Policy & Research


The Changing Landscape of E-Cigarettes: 2020 Update (July 2020)

By Hina B. Shah, M.P.H., Wyatt J. Beckman, M.P.H., C.H.E.S., Linda J. Sheppard, J.D. | July 27, 2020

The Changing Landscape of E-Cigarettes: 2020 Update (July 2020)


Electronic cigarettes, or e-cigarettes, entered the U.S. market in 2007, and their use quickly became widespread. In 2019, nearly a quarter (22.0 percent) of Kansas high school students reported using e-cigarettes in the past 30 days. Earlier this year, the FDA set a deadline for all e-cigarette manufacturers to submit a premarket authorization application, however, the deadline was extended from May 12 to September 9. Meanwhile, increasingly popular disposable e-cigarettes (e.g., Puff Bar) remain unregulated.

This issue brief provides updated data on e-cigarette use among youth, health impacts and regulatory actions to curb e-cigarette use.

Key Points from the brief include:

  • E-cigarette use increases the risk of ever using conventional cigarettes among youth and young adults because nicotine is highly addictive and early use of nicotine (i.e., by high schoolers) increases the risk of long-term dependence and use.
  • As commonly seen in traditional cigarette smokers, research has described how e-cigarette use can hamper mucus clearance from the airways, making it more difficult for the main pathways to the lungs to defend against injury or infections.
  • In 2019, Congress raised the national minimum age of legal access (MLA) from age 18 to age 21 for tobacco products, including e-cigarettes — a policy action often referred to as Tobacco 21 (T21). Agreement of federal and state law would improve enforcement and retailer compliance.
  • Kansas has a tax on e-cigarettes. However, the state has not passed or amended laws related to T21, smoke-free restrictions, flavor bans, online sales and delivery services, taxation or retail licensing. Kansas legislators had considered  some of these policies in House Bill 2563.

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.