Different approaches to youth vaping
As governor, Hickenlooper introduced a way to tackle key health issue; Polis, his successor, and lawmakers have another view of it
In his final months as governor, John Hickenlooper stood in front of a room full of reporters at Children’s Hospital Colorado and introduced an executive order that encouraged state legislators to tighten regulations on vaping devices in a bid to curb teen use.
It was November 2018, and for weeks the state’s health department had been preparing the announcement, which followed an earlier warning by federal regulators about the dangers of teenage use of e-cigarettes.
The state has one of the highest teen vaping rates in the U.S., and for some at the Colorado Department of Public Health and Environment, the Hickenlooper order was the start of what they hoped would be a series of policy changes that could put nicotine products back in the spotlight as one of the state’s most pressing public health problems, according to emails and documents obtained
by The Denver Post.
“This should be fun — we’re going to really upset some industry people today!” a health department employee wrote in an email the morning of Hickenlooper’s news conference.
A Denver Post review of more than 1,700 pages of emails and documents from the health department, obtained through the Colorado Open Records Act, shows the goal of the executive order was to “build momentum” for comprehensive tobacco-related measures in the state, with the purpose of reducing youth vaping and tobacco use among the broader public.
But almost a year later, as Colorado is one of the dozens of states responding to a mysterious vaping-related lung disease that has sickened more than 1,000 people and killed at least 18 across the nation, no action has been taken on Hickenlooper’s most ambitious recommendations: raising the age to buy tobacco products to 21 and banning flavored tobacco and vaping products.
Lawmakers took smaller steps this year, including banning the use of e-cigarettes inside public buildings — one of Hickenlooper’s suggestions — and allowing local governments to regulate nicotine products. They also considered an eleventh-hour bill pushed by Gov. Jared Polis to create an excise tax on vaping products — a policy supported by public health experts as one of the most effective ways to prevent teens from using e-cigarettes. But that measure failed.
“The time is always yesterday vs. now,” said Jodi Radke, regional director for Campaign for TobaccoFree Kids. “The longer we wait to enact policies to protect our kids, the more kids fall through those cracks and become addicted.”
Overall, 33% of Colorado youths use nicotine, and the product they use most is ecigarettes, according to a 2017 state survey of middle and high schoolers.
Now, in the wake of the vaping illness, the state health department is urging people not to use vape products, and President Donald Trump has called for the federal government to ban non-tobacco flavors used in e-cigarettes. In Colorado, at least nine individuals are reported to have the illness, with seven of them hospitalized, according to the department.
“Nothing could be more important than keeping Colorado’s kids safe, and I was proud to have taken action last year to reduce youth vaping,” Hickenlooper said in a statement last week.
And local governments slowly are taking their own steps. Aspen has banned the sale of all flavored nicotine products, including those containing menthol — flavors are known to attract young users — and Boulder also banned flavored e-cigarette products. Denver just passed a law raising the minimum age to buy to 21.
So far, at least 11 Colorado cities have raised the age to purchase tobacco to 21, and at least 17 have passed regulations related to tobacco retail licensing, according to the Campaign for Tobacco-Free Kids.
“Imagine the incredibly profound impact”
A few hours after Hickenlooper’s news conference last November, health department employees began emailing about their hopes for the 2019 legislative session.
“If all of this does see the light of day with the next administration we will be so busy from December to June,” wrote Gabriel Kaplan, chief of the department’s health promotion and disease prevention branch in a Nov. 2 email praising the team that worked on the executive order.
“But imagine the incredibly profound impact this is going to have on thousands of Coloradans,” he wrote. “Tobacco is again on the top policymakers’ radar, and the opportunity to achieve some major wins for public health is right there.”
But by the time Polis and a crop of freshman lawmakers took office in January, any momentum to execute the Hickenlooper order’s vision had slowed significantly. To be sure, plenty of lawmakers were interested generally in tackling the issue of vaping, particularly among kids — but no one was bringing forward any bills to raise the purchase age to 21 or to ban flavors.
It speaks to that slowed momentum that some of the lawmakers who worked most closely on vaping-related bills last session, including Democrats Kerry Tipper and Kyle Mullica and Republican Colin Larson, told The Post last week that they weren’t familiar with the Hickenlooper order.
Lawmakers instead focused their efforts on other things. They banned minors from entering cigar or tobacco bars. They updated the 2006 Clean Indoor Air Act to add hookahs, e-cigarettes and vaporizers to the list of devices that may not be used in indoor public spaces and workplaces. They passed a bill to let local governments set their own licensing, taxation and fee rules for tobacco products.
The big-ticket, statewide policies that Hickenlooper proposed never saw daylight.
“Things happen incrementally, and there isn’t necessarily an appetite from the public to handle vast change,” explained Rep. Dafna Michaelson Jenet, who sponsored the Clean Indoor Air Act update.
In interviews with more than a dozen lawmakers — from both chambers and both parties — no one suggested Hickenlooper’s order had been ignored. Rather, they noted that:
• People were working on different legislative angles from which to attack the problem.
• Polis, who tends to favor a local-control approach over sweeping statewide mandates, came in with different priorities.
“Hickenlooper was no longer in place to have his office or CDPHE be advocates,” said House Speaker KC Becker, a Boulder Democrat. “I’m glad Hickenlooper made those proposals, and I definitely support them. But we prioritize, and sometimes these things are just multiyear efforts.”
When asked if the state has done enough to regulate vaping, Carrie Cortiglio, director of prevention services division at the Colorado health department, said “absolutely.”
“We have continued the comprehensive tobacco control work we have been engaged in for quite some time,” she said.
Becker said some of the bills Hickenlooper proposed very well could pass in 2020.
Rep. Larson, a sophomore Republican from Littleton, and Rep. Mullica, a sophomore Democrat from Adams County, are promising to bring a bill to change the statewide minimum purchasing age to 21 for nicotine products.
That bill, lawmakers say, will include stricter licensure requirements — something Polis has resisted in the past.
Weighing age limits and flavor bans
The governor would not give a yes-or-no answer when asked last week about whether he would sign such a bill. He has said he’s “very open” to it but also that, “We certainly don’t want to see raising (the minimum age) to 21 as an excuse not to do anything else.”
Public health experts and anti-tobacco advocates said that raising the price of vape and tobacco products via a tax is the most effective approach that can be implemented to reduce the use of these products by youths — something Polis believes, too. And they agreed with the governor and lawmakers on the need for an “all of the above” approach.
It’s the combination of “policies that produce the strongest outcome in decreasing youth use of tobacco,” Radke said. “We also know that 81% of youths initiated use of tobacco by way of a flavor — so policy needs to be responsive in banning these products from sale.”
But when asked repeatedly during an interview whether the Department of Public Health and Environment supported a statewide flavor ban, Cortiglio didn’t answer the question. Instead, she focused on the fact that Polis supports an excise tax on vaping products.
The health department would be “happy” to see the state raise the age for purchasing tobacco products, Cortiglio said before adding, “We are looking to see what direction the FDA is going to go on flavors.”
“In terms of the most effective policies to curb vaping in youths, it’s still early days in this phenomena,” she said.
Others, including Zach Zaslow, director of government affairs at Children’s Hospital, are hoping Hickenlooper’s order will be a road map when the legislature convenes in January.
When asked if the state should have done more to regulate vaping, Zaslow said, “It’s always tough when a new administration is transitioning in to get up to speed.”