HONOLULU – The tobacco industry spends an estimated $22 million on marketing in Hawaiʻi each year costing the state $611 million in annual health care costs, $1.1 billion in lost productivity, and nearly $1,000 per household in state and federal tax burden.^[1] In an effort to combat the epidemic of youth vaping, the Hawaiʻi State Department of Health (DOH) and the Hawaiʻi Public Health Institute (HIPHI) recently relaunched the Stronger Together campaign. Since 2022, this campaign has called attention to strategies used by tobacco companies that target Hawaiʻi’s young people. Its current extension is in response to a recent movement among the counties to regain their ability to regulate the sale of tobacco products in their communities.  

“It is a glorious day today, but the fight isn’t over,” said Hawaiʻi County Councilmember, Susan Lee Loy, on January 10, 2024, as Bill 102 passed to ban flavored e-cigarette products on the Big Island. “We still need the state Capitol to act and return county authority. Today shows the Legislature that counties are listening to local needs and are ready to protect our communities.” 

Vaping disproportionately affects counties across the state. Data highlights that the brunt of the youth vaping epidemic has been laid on the shoulders of the counties. Approximately 16% of high school students on Kauaʻi, 18% on Maui, 22% in Hawaiʻi County, and 13% in Honolulu County report current vaping.^[2] Among middle schoolers, nearly one in 10 students currently use e-cigarettes in Hawaiʻi, Maui, and Kauaʻi Counties, and about one in 20 students in Honolulu County.^[3] 

Historically, Hawaiʻi’s counties have been trailblazers in passing policies to regulate tobacco products. In 2014, Hawaiʻi County was one of the first jurisdictions in the nation to raise the age on the sale of tobacco products to 21. All four counties passed policies to prohibit smoking at parks and beaches, prior to the prohibition becoming a state law. In response, it has been a strategy of Big Tobacco to target its special interest at the state level. The ability of counties to regulate the sale of tobacco products was removed by legislation in 2018. However, in the 2024 legislative session, several bills, including HB1778, have been proposed that seek to return county authority and allow appropriate action to protect keiki based on local needs. 

Big Tobacco has capitalized on the social impactof e-cigarettes among teens and younger ages, through targeted marketing and constant messages. In one study, teens listed the most common reason they started vaping was due to friends and socializing.^[4]Advertising and marketing through social media often play on that perceived social benefit, like increased friendships, as well as the creative designs and variety of flavors.^[5] The growing evidence reveals that the youth are indeed the intended target market for e-cigarette ads, despite tobacco companies denying the data. 

“My cousins are in middle and elementary school,” says Zoe, a student at Kamehameha Schools. “These girls are surrounded by the menacing drug in the place where they are trying to learn the difference between good and bad. It is so common we don’t know what to think anymore. We are drowning in a sea full of nicotine-addicted peers, but we want them back.” 

The continued problem of youth vaping and the growing data on the harmful effects of nicotine on the developing brain has fueled concern and prompted continued efforts by DOH and HIPHI to relaunch the Stronger Together campaign and offer services to those who wish to quit their addiction to tobacco. The Stronger Together campaign identifies populations targeted by the tobacco industry and advocates for community collective action through the motto “Together, we’re stronger than Big Tobacco”.

The public is encouraged to visit the campaign website, StrongerTogether.hawaii.gov, for more information about the tobacco industry’s targeted marketing tactics and to connect with their local Tobacco-Free coalition to stay informed and get involved. 

For those already addicted to tobacco products, the Hawaiʻi Tobacco Quitline offers free coaching and resources to support the quit journey. Call 1-800-QUIT-NOW or enroll online at hawaiiquitline.org. My Life, My Quit is a free program with trained coaches to help youth quit smoking or vaping. Teens can sign up by texting “Start my Quit” to 36072 or calling 855-891-9989. 

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[1] The toll of tobacco in Hawaiʻi. Campaign for Tobacco-Free Kids. (2023, November 21). https://www.tobaccofreekids.org/problem/toll-us/hawaii

2 Health, D. of. (2023, April 14). Query results for Hawaiʻi Youth Risk Behavior Survey (YRBS) data – electronic vapor product – current use, high schools, county-level. Hawaiʻi IBIS – Query Result – Hawaiʻi Youth Risk Behavior Survey (YRBS) Data – Electronic vapor product – current use, High Schools, County-level.  https://hhdw.org/report/query/result/yrbs/VaporCurr/VaporCurr_HS_CNTY.html

3 Health, D. of. (2023, April 14). Query results for Hawaiʻi Youth Risk Behavior Survey (YRBS) data – electronic vapor product – current use, middle schools, county-level. Hawaiʻi IBIS – Query Result – Hawaiʻi Youth Risk Behavior Survey (YRBS) Data – Electronic vapor product – current use, Middle Schools, County-level. https://hhdw.org/report/query/result/yrbs/VaporCurr/VaporCurr_MS_CNTY.html

4 Groom, A. L., Vu, T. T., Landry, R. L., Kesh, A., Hart, J. L., Walker, K. L., Wood, L. A., Robertson, R. M., & Payne, T. J. (2021). The Influence of Friends on Teen Vaping: A Mixed-Methods Approach. International journal of environmental research and public health, 18(13), 6784. https://doi.org/10.3390/ijerph18136784 

5 Struik, L. L., Dow-Fleisner, S., Belliveau, M., Thompson, D., & Janke, R. (2020). Tactics for Drawing Youth to Vaping: Content Analysis of Electronic Cigarette Advertisements. Journal of medical Internet research, 22(8), e18943. https://doi.org/10.2196/18943