By Cheryl Bettigole

The use of tobacco products remains the number one cause of preventable death in the United States. Here in Philadelphia, more than 2,000 people die of tobacco-related illness every year. Pennsylvania's new $1-per-pack tax on cigarettes, along with the commonwealth's first taxes on e-cigarettes, roll-your-own, and smokeless tobacco, are important steps toward reversing this epidemic.

The e-cigarette or vaping industry argues that its products are less toxic than cigarettes and should remain untaxed. And e-cigarettes may well be less risky than traditional cigarettes for long-term adult smokers. But use of these products by teenagers and preteens has exploded in recent years, tripling in a single year from 2013 to 2014, and continuing to increase in 2015. This increase has led to an overall trend toward increasing youth tobacco use, the first such increase in decades. Seven out of 10 teens who start smoking do so using flavored products, with flavorings like chocolate, strawberry, and mango, that are illegal in traditional cigarettes.

Several recent studies have shown that teens who begin using e-cigarettes are more likely than other teens to go on to smoke traditional cigarettes. Despite laws that require buyers of e-cigarettes, like other tobacco products, to be over age 18, teens continue to use these products in greater and greater numbers. Clearly for the teen market, the e-cigarette industry's harm-reduction argument does not hold water.

Price is a powerful lever in lowering smoking rates, particularly among teens. For every 10 percent increase in the price of cigarettes, adult smoking rates drop by about 4 percent and youth smoking rates drop by about 6 percent. If we want to halt the skyrocketing increase in teen e-cigarette use that threatens our hard-won gains in the battle to stop youth smoking, taxes provide one of the most effective tools available. That's why I applaud the legislature's approval of a tobacco tax increase last July. We have already waited too long to tax these products that serve as a gateway to nicotine addiction for many of our teens.

Where the new law falls short, however, is in failing to allow similar taxes on cigars and cigarillos. More than 10 percent of high school boys now smoke cigars and the failure to tax these products is likely to make them disproportionately cheap and hence more attractive to teens. Like e-cigarettes, cigarillos come in a multitude of flavors that seem designed to draw kids in, and are often displayed in Philadelphia's neighborhood stores next to displays of candy and gum.

If e-cigarette companies are serious about their health claims, they should commit to dropping the use of flavorings that serve to draw teens and preteens into nicotine addiction, and they should stop marketing e-cigarettes to young nonsmokers. More than 90 percent of smokers start as teens and that addiction, once begun, can be impossible to break.

Philadelphia's retailers should refuse the role the tobacco industry has given them as purveyors of a deadly product. And we should all welcome Pennsylvania's new tax on e-cigarettes and other tobacco products as a much-needed addition to the fight against death from tobacco.

Cheryl Bettigole, M.D., is director of the Division of Chronic Disease Prevention at the Philadelphia Department of Public Health. Cheryl.Bettigole@Phila.gov