As doctors and researchers, we feel it is our responsibility to speak on the negative health impacts of flavored tobacco products, including e-cigarettes and menthol cigarettes.

We cannot wait on the Food and Drug Administration (FDA) and federal government to finalize rules on menthol cigarettes, or process through the thousands of pre-market product applications it is inundated with by the tobacco companies while leaving potentially harmful products on the market. This process is too slow and allows for many loopholes. This has placed the responsibility on state and local governments to protect their communities.

Tobacco companies spend more than $8 billion per year on advertising and promotions, aggressively targeting youth — and their efforts are working. With each passing year, the number of kids that are hooked on nicotine continues to grow. If left unchecked, tobacco companies will continue to increase the number children and young adults facing nicotine addiction and other adverse health consequences.

According to the 2019 Youth Risk Behavior Survey by the Centers for Disease Control and Prevention, Hawaii has the third-highest e-cigarette use rate in the U.S., with 1 in 3 (30.6%) public high school students and more than 1 in 6 (18%) public middle school students self-reporting regular e-cigarette use.

The benefits of banning the sale of flavored tobacco products extend beyond youth and young adults. Studies have shown that there is disproportionate usage of menthol cigarettes by Native Hawaiians and Pacific Islanders, and so this is also a matter of health equity.

Flavored tobacco products make it easy to start smoking or vaping and can lead to nicotine addiction. Studies at the University of Hawaii Cancer Center have shown that 80% of youth e-cigarette users use sweet, mint and menthol flavors, which lead to faster addiction and a decreased likelihood of quitting.

Tobacco companies have focused on the use of flavors to attract new customers while continuing to present e-cigarettes as the “safer” alternative to combustible cigarettes. These claims are false; and are incredibly misleading.

While no e-cigarette has been approved by the FDA as a tobacco cessation product, recent studies are demonstrating that e-cigarette usage has similar negative health effects on cardiovascular health as smoking combustible cigarettes. In a study by the Boston University School of Medicine and the University of Louisville, both e-cigarette and combustible cigarette users had 8% higher blood pressure and higher heart rates compared to non-users.

The study also indicated that e-cigarettes released chemicals that are toxic to blood vessels. Elevated levels of these chemicals, also known as volatile organic compounds (VOCs), in both e-cigarette and traditional cigarette users were associated with various changes in vascular health measures. Nicotine from both e-cigarettes and traditional cigarettes has been found to increase blood pressure, heart rate and blood vessel constriction — all of which are key contributors to heart disease and stroke.

Research from the UH Cancer Center also shows that e-cigarette use is related to a higher likelihood of respiratory diseases, such as asthma and COPD, among adolescents and young adults in Hawaii. The dangers of nicotine and tobacco are increasingly detrimental to our youth; inhibiting and harming brain development at a key developmental stage while producing significant implications on the rest of the nervous system.

California, the District of Columbia, Massachusetts, New Jersey and New York have prohibited the sale of flavored tobacco products. Hawaii must join them and act now to prevent tobacco companies from manipulating, addicting and harming our youth.

We urge lawmakers to support House Bill 551, HB 537 and SB 975 to stop the sale of flavored tobacco products and implement comprehensive regulation and taxation of e-cigarettes as tobacco products.

Zia Khan, M.D., is a cardiologist and president of the American Heart Association-Hawaii Division Board; Michael Lui, M.D., is a neurologist and board member of the American Heart Association-Hawaii Division; Pallav Pokhrel, Ph.D., is co-director of the Population Sciences in the Pacific at the University of Hawaii Cancer Center.