vaping

The True “Cost” of Tobacco

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At least two things about cigarettes are popularly understood: 1. They are extremely harmful to your health. 2. They are expensive. But “expensive” is a subjective term. What is the personal cost of smoking? And what is the more broad economic impact of the tobacco industry? While there is no simple answer to these questions, there is much to explore regarding the financial, medical, and environmental burden of commercial tobacco use.

Arrested Development/Giphy

Individual Cost, Communal Bill

The average cost for a pack of cigarettes in Michigan today is $8.27.1 To put that into perspective, the average Michigan smoker of median income would spend roughly 7% of their earnings on cigarettes.2 3 There are other direct and indirect costs of tobacco use. Smokers can pay as much as 50% higher on health insurance premiums4, and copays for medications and frequent office or hospital visits add up quickly. There is also opportunity cost, or the loss of potential gains from using funds for tobacco and tobacco related illness rather than investing into other aspects of life. One study estimated the total lifetime cost of smoking for an individual in Michigan was $2,193,645.5 Smoking, and the use of other tobacco products, is a heavy expense for the individual, but it also places a heavy financial burden on society.

Humphrey Yang/Tik Tok

Direct and Indirect Cost

The CDC reported that the U.S. spends $226.7 billion in one year on public and private health care costs related to tobacco use. Over half of this figure is tax funded. For perspective, that averages to each household paying $1,223 in taxes yearly just for tobacco related health care expenses. The CDC report states there is an additional $6.99 billion in health care costs related to secondhand smoke.6 Tobacco related illnesses also demand medical resources, and delays in care can increase the severity – and cost of treating – other patients.

Unsplash/Brian Yurasits

Exploring the Environmental Cost

The treatment of tobacco related illness requires significant energy use and creates a massive amount of medical waste. This, along with the environmental damage related to production and consumption of tobacco products, contributes to a growing economic and existential problem. The White House recently released a report which claimed that by 2100 extreme weather events related to climate change could cost the country $2 trillion each year.7  It is difficult to estimate the economic impact of something as nebulous as the tobacco industry, which requires significant deforestation, water consumption, and carbon emissions to operate. One study found that the cost to simply address pollution caused by cigarette butts in the 30 largest U.S. cities was $264.5 million each year.8 Concern has been raised about even greater danger posed by electronic cigarette pollution.

Parks and Rec/Tenor

Liability, Lies, Limits

The cost to address these problems must be borne by someone, and the tobacco industry is spending a fortune to deflect that responsibility onto the individual, with society ultimately left to pick up the bill. It’s a tough battle for anti-tobacco activists. In 2020, tobacco companies spent $28.2 million lobbying Congress alone.6 Accountability is a hard sell when tobacco companies are able to legally pay politicians, spend $23 million a day on marketing, and sponsor their own “research”. Perhaps, though, the fact that tobacco companies need to spend so much to survive is a positive sign. As our society continues to gain better understanding of personal wellbeing, the broad implications of public health, and the danger of climate change, the facts will be too loud to hush. The simple conclusion is that the true cost of tobacco will always be too much.

Further reading:

  • This Smokefree.gov calculator shows how much money is saved over time after quitting cigarettes.
  • ASH (Action on Smoke and Health) provides a wealth of information on the effects of the tobacco industry and what legal/policy measures can be taken to eventually end tobacco related deaths.
  • Tobacco Free Funds provides information on funds that invest in tobacco manufacturers or entertainment agencies that promote tobacco use.

If you would like to learn more about tobacco reduction and cessation, please contact our team:

Melissa Small – Ypsilanti/Jackson Tobacco Treatment Specialist

(734) 329-9223

Monica Allen – Detroit Tobacco Treatment Specialist

(313) 949-2938

References

1: “Cigarette Prices by State 2022” World Population Review. Retrieved from: https://worldpopulationreview.com/state-rankings/cigarette-prices-by-state
2 & 3: Calculated using (average cost x average consumption) divided by median income.
2: “US Households Number of Cigarettes Smoked on an Average Day 2020” Statista. July 2021 Retrieved from: https://www.statista.com/statistics/275993/us-households-number-of-cigarettes-smoked-on-an-average-day/
3: “Median Individual Income in Michigan” Data Commons. Retrieved from:
https://datacommons.org/place/geoId/26?utm_medium=explore&mprop=income&popt=Person&cpv=age%2CYears15Onwards&hl=en
4: “Marketplace Premiums Rise Faster For Tobacco Users Because Of Subsidy Design.” HealthAffairs. September 2020. Retrieved from: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00015
5: “The Financial Cost of Smoking by State” WalletHub. January 2022. Retrieved from: https://wallethub.com/edu/the-financial-cost-of-smoking-by-state/9520
6: “The Toll of Tobacco in the United States” Tobacco Free Kids. November 2021. Retrieved from: https://www.tobaccofreekids.org/problem/toll-us
7: “The Future Cost of Climate Inaction 2 Trillion a Year Says the Government” NPR. May 2022. Retrieved from: https://www.npr.org/2022/04/07/1091258821/the-future-cost-of-climate-inaction-2-trillion-a-year-says-the-government
8: Schneider, J. E., Scheibling, C. M., Peterson, N. A., Granados, P. S., Fulton, L., & Novotny, T. E. (2020). “Online Simulation Model to Estimate the Total Costs of Tobacco Product Waste in Large U.S. Cities.” International journal of environmental research and public health, 17(13), 4705. https://doi.org/10.3390/ijerph17134705

Understanding E-cigarettes and Vaping

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“Would switching to an e-cigarette be helpful?” is not an uncommon question to hear working in tobacco treatment, even with the nationwide panic over vaping occurring just under a year ago. Since their introduction into the U.S. market in 2007, e-cigarettes have been seen as a way to potentially aid in tobacco reduction/cessation by many, but most specifically the industry’s marketing teams. Additionally they’ve been marketed towards teenagers and young adults through social media and youth-oriented flavors, and as result we’ve seen major growth in use over the last five to ten years. Because of this, it continues to be important to consider the health risks and concerns that come along with e-cigarette use. 

Background

E-cigarettes are a type of electronic nicotine delivery systems (ENDS), and are also commonly referred to as vapes or vape pens, as well as various brand names (example: JUUL). The devices work by producing an aerosol from a liquid that’s heated within the device by a metal coil, which the user then inhales. “E-liquids” are made up of nicotine, glycerin or propylene glycol, flavorings, and various chemicals. The aerosols that are inhaled may also contain  ultrafine particles and heavy metals like nickel, tin, and lead. 

When they were initially introduced to the market, e-cigarettes looked very similar to combustible cigarettes and were a disposable product. Since then, we’ve seen major changes to both the appearance and functional capabilities of these devices – and not necessarily for the better. E-cigarettes and vapes no longer have one design, instead they now might look like pens, lighters, highlighters, USB devices, or even inhalers. In addition to modern generations being refillable and/or reusable, users can modify what is being put into their e-cigarette which leads to the ability to use marijuana and other substances with these devices. 

Growth, Marketing, and Current Use

The first time I saw an e-cigarette was at least 10 years ago in a kiosk in the local mall (those who frequented Briarwood mall in the 2007-2010 might have memories of this as well), and what I remember specifically is that they were primarily being marketed as a way help adults who smoked quit cigarettes. At some point the kiosk was changed, and I didn’t really think about e-cigarettes or other ENDS products for many years. During this time, e-cigarette and vaping companies began to make major strides within the market, with focus shifting from current tobacco users looking to quit smoking to youth and young adults .

E-cigarettes are currently the most commonly used tobacco product among youth in the United States, with over 5 million middle and high school students reporting use within the last 30 days in 2019. Specifically between 2011 and 2015 we saw a 900% increase in use within this demographic. Some (and likely most) of this growth can be attributed to the youth-oriented marketing that has been present in the last 5-10 years. Examples of this marketing include brightly colored ads (like the one below), social media use (including hashtags like JUUL’s #vaporized), promotion through celebrities and “influencers”, and youth-targeted flavors (fruit, candy, and mint). These efforts have succeeded in reaching U.S. youth, with more than 5 in 10 (over 14 million) middle school and high school students reporting seeing e-cigarette advertising in 2018. 

People use e-cigarettes and vapes for numerous reasons. For adults these include: to aid in quitting combustible cigarettes, to get around smoke-free laws/regulations in public spaces, and that they view them as a “safer” or “healthier” option. Youth also often believe e-cigarettes and vapes to be less harmful than combustible cigarettes (many are also unaware that these products contain nicotine) and have cited novelty and flavors as additional reasons for use.

Health Risks

Being a “safer” alternative to smoking is a commonly cited reason for using an e-cigarette, as well as being a belief many have seen used to promote these products by companies and other pro-vaping organizations and groups. Something that is seen far less in these promotions is that “safer” does not mean SAFE. There are still health risks and concerns when it comes to e-cigarette and vaping product use, with more research on long term health impacts still needed. These risks include:

  • Nicotine/nicotine addiction – particularly a concern for those under the age of 25 and pregnant individuals as nicotine is associated with issues with attention, learning, mood, and impulse control within the developing brain
  • Harmful chemicals – including cancer causing chemicals and chemicals like diacetyl (chemical flavoring) which is linked with serious lung disease
  • Inhalation of ultrafine particles and heavy metals such as nickel, tin, and lead
  • Increased likelihood for dual use and increased likelihood for using combustible tobacco products later in life 
  • Unintentional injuries – such as explosions and/or fires caused by defective batteries or poisoning caused by swallowing, breathing, or absorbing e-cigarette liquid through the skin or eyes
  • Secondhand exposure to chemicals via aerosol 
  • E-cigarette or Vaping product use Associated Lung Injury (EVALI) – has been linked with vitamin E acetate and THC containing products, and research continues to look into other causes and risks

You can find more information on health risks and resources for discussing e-cigarettes (particularly with youth) on the CDC, Michigan Department of Health and Human Services, and Surgeon General webpages for e-cigarettes and vaping. 

Regulations 

E-cigarettes are currently regulated at the federal level by the FDA, which implemented regulations for sales and manufacturers, and some regulations to ban flavored (non-menthol) cartridges. Additionally, the FDA began recognizing ENDS as a tobacco product in 2016. In Michigan, we have two laws that currently regulate e-cigarette use and sales which:

  • Define “liquid nicotine” and “liquid nicotine container”, as well as establish minimum safety standards for these containers
  • Define e-cigarettes and vaping products separately from tobacco products
  • Requires these products to be stored in a locked case or behind the counter in vape and smoke shops
  • Prohibits sale to minors 
  • Prohibits use/possession by minors

Like the FDA, Michigan and other states across the country have attempted flavor bans or other regulations of flavored e-liquids. Overall there have been issues with these attempts not being strong enough. Menthol and mint flavors are often not being targeted by these bans, and some brands are able to avoid them through device design, allowing for flavors popular with youth to remain on the market. 

It should be noted that due to some of these efforts and restrictions at the federal and state level, there has been a shift in marketing tactics. Specifically JUUL, the largest e-cigarette and vaping company in the U.S., has removed their candy flavored “pods”, cleared out their social media, and given their website a sleeker and more mature look. With these changes, it appears they (along with other companies like IQOS) are now focusing their marketing on adults who currently smoke or adults who are looking to quit smoking. 

Use in Tobacco Cessation 

One of the most commonly asked questions when it comes to e-cigarettes and vaping products, and the question I decided to start this blog off with, is whether or not these devices are useful in quitting combustible cigarettes and other tobacco products. In a world that loves clear-cut answers, this one will certainly be unsatisfactory, and it is: we don’t know. Like long-term health impacts, there is still a need for more research on this topic moving forward. However, it should be noted by all who are considering using any form of these products that there currently is no evidence to support their usefulness in tobacco cessation. There is also concern that dual-use (i.e. use of an e-cigarette/vape and use of combustible cigarettes/tobacco products at the same time) may occur in those who try to use e-cigarettes to quit smoking. Additionally, e-cigarettes have not been approved by the FDA as an aid for quitting smoking, but there are currently seven approved quit medications that you can learn more about on our most recent tobacco blog.

The bottom line is that while these devices may be safer in some aspects, safer does not mean safe. Specifically, e-cigarettes and vapes are not safe for youth, people who are pregnant, and people who do not currently use tobacco products. There are numerous cessation aids and strategies that have been shown to be successful for people looking to quit their tobacco use, all of which should be considered first and foremost.

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Have additional questions about a blog topic or just interested in finding out more about Unified’s Tobacco Reduction services? Contact your local Tobacco Treatment Specialist:

Detroit:
Amber Jager – (269) 350-3826
ajager@miunified.org

Ypsilanti/Jackson:
Caitlyn Clock – (734) 489-9916
cclock@miunified.org