After noticing a lack of academic research and information on electronic cigarettes and the people who use them, a University of Iowa research team decided to investigate how laws in different states impact e-cigarette usage.

UI epidemiology Assistant Professor Wei Bao has conducted several studies on e-cigarettes during his tenure at the UI. Bao and a team of researchers recently published a paper on how e-cigarette regulation in different states correlates to usage in U.S. adults.

Bao said the research was incredibly important because he doesn’t believe there are enough existing studies on the current status and change over time of e-cigarettes. He said state laws have varying levels of correlation with how e-cigarettes are used and who uses them.

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“In [our] recent study, we looked at five e-cigarette-related laws implemented in some U.S. states,” Bao said. “We wanted to see what the potential impact these laws had on e-cigarette use. In our results, we showed a modest association between usage and four of these laws. Those laws are related to about 10 percent lower rate of usage with these products.”

Bao said e-cigarettes may help some people quit smoking traditional cigarettes but may also encourage others to pick up a smoking habit. The study showed that the prevalence of young adults using e-cigarettes declined from 2014 to 2017 but jumped between 2017 and 2018.

“We showed that for young adults aged 18 to 24, two e-cigarette-related state laws, including age restriction and taxation of these products, are associated with lower use of e-cigarettes,” he said. “Due to these results, we are happy that the FDA issued a new law that made it illegal to sell these products to people under 21.”

Of the laws Bao and his team studied, two are implemented in the state of Iowa. The state requires retailers to purchase a license to sell electronic cigarettes and prohibits self-service displays of the product.

Co-author of the research Linda Snetselaar, UI College of Public Health associate provost of Outreach and Engagement, said research on this topic is exceedingly important because related, serious medical concerns have recently come to light.

“Because of severe illness and deaths in some cases that were associated with electronic nicotine delivery systems, the American Medical Association set a policy in September that indicated the use of e-cigarettes was dangerous and [people] should quit,” she said. “However, there really aren’t resources or cessation programs available for e-cigarette users who want to quit. That’s something that still needs to be developed.”

Snetselaar said resources and programs to assist users who want to quit are necessary. She hopes that the UI’s research will help in developing programs to assist the large amount of people who use these products, regardless of the reasons that they do.

Around 10.8 million U.S. adults use e-cigarettes, she added.

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“This isn’t a small problem, and many people are dual users who smoke regular and e-cigarettes,” Snetselaar said. “There are also previous smokers who now use e-cigarettes and new smokers who thought these products are safer than regular cigarettes when that isn’t turning out to be true.”

UI epidemiology Professor Robert Wallace, Irene Ensminger Stecher Professorship in Cancer Research, also co-authored the research. Wallace previously researched tobacco and cigarettes and said he believed the importance of research on e-cigarettes could not be underestimated.

“The fact that the use of e-cigarettes was greater in states that didn’t have strong policies against them didn’t surprise me,” he said. “But I was glad to see it because we were among the first [researchers] to show that state policies matter.”

Similar to tobacco, habits and patterns of e-cigarette research change in unpredictable ways, Wallace said.

Bao said this research must continue at the UI and beyond.

“This is an emerging concern in the field of public health,” he said. “Although e-cigarettes are popular and millions of Americans use e-cigarettes, there is little scientific evidence to help people understand the public health effects. There has been a lot of debate on this. That is the reason I got interested in this area of study. We conducted research to understand the current status and trend of e-cigarette use, factors associated with e-cigarette use, and potential health outcomes related to e-cigarette use.”