"As Governor and as a mom, I'm concerned about the long-term effects of e-cigarette use, particularly on our young people," said Governor Gina M. Raimondo. "Companies are specifically targeting teens with colorful packaging and flavors. But recent reported injuries and deaths make clear that we do not have a full understanding of the associated risks. It's critical that we act now to protect our kids."
The Centers for Disease Control and Prevention, the Food and Drug Administration, and the United States Surgeon General have all declared youth vaping use a national epidemic, pervasive in every state. The Governor's action comes after both the CDC and FDA have issued advisories highlighting the dangers of e-cigarette use. Just yesterday, CDC officials testified in front of Congress and reinforced the need for swift action to combat this public health emergency.
Thanks to decades of public health education and advocacy, Rhode Island's teenagers have one of the lowest cigarette smoking rates in the country. But traditional cigarettes are no longer the single face of nicotine addiction in Rhode Island. Today, electronic nicotine-delivery system (ENDS) products are marketed aggressively, including marketing that promotes flavored ENDS products to youth. Many ENDS products – including e-cigarettes – are colorfully packaged and come in flavors such as cotton candy, strawberry, grape, cherry, wintergreen and mint.
"The inhalation of the harmful chemicals that are in many e-cigarettes can cause irreversible lung damage and lung diseases," said Nicole Alexander-Scott, MD, MPH, the Director of the Rhode Island Department of Health (RIDOH). "We also know that factors in our communities result in certain young people having higher rates of e-cigarette use, such as high schoolers who identify as lesbian, gay, or bisexual; and high schoolers who identify as having a disability. That is unacceptable. Every young person in every community deserves an equal opportunity to breathe free and grow up healthy."
ENDS products have become rapidly popular with young people. From 2017 to 2018, there was a 78% increase of usage among high school students and a 48% increase of usage among middle school students. Health risks to young people from e-cigarette use include learning, memory, and mental health problems, lung illnesses, heart problems, injuries resulting from battery explosions, and accidental childhood nicotine poisonings. High school students who use e-cigarettes are four times more likely to smoke cigarettes in the future.
"The growing popularity of e-cigarette use among teens is rapidly becoming a public safety crisis, and we need to take action to ensure the safety of our young people and our communities," said Rhode Island State Police Colonel James Manni. "I fully support the Governor for taking this critical first step."
The Centers for Disease Control and Prevention (CDC) is currently investigating a cluster of lung illness associated with e-cigarette use. Nationally, there have been 530 cases of lung injuries reported, and nine deaths have been reported. No cases in Rhode Island have been confirmed. Most patients have been younger than 25 and have reported using e-cigarette and vaping devices containing Tetrahydrocannabinol (THC), which is found in marijuana.
"There are a lot of unknowns about the dangers vaping and our number one priority needs to be the health and safety of consumers," said Liz Tanner, Director of the Department of Business Regulation. "I support and applaud Governor Raimondo on her efforts to put a regulatory framework in place that protects the health and wellbeing of our children and all consumers."
"We commend the Governor for taking this bold action," said Rebecca Boss, director of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. "We know that e-cigarettes are particularly harmful to young people, and we know that nicotine affects brain development. We hope that the decreased attractiveness and the increased enforcement will help to prevent young people from using these products. These products are not safe, and no youth should be using them."
The Executive Order calls on several state agencies to take the following measures:
-RIDOH will convene a Vaping Advisory Group comprised of medical, public health, and product safety experts to monitor state and national vape trends, illnesses, and product developments and provide regular recommendations on further steps that should be taken to ensure public health and safety related to ENDS products.
-The Rhode Island State Police ill investigate the sale and distribution of ENDS and ENDS products containing Tetrahydrocannabinol (THC) outside of the state's medical cannabis program, and the sale of ENDS products to underage youth.
-The Rhode Island Department of Business Regulation (DBR) and the Rhode Island Department of Revenue (DOR) with support from RIDOH will make recommendations on the application of the Other Tobacco Products (OTP) tax for all ENDS and ENDS products to support youth vaping prevention, as well as on implementing requirements that improve ENDS distributors' and vaping bars' license requirements related to any ENDS product.
-The Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH), RIDOH, and DBR will develop recommendations to reduce the availability of ENDS products to persons under 21 years of age, which shall include, to the extent permissible by law, establishment of warning signs about the health risks of vaping ENDS products at retailers where any ENDS product is sold and in any vaping advertisements, as well as increased enforcement needs regarding illegal sales of ENDS products, and specifically flavored ENDS products, to youth.
-RIDOH and DBR will make recommendations regarding the establishment of standards for disclosures and uniform packaging related to flavored ENDS products for purposes of empowering consumers to make informed product purchases.
-RIDOH, BHDDH, and DBR will make recommendations on ENDS distributors' density limits, aimed at preventing an increase of licensed ENDS sellers within 500 feet from schools and/or after-school providers.
-All State agencies, especially the Rhode Island Department of Education (RIDE), the Office of the Post-Secondary Commissioner (OPC), and BHDDH will incorporate ENDS product use prevention and cessation materials into drug and addiction, tobacco, anti-smoking, smoking cessation, pulmonary health, and behavioral health wellness materials, programs, or advocacy produced by State agencies, or obtained from third parties, and offered to employees or the general public.
-RIDOH and DBR will make recommendations regarding the establishment of safety standards for all ENDS products.
The Executive Order takes effect immediately.