KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on the WAMU 88.5, welcome. Later in the broadcast a one man show about the life of 70s soul singer Donny Hathaway. But first, this year the CDC, the Centers for Disease Control and Prevention reported that the use of tobacco products among high school students grew by almost 40 percent between 2017 and 2018. That includes traditional cigarettes as well as vaping. And local jurisdictions are concerned about those numbers.

KOJO NNAMDIIn the fight against youth tobacco use D.C., Maryland, and Virginia have all implemented new legislation to place more restrictions on the purchase of tobacco products. Joining me in studio is Kathi Hoke, Law Professor at the University of Maryland Francis King Carey School of Law and Director of the Legal Resource Center for Public Health Policy. Kathi Hoke, thank you for joining us.

KATHI HOKEThank you for having me.

NNAMDIMatt Myers is the President of the Campaign for Tobacco Free Kids. Matt Myers, thank you for joining us.

MATT MYERSThank you for having me as well.

NNAMDIAnd joining us by phone is Alex Clark. He is the CEO of The Consumer Advocates for Smoke-free Alternatives Association. Alex Clark, thank you for joining us.

ALEX CLARKThanks for having me.

NNAMDIKathi Hoke, what are the most recent rules around on tobacco products in the District, Maryland, and Virginia? And I should ask you to clarify where e-cigarettes fit in.

HOKESure. So I think twofold tobacco 21 laws as well as tax increases are relevant in the DMV. So now -- well, effective October 1st in Maryland, all three jurisdictions will have tobacco 21 meaning you have to be 21 years of age to purchase, use, or possess tobacco in any of the jurisdictions. And the other side of things is the taxation. And I just want to point out and laud the District for raising the per pack cigarette tax to $4.50, and then now leading the country at that rate. Maryland at $2 a pack is in about 17th place. And Virginia lags quite behind everyone at only 30 cents a pack. We do know that increasing the price of tobacco products will reduce youth use as well.

HOKESo on both of those provisions, the tobacco 21 provisions in each of the jurisdictions does also apply to vape products and then there are varying taxes for vape products. And the District does not have at this time a vape tax nor does Maryland. However, Virginia does include vape products in their quote "other tobacco product taxation."

NNAMDIYes. There is some confusion among people about whether or not e-cigarettes are in fact tobacco products. But that is how they are legislated, because they contain nicotine and nicotine comes from tobacco.

HOKEAt the federal level it is clean under the Family Smoking Prevention and Tobacco Control Act that vaping products are in fact tobacco products. Otherwise one has to look at the state or hear the District law to see how they define tobacco product. But in each of these cases they're defining tobacco product for the tobacco 21 law as including vape products, which is critically important at this time.

NNAMDIMatt Myers, how has the culture around tobacco products shifted since the start of the Campaign for Tobacco Free Kids 23 years ago?

MYERSWell, we have seen a dramatic reduction in cigarette smoking. It is one of the great public health victories. And we've seen it in all three jurisdictions and across the United States. It's a direct result what we're seeing is beginning in changing of cancer rates and heart disease rates as a result of it. It's one of the reasons why some of us have been so concerned about the explosive growth of e-cigarette use among our youth. What we've seen is that as a direct result of the marketing of the e-cigarette companies and the sale of flavored products that appeal to kids that even as cigarette smoking has been going down we have seen a dramatic rise in e-cigarette use, and it's particularly disturbing, because it's by and large among kids, who never would have smoked. So that for the first time in a decade we're seeing the total number of kids, who are using nicotine base products on a regular basis actually grow.

MYERSOne of the reasons why that's so disturbing is that what we now know is that even though most of the kids, who use e-cigarettes would never have smoked, a kid who starts using an e-cigarette is far more likely to go on to become a regular cigarette smoker. So, you know, while the e-cigarette industry always talks about, we target adults. The reality is their marketing has targeted kids and has been extraordinarily successful.

NNAMDIJust to clarify the overall rate of smoking cigarettes since you started this campaign among high schools has gone down to 8 percent from 36 percent. That's a huge public health coup, isn't it?

MYERSIt is one of the great public health victories in the last -- in decades. Cigarette smoking when we opened our doors in 1996 was over 36 percent among high school students. Today it's down to eight percent. And in some jurisdictions it's well under five percent. The public health benefit of that is enormous. It is a reason why we are concerned. That when the e-cigarette industry targeted our youth and they did that it threatens that progress. Over the last year we saw cigarette smoking among high school students actually stabilize and in some places increase and we saw overall use of e-cigarettes dramatically increase. It's one of the reasons we need to get a handle on it. And raising the age to 21 is a good step, but it's not a comprehensive approach. What we need to do is get out of the market place the highly flavored products, mango, fruit medley, crème brulee, and many that are worse that are enticing our kids.

NNAMDIAlex Clark, the laws in D.C., Maryland, and Virginia affect all kinds of tobacco products as we mentioned earlier not only regular cigarettes. What are your thoughts on this kind of blanket legislation?

CLARKWell, we maintain our position that including low risk products like vapor products and other smokeless tobacco products in tobacco 21 laws -- I think potentially causes a net harm. You know, these laws are communicating to consumers that -- inaccurately that smoke free products and combustible products carry the same risks. And so we're mostly concerned about young adults between the ages of 18 and 20 -- 18 and 21, who are going to smoke anyway. And now it seems under this law they would have to wait three years in order to I think feel comfortable purchasing an alternative from retailers who are responsible in making sure that they're not selling to minors. Moreover, you know, there is going to be a certain percentage of young people between the ages of 16 and 18 who start smoking anyway.

CLARKThese laws in a way protect sales of combustible tobacco products by keeping them as the most visible most available products on the market.

NNAMDIWhat would you say to those, who are not simply looking to eliminate regular cigarettes, but all kinds of tobacco products including vaping?

CLARKSo we know from experience, we know from our own history that prohibition does not work. In fact it creates situations that can end up being a lot more harmful to the public. So certainly we're opposed to policies that creep toward prohibition. And we urge everybody to, you know, work towards policies that make sure there's a legal regulated market place for these products.

NNAMDILet's go on to the phones and talk with someone, who self-identifies as a high school student. Here is Sujim in Clarksburg, Maryland. Sujim, you're on the air. Go ahead, please.

SUJIMHi, Kojo. Thank you for letting me be on the show. I'm a high schooler from (word?) High School. And I do agree with the speaker that cigarette smoking has gone down, but e-cigarettes such as Juuls have gone up incredibly. I see it all throughout the gyms, the locker rooms, the bathrooms. I feel like they sneak Juul pods. And they sneak a hit whenever they can. And I think the main reason why is because it's not -- just not enough information out there about the dangers of e-vaping. Most people think that cigarettes are dirty, but Juul pods are not as dirty. And I think the new 21 rule that Maryland has passed will not do as much as people think to lower the e-vaping issues that we have in our high schools.

NNAMDIOkay. Thank you very much for sharing your opinion with us. I'll move on to a slightly different opinion. Michelle in Cheverly, Maryland. Michelle, you're on the air. Go ahead, please.

MICHELLEThanks for having me on, Kojo. So, yeah, I think youth being addicted to nicotine is a big problem. We would should have them be able to talk to their parents or school teachers, but we've been -- you know, people like Matt Myers's company have been demonizing e-cigarettes without a lot of information or a lot of data to back it up. Including saying that there's enormous numbers of teenagers who are vaping regularly, which is not actually the true if you look at the numbers. Only 0.6 percent of high schoolers who are underage who don't already use tobacco are regularly vaping. A lot of this is experimentation, and we shouldn't leap to the extreme measures that could potentially harm adult smokers and adult vaporers who have -- you know, you can look on line and see hundreds of thousands of comments from people who switched almost accidentally and feel like it has saved their life.

MICHELLEAnd we really need to study what raising the age limit to 21 will do to teenagers, to their behaviors specifically with smoking, because a few studies have shown that when you raise the age of e-cigarettes and cigarettes together up to 21 adolescent smoking increases.

NNAMDIMichelle, are you with an organization of any kind?

MICHELLEYes. I have Competitive Enterprise Institute.

NNAMDIWhat's the name of the organization?

MICHELLESorry. It's the Competitive Enterprise Institute in D.C.

NNAMDIOkay. Thank you very much for your call. Matt Myers, what are your thoughts about what we just heard and that is is it counterproductive to lump e-cigarettes and regular tobacco into the same regulations?

MYERSWell, you know, it's a classic case. We're all allowed our own opinions, but not our own facts, and this is one of those cases. The CDC, the Surgeon General in the Food and Drug Administration has all looked at the issue and says we actually have an epidemic among of youth use of e-cigarettes. Over 20 percent of our high school students are currently using e-cigarettes. The data shows also that over 27 percent of them use it with sufficient frequency to be signs of addiction. And the third critical juncture is that it shows is that the large majority of those kids are kids who never would have smoked. So what's happening is that the marketing of e-cigarettes to young people has resulted in a whole new population using them rather than getting kids, who might have switched over with it.

MYERSLet's make no mistake. It's not the nicotine in e-cigarettes that causes cancer. But use of nicotine particularly products that deliver high levels of nicotine like the ones that kids are currently using is harmful to the developing brain of adolescents in that kids are far more susceptible to addiction. So one of the reasons we're concerned and -- you know, when I say the Campaign for Tobacco Free Kids I'm echoing the views of the Surgeon General, the Centers for Disease Control, the Food and Drug Administration and every major public health organization that we need to do much more to both reduce cigarette and prevent e-cigarette smoking from creating a new generation of young people addicted.

NNAMDIAlex Clark, we got an email from Jane, who asks, how do kids get access to vape products? The high schoolers I know say everyone vapes in the bathrooms at school and sometimes even in class. Where are they getting the products, Alex Clark?

CLARKWell, I can't speak as a parent or as a teenager, obviously, but I can certainly draw on my own experience when I was in high school and certainly there are social sources. There are retailers, who are not following the law for one reason or another. And I think an important critical part in that is that for some retailers there's no incentive for them to follow the law. And, of course, you know, we live in the age of the internet. And internet sales have been cited by several young people as the primary source for these products particularly eBay where there are no age verification protocols in place for individual retailers. So there are several sources that kids can get these products from. And I think one of the most concerning things is that the further that we push the market place into an underground market, the less age verification that there's going to be.

NNAMDIGot to take a short break, when we come back, we'll continue this conversation. I'm Kojo Nnamdi.

NNAMDIWelcome back, we're talking about how new laws might be affecting smoking in this region with Alex Clark. He is the CEO of The Consumer Advocates for Smoke-free Alternatives Association. Matt Myers is the President for the Campaign for Tobacco Free Kids. And Kathi Hoke is a Law Professor at the University of Maryland Francis King Carey School of Law and Director of the Legal Resource Center for Public Health Policy. We got a question for Matt Myers from -- by way of a tweet from Michelle. How are e-cigarettes harmful to the brain? Harm can mean anything. Cigarettes kill people.

MYERSThe answer is pretty clear cut. The Surgeon General articulated it after a lengthy study. Delivering nicotine to the young person has multiple different harms. First of all the developing brain is particularly susceptible and it affects long term development. Second this research shows fairly conclusively that as the brain is developing it's much more susceptible to the impact of addiction. So that when young people become addicted while their brain is still developing they become addicted more quickly, more intensely, and later in life they have a hard time quitting. It's one of the reasons why so much emphasis has successfully been placed forestalling young people from starting smoking, because if we can delay someone's even trying smoking until past the age of 21, 22 what we discover is they don't become long term smokers.

MYERSIt's an issue that's been studied by the Centers for Disease Control, American Heart Association, American Cancer Society as well as many others. And it's one of those issues in which there is absolutely uniform view.

NNAMDII wanted to move on to another issue here. Kathi Hoke, another avenue for curbing smoking is higher taxes. The District has one of the highest cigarette taxes in the country. Have there been any economic consequences of the District's tax increase?

HOKESo I think the District's tax increase is too recent for us to really judge that. But we do know when a jurisdiction increases its tobacco tax it's one of the primary results is a reduction in youth smoking, because youth are particularly price sensitive. So that's why we encourage, you know, from a public health perspective the increase in taxes. The other valuable component of a tobacco tax increase is something perhaps Virginia might look to do with a significant tax increase that is fund enforcement programs. So if you increase your taxes and use that money to fund enforcement of the tobacco 21 provision, because that provision is only good if it is enforced. Then you get a double whammy. You price out young people and you conduct enforcement so that the retailers are not selling to them.

NNAMDIWhat are the impacts of these tax increases on low income communities?

HOKEAny tax is regressive in that nature that folks in lower income are affected by any price increase whether it's by tax or other inflationary principles. And there are resources available through many of our non-profitable organizations. American Cancer Society, American Heart Association, American Lung Association, as well as each of the jurisdictions we're talking about here have state or district based resources to help people quit.

MYERSKojo, one of the things I also want to say is it's important to understand that the actual overall impact of a tax increase even in low income -- particularly in low income communities tends to be positive, because the tobacco industry marketing has resulted in a far higher percentage of low income people who smoke cigarettes. It costs them money in terms of lost productivity, disease, and out of pocket expenses. The studies indicate that when you raise the tax a dramatic percentage of people actually quit. And for those, who quit it means that there's more income into their family to be used for positive things like food and other purposes, and so the overall impact in the community tends to be far higher.

NNAMDIBut how are small businesses affected by these tobacco tax increases?

HOKEWell, it's an interesting thing. This is one of those cases where small businesses before taxes always say that they're going to be harmed. But the evidence shows that when you raise taxes people don't stop spending money. They spend money on different things. And very often it's things that actually help the local community even more. Don't forget the tobacco industry is controlled by a few very large corporations that literally suck the money out of the community. If people go into the same store, spend their money on things that don't cause them harm, what we find is that the overall economic impact even on convenience stores and small stores tends to be very positive.

NNAMDIBefore I go to the phones, some argue that raising cigarette taxes pushes up the sale of black market cigarettes. Has that happened here?

MYERSIt happens, but only at a very small level and it's controllable. With tax stamps and enforcement of the law what we see is that there is a small level of increase. Don't forget it's only a small number of companies, who actually produce cigarettes. And so we have the capacity to control that very seriously. What we find is that the correlation between illicit trade directly relates to how seriously the government's enforcement efforts are not how high the taxes are.

NNAMDIAlex Clark, your turn.

CLARKWell, I think Matt might actually be down playing the effects of excessive taxes contributing to underground market sales of any tobacco product, and, you know, I think New York State is probably the best example of this where over half of the cigarettes sold in the State of New York are sold on underground markets. And now that D.C. is certainly competing for a top spot with the highest cigarette taxes, I would not be surprised. I think everybody should anticipate an expansion of an underground market there especially considering that the tax in neighboring Virginia is only 30 cents. You know, and again, expanding underground markets means that you have unscrupulous retailers and distributors, who are already violating the law. And the chances of them actually following restrictions on age -- selling to minors are, you know, potentially very low.

NNAMDIWell, Alex, how do online sales of vaping products play into this conversation involving these tobacco taxes?

CLARKWell, of course, it depends on how the law is written whether or not retailers are required to remit the tax collected to the state. I know that Pennsylvania had enacted a law and several states are trying to capture that tax revenue. But, you know, online sales actually makes up somewhat of a small portion of the overall industry.

NNAMDISame question to you, Kathi.

HOKEYeah. I think the online sales is really an issue with respect to youth, because we know that youth increasingly have access to vape products online. And there is really no truly effective way to do age verification or to assure that taxes are being collected. And that's why it is best to prohibit online sales.

CLARKIf I may just jump in quickly here, there are age verification protocols for online sales that are arguably more effective than face to face age verification. So they do exist. There are leaders in the industry, who have already implemented these age verification protocols.

NNAMDIWell, Bonnie emails, your guest is absolutely correct about how easy it is for teens to acquire vaping products. E-cigarettes should be available by prescription only. Just as nicotine gum and nicotine patches have been. Now on to Eve in College Park, Maryland, who self-identifies as a high school student. Hi, Eve.

EVEHi, Kojo. I'd like to put a little input as to where (unintelligible) I personally don't smoke, but I do have a couple of friends who do. The fact of the matter is everybody knows someone, who is 18. So if you're not getting (unintelligible).

NNAMDIOkay. You're breaking up. But from what I understand you're saying is that everybody knows somebody, who's 18 and therefore they can get it by way of that person. So thank you very much for your call. Here now is Brian in Washington D.C. Brian, your turn.

BRIANHi. Yes, I just think that it's all great to get rid of -- to lower the percentage of smokers and vapors and so on. But you're doing it on the backs of these adults of voting and military age. And lowering or raising the smoking age to 21, we should be thinking about lowering the drinking age back to 18. You know, it just violates our constitutional rights.

NNAMDIWell, thank you very much for your contribution, but I don't see that happening anytime soon. But he did raise an important issue, Kathi Hoke, that tobacco 21 laws in Virginia and Maryland have exemptions for members of the military. Who pushed for this exemption and what was their reasoning?

HOKESo from a public health perspective there is no justification for an active duty military or any military exemption in the tobacco 21 laws. And it was a disappointment to find both of those provisions in Virginia and Maryland. Just recently this month, the Surgeon General held a webinar with leaders from the military impressing upon the nation that they do not want military exemptions, and in fact they're considering internal policies to limit or prohibit on some level use of tobacco products or smoking among military members, because we need our military members to be in the best condition and not the worst condition. And that's what smoking contributes to.

NNAMDIWhat was the rational given for exempting military members?

HOKEFrankly in Maryland there were a few members of the General Assembly, who stood on the floor that if you should be able to go and die for your country you should be able to go and die for your country by smoking cigarettes, and it's an irrational argument. It just had the hold of leadership in Maryland. And we, you know, admire, respect the veterans in our communities and the active military members of our communities. And for that reason we want them to remain healthy as well.

NNAMDIHere's Jill in Rockville, Maryland. Jill, your turn.

JILLThank you, Kojo, for this opportunity. I'm a high school teacher. And I just thought part of the conversation that should be brought forward is that it is pervasive in schools that students are Juuling, but more concerning to my co-workers and myself and parents is the fact that as students use the Juul as a gateway, they're able to buy different devices to vape with like Dab Pens. And with those Dab Pens they're then able to vape THC. And so what we're seeing is also an uptick in students getting high, using the Juul as a device to then move forward into using the equivalent of marijuana. And it's very concerning. In addition to that, we're seeing students that have serious respiratory issues, bronchitis, pneumonia. I am aware of one death with pneumonia.

JILLI know that Juuls and vaping isn't directly linked to it, but, however, it does complicate the matter. And my friend works at a pulmonologist office and she said at 2:30 the kids just come rolling in with collapsed lungs, recovering from collapsed lungs, and with chronic respiratory issues. And so I just wish the conversation would go beyond whether these kids are going to turn into cigarette smokers, but to the fact that as teenagers and high school students they are vaping other things. And Juuling was the gateway to those alternatives.

NNAMDIDo you agree with that, Alex Clark, that vaping it can be a gateway?

CLARKWell, you know, the evidence does not conclusively support that. Even the National Academy of Science included that in their report. In fact, I think a lot of the research that's been done on that is not longitudinal. It's sort of misleading the way that's presented that a young person, who vapes is likely to also smoke. In reality, we're talking about someone, who was smoking likely prior to picking up a vaper product. And they are in fact using these products as a form of harm reduction.

NNAMDIWe're almost out of time, Matt Myers, but what are PUP laws and why do some anti-smoking activists oppose them?

MYERSYeah, PUP laws are laws that penalize the young people who purchase the product, rather than placing the responsibility on the adults, the retailers, who sell them the product. The reason we're opposed to it is we think the solution to the problem isn't to criminalize our young people who are lured into these products by marketing and attractive products. What we want to do is work with our young people, educate them, but we want to hold responsible the manufacturers and the retailers who sell them these products.

MYERSWhat we've seen is that it's a successful strategy. Working with young people, it's not inevitable that they will smoke. We've shown that by the dramatic decrease in tobacco use. And we believe we can do the same thing with regard to vapor problems. The one thing we've learned is that we gain nothing by calling our young people the wrongdoers rather than the people who have been marketing to them.

NNAMDIMatt Myers is the President of the Campaign for Tobacco Free Kids. Thank you for joining us.

MYERSThank you very much for the discussion.

NNAMDIKathi Hoke is a Law Professor at the University of Maryland Francis King Carey School of Law and Director of the Legal Resource Center for Public Health Policy. Kathi Hoke, thank you for joining us.

HOKEThank you so much. It was my pleasure.

NNAMDIAlex Clark is the CEO of The Consumer Advocates for Smoke-free Alternatives Association. Alex, thank you for joining us.

CLARKThank you. It was a pleasure.

NNAMDIShort break, when we come back, a one man show about the life of 70s soul singer, Donny Hathaway. I'm Kojo Nnamdi.