Testimony by Ryan Van Ramshorst, MD, for TMA and Texas Pediatric Society
Senate Health and Human Services Committee
Committee Substitute for Senate Bill 97 by Sen. Juan Hinojosa
Feb. 11, 2015
Good day, Chairman Schwertner and Committee Members,
My name is Dr. Ryan Van Ramshorst. I am a practicing pediatrician in San Antonio and a member of the Texas Pediatric Society and the Texas Medical Association. I appreciate the opportunity to testify on the committee substitute of Senate Bill 97. The Texas Pediatric Society and the Texas Public Health Coalition have made it a priority to advocate for limiting youth access to e-cigarettes, including marketing strategies aimed at youth. The coalition is made up of more than 30 major health organizations in Texas, as you can see on the back of our flyer.
Texas pediatricians are concerned about the known and unknown health risks associated with e-cigarettes. Scientific conclusions on the effects of e-cigarettes, which are only now beginning to emerge, vary due to differences among devices, e-juices, and product brands. However, we feel that the available information warrants restrictions on youth access to e-cigarettes and the marketing of these products to youth for three major reasons.
First, the nicotine present in these devices is not benign and has measurable levels of toxicity. While at low doses, nicotine acts as a stimulant that can produce pleasurable symptoms, sizeable amounts of nicotine can be dangerous for the nicotine naïve, such as children. Furthermore, nicotine is a psychoactive drug that is easy to become addicted to, requiring additional levels of nicotine as your body becomes more tolerant. Research has shown that adolescent brains are uniquely susceptible to nicotine addiction, and nicotine exposure modifies developing brains with long-term effects into adulthood. 
Second, and perhaps more worrisome, is the considerable risk that smoking and tobacco use will become normalized once again. Since the recognition of the harmful effects of smoking and significant intervention efforts to educate youth, smoking has become an unpopular behavior among most young people. However, now that e-cigarette use can be seen in places that do not allow traditional smoking, the behavior is becoming more acceptable. This is especially problematic for children who often cannot perceive the difference between electronic and traditional cigarettes.
Finally, we are concerned that e-cigarette users risk progression to other forms of tobacco use. And we, as a state, are quite aware of the harmful effects of tobacco use, with higher rates of death attributable to smoking – 273 per 100,000 – than the rest of the United States. Despite major progress, Texas still has a ways to go to reduce the use of tobacco by youth. For instance, 14.1 percent of high school students still smoke, and 24,200 kids become new smokers each year. We need to do all we can to limit youth from starting down the road toward addiction. 
While the Texas Public Health Coalition is not yet comfortable with the wording of the definitions in the bill, we hope to work with the author and the committee on possible changes to improve this language. Thank you for your time. The Texas Pediatric Society and the Texas Medical Association look forward to working with you on this legislation to achieve what we believe is our unified goal of limiting youth access to e-cigarettes.
 Difranza JR, et al. Initial symptoms of nicotine dependence in adolescents. Tobacco Control. 2000;9:313-319. Difranza JR, et al. Symptoms of Tobacco Dependence After Brief Intermittent Use. Arch Pediatr Adol Med. 2007;161(7):704-710.
 U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 (Health consequences of nicotine exposure, pages 120-122).
 Tobacco-Free Kids, October 2014.
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