A public health official worries the high number of places selling vaping supplies “normalized” the use of tobacco products for young people.
Hawaii gas stations and convenience stores are among the largest retailers of electronic smoking device products in Hawaii and there are more vape shops per capita on neighbor islands, according to a Civil Beat analysis.
As of August 2019, approximately 670 electronic smoking device retailers, or ESD retailers, held state certificates to sell vaping products. Kauai County was home to the highest number of shops per capita selling those supplies, followed by the Big Island and Maui.
7-Eleven stores owned the most retail locations with ESD certificates, with 66 locations across the state. ABC Stores was the second largest retailer of vaping products at 64 locations.
All retailers were required to register with the Hawaii Attorney General’s Office starting Nov. 1, 2018, after the passage of Act 206 into law last year. Since 2016, it has been illegal for anyone under the age of 21 to possess or purchase electronic smoking devices in Hawaii.
The new law required the attorney general to create an Electronic Smoking Device Retailer Registration Unit and oversee ESD retailer registration, as the department does for tobacco products. Businesses must pursue an ESD retailer certification in addition to a separate certification to sell tobacco products.
“You have a lot of service stations, a lot of 7-Elevens, a lot of mom and pops — businesses other than those that strictly sell ESDs in various forms and shapes,” said Earl Hoke, an attorney who works for the tobacco enforcement unit in the attorney general’s criminal justice division.
He spoke up when e-cigarette vendors were the topic of discussion at the Coalition for Tobacco-Free Hawaii’s Menthol and Flavored Tobacco Summit, a public event held earlier this month. Hoke said the number of businesses — particularly independent vaping shops — has fluctuated over the years.
“These businesses pop up and shut down,” he said. “You’re chasing ghosts all over the place.”
Larger business retailers that sell e-cigarette devices and cartridges, however, have had a longer and steadier presence in the islands.
Aloha Petroleum, which operates gas stations in the islands, has 53 locations where e-cigarette supplies are sold. HIE Retail and Mid Pac Petroleum, which both conduct business as NomNom Express, have 34 retailers statewide.
Hotels were found to have a large number of stores that offer vaping products for sale. The Food Pantry, which does business at various hotels throughout the islands, operates 57 locations that sell e-cigarette products.
Some grocery stores also sell vaping devices and products, including Costco, Foodland and QSI Inc., which operates Big Save, Times Supermarket, Fujioka’s Wine Times and Shima’s Market.
Hawaii has some of the highest youth vaping rates in the nation, with more than 26% of public high schoolers reporting that they currently use e-cigarettes.
The trend has grown among neighbor islands in particular. Public health officials say a lack of regulation on marketing and the industry is to blame.
However, data show more youth purchase e-cigarettes from their friends than they do in person at a store, since they are under age.
According to the 2017 Youth Tobacco Survey, 60% of youth reported purchasing ESDs from their friends, and 16% purchased them from a family member. Approximately 8% said they purchased vaping products online, and nearly 10% reported purchasing e-cigarette products in gas stations, grocery stores, drug stores or the mall.
Still, Lola Irvin, chief of the state health department’s Chronic Disease Prevention and Health Promotion Division, said she is concerned about the proximity of vape shops to schools.
She believes the heavy concentration of vape shops in Hawaii has “normalized the use of tobacco products to our youth.”
“The high concentration has likely contributed to the higher rates of youth experimentation, and these products are highly addictive,” she said.
“With cigarettes, there have been a lot of studies that show the density of cigarette promotion and advertising in communities does increase the risk of smoking rates in young people in those communities. In terms of taxing, permitting and licensing, we don’t have that equity between cigarettes and e-cigarettes.”
Research from the University of Hawaii Cancer Center shows Hawaii teens are most frequently exposed to e-cigarette marketing at the point of sale in convenience stores, gas stations and other retailers.
UH Cancer Center researcher and associate professor Pallav Pokhrel is currently conducting studies on e-cigarette use among young adults in Hawaii. Data that his team collected in the past show that minors who are exposed to e-cigarette marketing are more likely to pick up the vaping habit later, he said.
At one point Hawaii had the highest number of vape shops per capita, second only to Las Vegas, according to a Quartz analysis of Yelp and U.S. Census data.
“The vape shop presence in Hawaii has been very strong,” Pokhrel said.
The Hawaii attorney general’s list may not be comprehensive.
“It is possible that some retailers have not registered,” said Rich Stacey, the deputy AG for the tobacco enforcement unit. “We do follow up with complaints and investigators do inspections that include both retail tobacco permit holders and ESD retailer certificates.”
Federal health officials are currently conducting an investigation into vaping products, which appear to be linked to a growing number of lung injuries across the nation.
As of Oct. 22, more than 1,600 cases of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — now dubbed EVALI — have been reported. More than 30 people have died.
Approximately 86% of patients reported using tetrahydrocannabinol-containing products in the three months before their symptoms started. But because the cause of EVALI is still unknown, the Centers for Disease Control and Prevention and Hawaii Department of Health officials recommend that people refrain from using all vaping products until the investigation completes.
In response, some major retailers have pulled products from their shelves.
Walmart announced Sept. 20 that it would stop selling e-cigarettes once its current inventory sells out, citing “growing federal, state and local regulatory complexity and uncertainty regarding e-cigarettes.”
Walgreens, which did acquire an ESD retailer certification from the state AG, announced Oct. 9 that it would stop selling e-cigarettes as well.
Civil Beat reached out to seven major e-cigarette retailers in Hawaii for comment, but did not receive a response.
Over the past decade, the U.S. Food and Drug Administration let the business grow with relatively little oversight. There was no product review before e-cigarettes hit the market.
The administration waited until 2014 to propose regulations which went into effect two years later, restricting the age of sale and requiring ingredient transparency. The 2016 FDA regulations require a pre-market review for any new e-cigarette products. Companies that sold e-liquids and vaping devices prior to Aug. 8, 2016 must apply for FDA approval by May 2020.
“Based on current research, e-cigarettes appear to be less harmful than combustible cigarettes, but they are definitely not harmless,” said Pokhrel. “E-cigarettes are vastly unregulated.”
Eleni Gill/Civil Beat