It’s not often that a state health commissioner disagrees with a former surgeon general, but the commentary by former Surgeon General Richard Carmona (“Proposed ban on flavored tobacco in Minneapolis is counterproductive,” July 3) compels me to do just that. By claiming that e-cigarettes are “a safer alternative to smoking,” Carmona advocates against restrictions on where e-cigarettes can be sold and what kind of flavors can be used to enhance their enjoyment and increase their use.

While arguing that it’s better public health practice in tobacco control to support approaches that increase e-cigarette use among adults, he ignores the devastating impact this laissez-faire approach would have on children and adolescents.

He does recognize that there are special concerns about youth smoking but doesn’t acknowledge the harm that nicotine inflicts on young people. The recent Minnesota Department Health Advisory ( documents that nicotine exposure in any form is toxic to young children and harmful to adolescent brain development.

Carmona ignores the potential harm of e-cigarettes on children because he assumes that youth tobacco use is inevitable, even though rates are dropping dramatically, and that it’s safer for children to use e-cigarettes than combustible products. He even goes so far as to say that “electronic cigarettes are capable … of allowing our children to grow up in a world without combustion smoking.” Unsaid is that this world would have many children growing up addicted.

In his attempt to expand the market for the e-cigarette product produced by the company for which he is a board member, he misrepresents the purpose of the proposed Minneapolis ordinance around flavored tobacco. The purpose of limiting the sale of flavored tobacco to adult-only stores is not to prevent adult smokers from using e-cigarettes. The purpose is to reduce the visibility and availability of flavored tobacco products, including e-cigarettes, to children and teenagers.

Evidence shows that flavored tobacco products attract children and that the tobacco and vaping industries are using this as a deliberate strategy to increase the number of customers. That strategy is working, because e-cigarette use among Minnesota children (even those who have never smoked cigarettes) has risen dramatically in recent years, as have calls to Minnesota poison centers about e-cigarette-related poisonings. Limiting availability of flavored nicotine products protects children.

We are steadily learning more about the impact of e-cigarettes on people’s health. What we already know is that they effectively provide an addictive substance to the user. I also know that none of us wants our children to grow up addicted to nicotine. Given the sharp rise in youth e-cigarette use and the clear health risks of nicotine to developing brains, keeping the flavored nicotine products that appeal to children in adults-only stores is just common sense. I believe that every other former surgeon general would agree with that.


Dr. Edward P. Ehlinger is commissioner of the Minnesota Department of Health.