The NCSL Blog


By Mark Wolf

Phoenix—In the wake of the deadly and mysterious vaping-related lung infections that have killed at least 48 people and injured more than 2,300 others, 10 states and six tribes have temporarily banned or limited vaping products.

Dr. Chris Jones; photo by Berkeley TeateMassachusetts is the only state to pass a full ban on vaping; an emergency ban was rescinded Dec. 11.

The lung injuries are believed to have been caused by vitamin E acetate, used as a cutting agent for marijuana in the illicit vape cartridge marketplace, Dr. Chris Jones, U.S. public health service senior adviser, said during a session titled "The Latest on Vaping: Addressing Injuries, Misinformation and Policy" at the NCSL Capitol Forum. At least 80% of those infected reported vaping THC.

After Illinois and Wisconsin reported clusters of the lung disease, the Centers for Disease Control discovered it was not an isolated outbreak and activated an emergency action center, according to Jones.

"We're getting fewer and fewer new cases," he said. "We don't fully understand why but it's certainly a good thing."

Jones cited studies showing a 50% decline in high school students smoking cigarettes from 2011-2018 but a skyrocketing rise in vaping (1.5% to an estimated 27.5%) over the same period. He also said more than 10% of middle school students reported using e-cigarettes, more than five times the number who said they smoked cigarettes.

The number of people aged 18-24 who smoke cigarettes has declined over the last five years while those using e-cigarettes has steadily increased and is on pace to pass cigarette smokers.

Jones listed the potential health risks of e-cigarettes as leading to the initiation of combustible tobacco use among nonsmokers, particularly children: leads to relapse among former smokers; diminishes the chances that a smoker will quit; discourages smokers from using proven quit methods; exposes children, pregnant women and nonusers to second aerosol; and glamorizes or renormalizes tobacco use.

"The erosion of the perception of harm leads to normalization of tobacco," he said.

The CDC's recommendations regarding vaping include not using THC-containing e-cigarettes or vaping, not buying from informal sources and not modifying or adding any substances to the products.

"The only way to assure you are not at risk is to abstain from all e-cigarette products," he said.

Dr. Cara Christ, state health official and director of the Arizona Department of Health Services, said Arizona has been looking at vaping for several years. Current use has gone down since 2015 but is still higher in Arizona than the national average. The state pulled together focus groups to talk to young people and found, Christ said, "youth don't like to be lied to. They thought it was just flavored water vapor. If they had known (it was nicotine) they wouldn't have started."

Late last year the state launched an anti-vape campaign,, targeting 9- to 13-year-olds and including slogans like, "Fruity flavors can hide a rotten habit."

Senator Elizabeth Steiner Hayward (D), deputy majority leader of the Oregon Senate, said Oregon raised the legal age for tobacco purchases to 21 in 2017.

"That's helped a little bit. In 2019 we saw an increase in smoking and vaping initiation rates among young adults," she said. Oregon is a recreational marijuana state and had 20 documented cases of the lung illness, including two fatalities. 

She said the state is starting a campaign called "Stay True to You" to talk to middle schools and high school students.

"They are being lied to by the industry," she said, "told these products are safe, and they're not; that they contain no harmful chemicals but they do."

Mark Wolf is editor of the NCSL Blog. 

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.