Smoking rates among military service members continues to decline as e-cigarette use increases, according to a 2018 study by the Rand Corporation. In Rand’s Health Related Behaviors Survey Substance Use Among U.S. Active-Duty, “13.9 percent of service members were current cigarette smokers, and 7.4 percent smoked cigarettes daily.” Among the general population, 16.8 percent of Americans were current smokers, and 12.9 percent were daily smokers.

The finding is significant because military service members now smoke at lower rates than the general population. Historically, smoking rates among service members have been higher than the national average. In 2011, 24.5 percent “of service members reported cigarette use in the past 30 days,” compared to 20.6 percent of civilians.

The Rand analysis also finds a significant portion of military service members use electronic cigarettes, as 35.7 percent reported they have tried e-cigarettes, 12.4 percent reported being current past-month users, and 11.1 percent reported being daily users. These numbers are noteworthy because scant research exists on e-cigarette use among military service members.

For decades, cigarette use has been pervasive across the U.S. military. Cigarettes are not subject to state and local taxes on the vast majority of military installations. In fact, an analysis comparing cigarette prices noted that cigarettes “were 11% - 12% cheaper at on-base retailers compared with off-base retailers.” It is estimated the Department of Defense “spends more than $1.6 billion each year on tobacco-related medical care.”

The rise in use of electronic cigarettes and simultaneous decline in cigarette consumption is further proof to the efficacy of e-cigarettes as a tobacco harm reduction tool. Numerous public health groups including Public Health England (PHE), the Royal College of Physicians, the National Academies of Sciences, Engineering, and Medicine, and the American Cancer Society have publicly acknowledged reduced harm form the use of e-cigarettes. PHE England has even found e-cigarettes to be “95% safer than smoking.”

Moreover, reduced harms resulting from use of e-cigarettes is believed to help reduce state budgets that must account for health costs associated with combustible cigarettes. In fact, according to an analysis, if all current Medicaid recipients who use combustible tobacco were to switch to e-cigarettes, states could have saved $48 billion in Medicaid costs in 2012. A smaller study found Medicaid savings “would be approximately $2.8 billion per 1 percent of [Medicaid] enrollees” over the next 25 years. As more military members use e-cigarettes instead of combustible cigarettes, the Defense Department’s long-term health care costs should decline significantly.

E-cigarettes have also become a very popular and successful smoking cessation tool. In 2014, the Centers for Disease Control and Prevention found that among smokers who attempted to quit smoking cigarettes within the past year, “more than one-half have ever tried an e-cigarette and 20.3% were current e-cigarette users.” A 2016 analysis noted that of the 10 million American adult vapers, approximately 3 million had used e-cigarettes to quit smoking tobacco cigarettes. Recently, a 2019 study found electronic cigarettes and vaping devices to be “twice as effective” as nicotine replacement therapy.

It should be very apparent to policymakers that e-cigarettes are an effective smoking cessation tool. E-cigarettes are safer than combustible cigarettes and provide economic gains by reducing health care costs associated with combustible cigarettes. Further, e-cigarette retailers improve local economies by providing new business opportunities and tax revenue. Therefore, policymakers should refrain from imposing onerous regulations and egregious taxes on e-cigarettes, which would only threaten the viability of these tobacco harm reduction products.

The following articles provide more information about electronic cigarettes and tobacco harm reduction.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking

https://www.heartland.org/publications-resources/publications/vaping-e-cigarettes-and-public-policy-toward-alternatives-to-smoking

For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Podcast Series: Voices of Vapers

https://www.heartland.org/multimedia/podcasts?fromDate=&toDate=&q=voices+of+vapers

In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.

Research & Commentary: Largest Vaping Survey Finds Flavors Play Important Role in Tobacco Harm Reduction

https://www.heartland.org/publications-resources/publications/research--commentary-largest-vaping-survey-finds-flavors-play-important-role-in-tobacco-harm-reduction

In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines a survey of nearly 70,000 adult vapers in the United States. The survey was completed in response to the U.S. Food and Drug Administration’s recent Advanced Notice of Proposed Rulemaking seeking comment on the role of flavors in tobacco products. The authors found nearly 95 percent of survey respondents were at one time smokers and the majority reported using flavors at the point of e-cigarette initiation. Stroud compares this to other surveys. She concludes, “eliminating flavors will force [vapers] to vape only tobacco-flavored e-cigarettes, which would likely cause them to return to combustible cigarettes.” Stroud also found research has found e-cigarettes are a key tobacco harm reduction product and could help alleviate state budgets by mitigating health care costs.

Research & Commentary: Randomized Trial Finds E-Cigarettes Are More Effective Smoking Cessation Tool Than Nicotine Replacement Therapy

https://www.heartland.org/publications-resources/publications/research--commentary-randomized-trial-finds-e-cigarettes-are-more-effective-smoking-cessation-tool-than-nicotine-replacement-therapy

Lindsey Stroud, a State Government Relations Manager at The Heartland Institute examines a study in The New England Journal of Medicine that finds e-cigarettes and vaping devices to be twice as effective as nicotine replacement therapy (NRT) in helping smokers quit cigarettes. Nearly 700 participants were studied over a 52-week period, with researchers finding that 18 percent of e-cigarette users reported abstinence, compared to 9 percent of those using NRT. Stroud writes that “these latest findings provide more valuable information on the public health role that e-cigarettes and vaping devices provide for the 38 million cigarette smokers in the United States,” an implores policymakers to regulate these devices in a way that promotes their usage.

Research & Commentary: Study Finds E-Cigarettes Would Prevent 6.6 Million Premature Deaths

https://www.heartland.org/publications-resources/publications/research--commentary-study-finds-e-cigarettes-would-prevent-66-million-premature-deaths

Heartland Institute State Government Relations Manager Lindsey Stroud examines an October 2017 Tobacco Control study that found electronic nicotine delivery systems (ENDS) might help extend life for millions of people. The authors of the study found there was an estimated 6.6 million fewer deaths and more than 86 million fewer-life-years lost over a ten year period because of ENDS products. Stroud concludes the use of ENDS could also help improve the budgets of numerous state programs, including Medicaid.

Research & Commentary: Public Health Officials Urge Use of Electronic Nicotine Delivery Systems

https://www.heartland.org/publications-resources/publications/public-health-officials-urge-use-of-electronic-nicotine-delivery-systems

Heartland Institute State Government Relations Manager Lindsey Stroud notes the importance of NHS Health Scotland’s joint statement encouraging the use of electronic nicotine delivery systems (ENDS) as an alternative to tobacco products. NHS Health Scotland, Public Health England, and other groups have found ENDS are 95 percent less harmful than tobacco cigarettes.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus, host an event in your state, or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Lindsey Stroud, a state government relations manager at The Heartland Institute, at lstroud@heartland.org or 757/354-8170.