Mahalo for your editorial urging Hawaii’s legislators to pursue legislation to remove flavored e-cigarettes, which have addicted millions of youth and adolescents to nicotine and jeopardized their short- and long-term health, from our local market (“Curb marketing of vaping flavors,” Our View, Oct. 22).

While your editorial did not address menthol or mint flavors specifically as among the added e-cigarette and tobacco flavors attracting youths, they need to be included in legislation.

Menthol is found in most tobacco products, even those not marketed specifically as menthol flavors. Menthol’s cooling and analgesic properties reduce the harshness of cigarette smoke and e-cigarette aerosol, and irritation from nicotine that increases exposure to nicotine because smokers inhale more deeply and hold smoke in their lungs longer. Evidence indicates that menthol enhances the addictiveness of cigarettes, both by increasing the likelihood of nicotine addiction in youth who experiment with both cigarettes and e-cigarettes and by making cessation among adult smokers more difficult.

Menthol amplifies nicotine-induced changes in the young brain’s reward system that contribute to addictive behaviors. There is also some evidence that smoking menthol may produce worse cardiovascular physiological effects and increase cardiovascular risk as compared to nonmenthol smokers.

JUUL and other e-cigarette companies have preyed upon youth and adolescents with million-dollar marketing campaigns and thousands of appealing flavors and device designs (vape mods) that are proven to attract kids. These companies did this knowing that nicotine is an addictive drug that rewires the developing brain and poses significant health risks to e-cigarette users.

We don’t yet know the full impact of e-cigarette use on public health, but we do know that e-cigarette companies have done real harm to a generation of children. One of the largest research studies to date examining e-cigarettes and cardiovascular disease, released in January at the International Stroke Conference held at the Hawaii Convention Center, found that compared with non-users, e-cigarette users had:

>> 71% higher risk of stroke;

>> 59% higher risk of heart attack or angina;

>> 40% higher risk of coronary heart disease; and

>> Double the rate of cigarette smoking.

Other research has indicated that exposure to e-cigarette aerosol and the nicotine contained in it causes premature aging of the blood vessels, which can lead to early onset of cardiovascular disease.

Flavors motivate individuals to start using e-cigarettes and to more often report feeling addicted to e-cigarettes.

Hawaii officials should pursue legislation to remove all flavored tobacco products, including those containing menthol or mint flavors, from Hawaii’s market. They should also take other necessary measures to prohibit online sales of e-cigarettes, and tax those products at a level comparable to combustible cigarettes to make them less attractive to our children who are price sensitive.

Most importantly, any new e-cigarette or tobacco tax revenue generated should be allocated to prevention and control programs to help our state and community organizations better combat the millions of dollars being invested by tobacco companies to hook our keiki.