U.S. Food and Drug Administration’s Center for Tobacco Products and the National Institute of Health’s National Institute on Drug Abuse announced the availability and location of newly released and updated data files from the Population Assessment of Tobacco and Health (PATH) Study, including the following:
The Wave 5.5 Special Collection data were collected from youth participants ages 13 to 19 between July and December 2020. Data in the PATH-ATS were collected between September and December 2020 from a subsample of adult participants ages 20 and older, complementing the Wave 5.5 Special Collection. Additionally, Restricted-Use Files have been updated to include Wave 5 Ever/Never Reference Data, and the Restricted-Use and Public-Use Master Linkage Files have been updated.
Questions about the collection, content, weighting, documentation, or structure of PATH Study data (this excludes questions on statistical analysis or analytic guidance) may be submitted to PATHDataUserQuestions@Westat.com.
This use of electronic cigarettes costs the United States $15 billion annually in health care expenditures — more than $2,000 per person a year — according to a study by researchers at the University of California San Francisco School of Nursing.
The study, published on May 23 in Tobacco Control, is the first to look at the health care costs of e-cigarette use among adults 18 and older, according to the release.
“Our finding indicates that health care expenditures for a person who uses e-cigarettes are $2,024 more per year than for a person who doesn’t use any tobacco products,” said lead author Yingning Wang, PhD, of the UCSF Institute for Health & Aging.
According to the U.S. Center for Disease Control and Prevention, combustible cigarette smoking-related illness in the United States costs more than $300 billion each year, including more than $225 billion for direct medical care for adults.
The researchers based their estimates of health care costs and utilization on data from the 2015-2018 National Health Interview Survey. Health care utilization included nights in the hospital, emergency room visits, doctor visits and home visits.
“Health care costs attributable to e-cigarette use are already greater than our estimates of health care costs attributable to cigar and smokeless tobacco use,” said Wang. “This is a concerning finding, given that e-cigarettes are a relatively new product whose impact is likely to increase over time.”
