House Committee on Public Health
March 24, 2015
House Bill 81 by Representative Guillen House Bill 970 by Representative Paddie
House Bill 646 by Representative Collier House Bill 2321 by Representative Longoria
House Bill 647 by Representative Isaac
Chair Crownover and members of the committee, I appreciate the opportunity to speak to you today on behalf of the Texas Medical Association and the Texas Pediatric Society. The five bills you are considering today address a topic of great concern to our members — electronic cigarettes or e-cigarettes. We are here to express our support for each measure, as we recognize each will decrease minor access to e-cigarettes and increase regulation of these products. While we can recommend modifications to each, it is our priority to ensure Texas takes action now to reduce minors’ access to these products.
In our studies of e-cigarette use, we found that many states and communities have already restricted the use of these products. Texas is one of only 10 states that have not already restricted the sale of e-cigarettes to minors. While research continues to broaden our understanding of e-cigarettes, several studies already have identified their major components: nicotine — an addictive substance; propylene glycol; glycerin; and formaldehyde, a known carcinogen. And although e-cigarettes often are described as “vapor” products, there is no water in e-cigarettes, and the by-product they release is more accurately described as an aerosol rather than vapor. Additionally, as these are unregulated products with unknown quality control, physicians and public health experts are concerned about the lack of information on the precise amount and type of compounds in the many different brands of e-cigarettes, and the potential short- and long-term health effects of the compounds produced by heating in these devices.
The marketing to young people of these products worries physicians, and we join others in expressing concern that young people using these products also are likely using other tobacco products. The Centers for Disease Control and Prevention has reported e-cigarette use among U.S. students in grades 6-12 doubled from 2011 to 2012. And while cigarettes, little cigars, and spitting tobacco are the tobacco products most likely to be used by high school students, in 2013 almost 5 percent of high school students reported using e-cigarettes.
The nicotine present in these devices has measurable levels of toxicity. Nicotine has known psychoactive effects and quickly becomes addictive — requiring additional levels of nicotine as the body becomes more tolerant. Physicians know that adolescent brains are uniquely susceptible to nicotine addiction, and nicotine exposure can modify a developing brain with long-term effects into adulthood. This is why the American Academy of Pediatrics, along with other health organizations, has called for prompt response from U.S. Food and Drug Administration (FDA) on regulating e-cigarettes. Public health officials also have expressed concern that wider e-cigarette use will “normalize” this behavior and lead to greater tobacco use.
We encourage you to take steps to prohibit the use of tobacco products in schools and other public places as some of these bills propose. We also join other national and state organizations in urging caution in recognizing e-cigarettes as a tobacco-cessation or harm-reduction strategy for current tobacco users because of the lack of scientific evidence on the safety of these products. E-cigarettes have not been approved as either a cessation or a replacement product for cigarettes by FDA. While regulations are expected from FDA on e-cigarettes in the future, the market and use for e-cigarettes is growing rapidly. We must take steps today to curtail access to these products for minors.
As you review these proposals, we offer our assistance in your work. Many Texas communities have already passed measures to keep e-cigarettes out of the hands of minors, and we applaud and support these actions. Electronic cigarettes are a multibillion dollar global business, and we are only now beginning to understand the impact of the use of these products in our state. We encourage you to consider developing tracking methods, such as the use of the Texas Quitline, for us to begin to develop a baseline on the use of electronic cigarettes in Texas.
We must continue to respond to new public health threats to the health of our children, and we believe each bill the committee is considering today offers some responsible steps to take in this direction.
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