Letter: Regulate E-cigarettes Like Tobacco Products

TMA Letter by Jason V. Terk, MD

March 30, 2015

The Honorable Charles Schwertner, MD
PO Box 12068
Austin, TX 78711 

Dear Chairman Schwertner:

We are providing comment on Senate Bill 1618 by Sen. Craig Estes. This legislation attempts to address a serious concern about minors’ access to nicotine products or e-cigarettes. The Texas Medical Association and Texas Pediatric Society are concerned about the known and unknown health risks associated with these products. Scientific conclusions on the effects of e-cigarettes are only now beginning to emerge and vary due to variability across devices, e-juices, and product brands. However, while rigorous testing is underway, we must take steps now to ensure our children are well protected and products that may cause harm or lead to the use of other tobacco products are prohibited for minors.

We appreciate the efforts of SB 1618 to regulate nicotine products, but we believe this definition of e-cigarettes is too narrow and does not encompass the entire range of products currently available on the market. While it is important to prohibit the use of nicotine products by children because of nicotine’s inherent toxicity and ease of addiction in the child population, other e-cigarette products pose significant danger to minors.

E-cigarette labeling is not always accurate. According to a literature review of several studies on the contents of e-cigarettes, the label deviated from actual nicotine level in the product by as much as 100 percent.  Many products advertised as containing no nicotine, thus not regulated by this bill, can still contain trace levels of nicotine. In addition, supposedly non-nicotine e-cigarettes contain many other chemicals depending on the brand, products, and juice being used. The same literature review identified significant levels of aldehydes, metals, volatile organic compounds, phenolic compounds, polycyclic aromatic hydrocarbons, and tobacco alkaloids, which are all harmful or potentially harmful when released via conventional smoking.

Additionally, and perhaps more worrying, is the considerable risk that use of supposedly non-nicotine e-cigarettes once again normalizes smoking and tobacco use. 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 supposedly non-nicotine e-cigarettes, e-cigarettes, and traditional cigarettes. We fear that the definition of nicotine products in SB 1618 and its regulation outside of current tobacco product statute may lead to an acceptance of use of supposedly non-nicotine e-cigarettes by minors and potentially lead to youth progressing to nicotine and tobacco-based products. We need to do all we can to limit youth from starting down the road to addiction.

For these reasons, it is of the opinion the Texas Medical Association and the Texas Pediatric Society that e-cigarettes should be included in the same section of statute that regulates tobacco products and traditional cigarettes — Subchapter H, Chapter 161 of the Health and Safety Code: Distribution of Cigarettes or Tobacco Products.

We thank you for your passion for ensuring the health and safety of our youngest Texans, and we are ready to work with you to ensure e-cigarette products remain out of the hands of our children.


Jason V. Terk, MD, FAAP,
President Texas Pediatric Society 

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