Kids who vape and use other forms of e-cigarettes are likely to try more harmful tobacco products like regular cigarettes, but e-cigarettes do hold some promise for helping adults quit.

That’s according to the National Academies of Science, Engineering and Medicine, which published a comprehensive public health review of more than 800 studies on e-cigarettes on Tuesday.

“There is conclusive evidence that most products emit a variety of potentially toxic substances. However the number and intensity is highly variable,” says David Eaton, who heads the committee that wrote the report. He is also the dean and vice provost of the graduate school of the University of Washington, Seattle.

“In some circumstances, such as their use by nonsmoking adolescents and young adults, their adverse effects clearly warrant concern. In other cases, such as when adult smokers use them to quit smoking, they offer an opportunity to reduce smoking-related illness.”

In fact, 15 of the studies NAS reviewed found that when teens and young adults use e-cigarettes, they are more likely to try regular tobacco within a year.

“We found that kids who tried e-cigarettes, hookah, or smokeless tobacco or cigars — any non-cigarette tobacco product — were all twice as likely to try cigarettes a year later, compared to kids who hadn’t used any of those other tobacco products,” says Shannon Lea Watkins, a public policy researcher at University of California, San Francisco. Watkins and her colleagues also found that the effects of using non-cigarette products compound: “Kids using two or more non-cigarette products were four times as likely to report using cigarettes a year later.”

However, it is not yet known how much tobacco they use on a regular basis and whether it became a habit. More long-term studies are needed.

The NAS report also indicates that there is some evidence that e-cigarettes may help adults already smoking regular cigarettes quit, but only if they switch exclusively to e-cigarettes.

Eaton emphasized that there is insufficient evidence on whether e-cigarettes work as well as either no treatment or FDA-approved smoking-cessation treatments, such as nicotine patches or gum, to get smokers to quit.

E-cigarettes are still fairly new and are largely unregulated. The were introduced only in 2003 as an alternative to tobacco-containing cigarettes, which is why the government requested that the analysis be conducted.

The report found that most e-cigarettes contain nicotine, even if they are marketed as flavored like bubble gum and potpourri.

The report also found that emissions from e-cigarettes do contain some harmful byproducts like metal, but far less than conventional cigarettes.

“Conventional cigarettes burn, and in the process of burning tobacco, a large number of fairly toxic chemicals are generated in the tobacco smoke,” Eaton says. So there are more adverse health effects related to these combustible products.

However, a recent national survey suggests adults do not believe that e-cigarette vapor is toxic.

Food and Drug Administration Commissioner Scott Gottlieb says the report “helps identify areas that need further study to better understand the net public health impact of e-cigarettes … . We need to put novel products like e-cigarettes through an appropriate series of regulatory gates to fully evaluate their risks and maximize their potential benefits.”

FDA commissioned the report at the direction of Congress to evaluate evidence of health effects of e-cigarettes after it delayed proposed regulations last year.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, issued a statement expressing disappointment that the FDA has not acted quickly enough to regulate these products. “This report shows what happens when a new product is introduced without meaningful government oversight. It demonstrates why the FDA should fully and aggressively implement the overdue e-cigarette regulations that took effect in August 2016,” it says.

The national academies report calls for more studies.

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In California, the state Senate is considering legislation that would ensure that students at four-year public universities in California have access on campus to medication for abortions.

Sen. Connie Leyva introduced the bill, SB 320, in February 2017. It would require all health centers within the University of California and California State University systems to stock the drugs prescribed for medication abortion and ready their campus health clinics to provide them by 2022.

Medication abortion involves two drugs, mifepristone and misoprostol, that a woman can take at a clinic or at home to terminate pregnancies less than 10 weeks along.

The campaign for the bill began at University of California, Berkeley in 2016, when the student government passed a resolution urging the health center there to include medication abortion in its services.

Adiba Khan, co-founder of Students United for Reproductive Justice and the author of the resolution, noticed that the student health service offered 18 forms of contraception, but not abortion. She was also influenced by fellow students’ experiences. “I was able to meet a few peers who attempted to get an abortion through the student health center, and they faced a lot of hurdles, mostly bureaucratic, before they were able to get an abortion,” Khan says.

Members of the group met with the health center administration as well as university leaders to try to make medication abortion available at Berkeley’s health center, but it didn’t happen.

“When they were denied, they brought the issue to us, and I thought that this was something that young women should have access to, because it is their constitutional right,” says Leyva. The Women’s Foundation of California Women’s Policy Institute stepped in to help draft the legislation.

The bill is moving ahead in the California Legislature even as other states have taken steps to limit access to medication abortion.

The Oklahoma Legislature passed a bill that was signed into lawin 2014 that set a strict protocol for the drugs involved in medication abortion; it was initially overturned in the state courts, then upheld and was overturned again in 2017. In Louisiana, a law requiring that all aborted tissue be buried or cremated — an impossible task in the case of medication abortion — is currently suspended as the state court tries it. And as of last fall, the Missouri health department requires any facilities providing medication abortion to contract with an OB-GYN who can be on call around the clock to personally handle any complications.

Opponents of the bill in California are unsure that public university health centers should provide medication abortions. Anna Arend, the Northern California Regional Coordinator for Students for Life of America, testified during the Senate education committee hearing on behalf of student groups across California that oppose the bill. “These students have formed a coalition to oppose SB 320 due to the horrible realities of RU 486, the abortion by medication technique, and the dangers that it would bring to their campus. And the simple fact that abortion pills are not a factor in student success,” Arend said.

California is alone in considering a measure like this, but the legislative push is in line with the state’s previous policies, says Elizabeth Nash, a senior state issues analyst at the Guttmacher Institute. The state also requires all health insurers to provide abortion coverage and sets no waiting period for abortion procedures.

The California Senate committees on health, education and appropriations committee have each approved the bill. Next, the bill will move to the Senate floor for a vote, which is expected by the end of January.

As for funding the abortion services, SB 320 doesn’t specify the use of any state or university money. A private consortium that includes the Women’s Foundation of California, Tara Health Foundation and a private donor has agreed to pay for implementation. The estimated cost is about $14 million, says Dr. Ruth Shaber, president of Tara Health Foundation. That figure “includes the training, any type of new equipment that’s necessary, and training in the processes, billing for the procedure, and making sure that the clinics are really prepared to implement the procedure and to offer the care well,” she says.

Campus health clinics currently provide reproductive health care like testing for sexually transmitted diseases and contraceptives. The risk of complications from medication abortion is low. A University of California, San Francisco study of more than 50,000 abortions provided between 2009 and 2010 found that 0.31 percent of medicated abortions resulted in major complications.

Still, the transition to providing the abortion procedure at campus health clinics may give some people pause. “You can say, well, look at the percentages, but if they’re happening to you, it’s not a fun thing in medicine for you and your patient,” says Dr. Richard Boucher, who directs student Health Services at California State University Fullerton.

Boucher also cited the issue of whether individual providers would feel comfortable administering the procedure, an issue that is in the spotlight now. On Jan. 18, the federal Department of Health and Human Services announced the creation of a Conscience and Religious Freedom Division that would offer protection to medical providers who refuse to participate in certain services, like abortion, on religious or moral grounds.

Even if the California Senate votes in favor of the bill, it has a ways to go before becoming law. The legislation would have to be passed by the state Assembly and be signed by the governor.

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Oregon is in a battle royal over how to pay for expanded Medicaid.

The fight revolves around Measure 101, a ballot initiative that you have to go back a few years to understand.

During the 1990s, Oregon’s then-governor, Dr. John Kitzhaber, had a background in health care — he’d worked as an emergency room doctor. His legacy in the state includes the expansion of health insurance for the poor, an idea he managed to sell to both Democrats and Republicans.

So when President Barak Obama proposed expanding Medicaid under the Affordable Care Act, Oregon lawmakers on both sides of the aisle embraced it. As a result, some 95 percent of Oregonians now have health insurance. That’s among the highest rates in the nation.

But now the federal government is trimming its contribution to Medicaid. And legislatures all around the U.S. are scrambling to find money to replace those federal payments.

In Oregon last summer, Democrats joined with Republicans, hospital owners and health insurance CEOs to come up with a tax package that would fund the Medicaid expansion. And hospitals and insurance companies agreed to the plan, though they are on the hook for many of the included taxes.

Here’s where the wrinkle comes: Under state law in Oregon, voters can use the initiative process to collect signatures and force a public vote on any new tax. And that’s what state Rep. Julie Parrish did.

Parrish and others managed to get “Measure 101” on Oregon’s Tuesday ballot — putting part of the Medicaid tax package passed last summer into the hands of voters. If it succeeds not much will happen — the tax package will continue to fund Medicaid expansion. But if it fails, Oregon’s legislature will have to go back to the drawing board and come up with a new way to pay for the health care of its poorest residents and others who rely on Medicaid.

Parrish is a Republican state legislator whose family was on Medicaid when she was a child.

But she doesn’t like the tax package.

“This is about a fundamental disagreement that taxing other people’s insurance is the way to fund Medicaid,” she says. Parrish says the funding package Oregon came up with is inequitable because it doesn’t apply to big corporations and unions. Instead, she says, it hurts the little guy — people who couldn’t afford to hire lobbyists.

“Small businesses — Mom and Pop businesses,” she says, ticking off the groups she thinks would unfairly bear the tax burden under the state’s plan. “Individuals who have to buy their own [health insurance].”

Parrish thinks Medicaid would be better-funded in Oregon with something like a cigarette tax increase — although it’s not clear that would generate enough money or garner enough votes to pass.

Cedric Hayden is a Republican representative from Falls Creek, Ore. He’s a dentist who accepts Medicaid patients and runs a charitable health clinic in Lane County. He’s also a member of Parrish’s Stop Healthcare Taxes committee — the group that collected enough signatures to put Measure 101 on the ballot.

Hayden says if he and other members of his committee had been against funding Medicaid altogether, they could have insisted the legislature’s entire funding plan be put up for a public vote.

“We did not,” he points out.

Instead, if approved, Measure 101 would ratify the Medicaid expansion in Oregon that the state legislature approved last summer. But if Measure 101 fails, a part of that tax package will be eliminated. A no-vote would eliminate the .7 percent increase to an existing tax on hospitals that the state legislature wants. And it would also stop a 1.5 percent tax on health insurance contracts.

It’s unclear how the passage of Measure 101 would affect consumers. That’s because, on the one hand, any new taxes would likely be passed on to consumers. But on the other hand, Measure 101 funds a program that saves consumers of health care $300 a year.

Some Republicans in the state want a ‘no’ vote. They don’t like the new tax and they don’t trust the Oregon Health Authority with the money. They say the OHA wasted millions of dollars on things like Medicaid overpayments and CoverOregon — the webpage that sells Obamacare insurance.

On the ‘yes’ side are all kinds of advocacy groups and the vast majority of Oregon’s health organizations. They say 48 other states have some form of this tax package to pay for Medicaid.

“The alternative of lack of coverage — we’re talking kids, seniors, people with disabilities — is unacceptable,” says Andy Van Pelt, the executive director of the Oregon Association of Hospitals and Health Systems.

He says it’s cheaper to treat people with health insurance, than to treat them without insurance, when they turn up sick in emergency rooms anyway.

“There’s a real possibility that people could lose their coverage. It will just destabilize the Medicaid program for hundreds of thousands of people and that would be utter chaos,” Van Pelt says.

While the Donald Trump administration hasn’t managed to repeal the Affordable Care Act, it has taken several steps to dismantle it. For example, Americans are no longer legally required to buy health insurance.

The effect of Measure 101 on Oregon’s Medicaid expansion remains to be seen. If it fails, state lawmakers will spend the next couple of months searching for new ways to pay for Medicaid expansion.

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Tucked into the new tax law is a provision that offers companies a tax credit if they provide paid family and medical leave for their lower-wage workers.

Many people support a national strategy for paid parental and family leave, especially for workers who are not in management and are less likely to get that benefit on the job. But consultants, scholars and consumer advocates alike say the new tax credit probably won’t encourage many companies to take the plunge.

The tax credit, proposed by Sen. Deb Fischer, R-Neb., is available to companies that offer at least two weeks of paid family or medical leave annually to workers; but two key criteria must be met. The workers must earn less than $72,000 a year and the leave must cover at least 50 percent of their wages.

If the company contributes at the half-wage level, it will receive a tax credit equal to 12.5 percent of the amount it pays to the worker. The tax credit will increase on a sliding scale if the company pays more than 50 percent of wages. It could go up to a maximum credit of 25 percent of the amount the employer paid for up to 12 weeks of leave.

Payments to full- and part-time workers taking family leave who’ve been employed for at least a year would be eligible for the employer’s tax break. But the program, which is designed to test whether this approach works well, is set to last just two years — ending after 2019.

Aparna Mathur, a resident scholar in economic policy studies at the American Enterprise Institute, says the new tax credit sidesteps a common pitfall in the eyes of many Republicans by not requiring employers to provide paid leave. The tax credit also is appropriately aimed at lower-wage workers — who are the ones least likely to have access to paid leave, says Mathur, who co-authored a recent report on paid family leave.

Still, she says, the provision is not a big enticement to companies.

“Providing this benefit is a huge cost for employers,” Mathur says. “It’s unlikely that any new companies will jump on board just because they have a 12.5 to 25 percent offset.”

That view is shared by Vicki Shabo, vice president for workplace policies and strategies at the National Partnership for Women & Families, an advocacy group. Shabo says the provision will primarily benefit workers at companies already offering paid family leave. The new tax credit “just perpetuates the boss lottery,” she says.

Heather Whaling says her 22-person public relations company, Geben Communication in Columbus, Ohio, probably qualifies for the new tax credit. But she doesn’t think it’s the right approach.

Whaling, who is president of the PR firm, says Geben already provides up to 10 weeks of paid leave at full pay for new parents. So far, four employees have taken leave; by divvying up their work to other team members and hiring freelance help, the firm has been able to get by.

“It is an expense,” Whaling says, “but if you plan and budget carefully it’s not cost-prohibitive.”

The tax credit isn’t big enough, she says, to be a strong incentive. Besides, “having access to paid family leave shouldn’t be luck of the draw — it should be available to every employee in the country.”

Still, the tax credit may be appealing to companies that have already been leaning toward adding a paid family and medical leave benefit, says Rich Fuerstenberg, a senior partner at Mercer, a benefits consulting firm.

By defraying some of the cost, the tax credit might help “tip them over” into offering paid leave, he says. But “I’m not even sure I’d call it the icing on the cake,” Fuerstenberg says. “It’s like the cherry on the icing.”

Only 15 percent of private-sector and state and local government workers had access to paid family and medical leave in 2017, according to the Bureau of Labor Statistics’ National Compensation Survey. Eighty-eight percent, however, had access to unpaid leave.

Generally, under the federal Family and Medical Leave Act, employers with 50 or more workers must allow eligible employees to take unpaid leave for up to 12 weeks annually, for specified reasons.

These reasons include the birth or adoption of a child, caring for your own or a family member’s serious health condition, or leave for military caregiving or deployment. An individual’s job is protected during such leaves.

Erik Rettig, an expert on family leave policies at the Small Business Majority, which advocates for those firms on national policy, says a tax credit, claimed at the end of the year, is unlikely to encourage small businesses to offer paid family and medical leave.

“It isn’t going to help the family business that has to absorb the costs of this employee while they’re gone,” Rettig says.

A better solution, according to Shabo and others, would be to provide a paid family leave benefit that’s funded by employer and/or employee payroll contributions. Sen. Kirsten Gillibrand, D-N.Y., and Rep. Rosa DeLauro, D-Conn., last year reintroduced such legislation. Their bill would guarantee workers, including those who are self-employed, up to 12 weeks of family and medical leave with as much as two-thirds of their pay.

A handful of mostly Democratic states — including California, New Jersey, Rhode Island and New York — have similar laws in place, and a program in the District of Columbia and Washington state will begin in 2020.

“We know from states that this approach works for both employees and their bosses,” Shabo says.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter @mandrews110.

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As a presidential candidate, Donald Trump promised abortion opponents four specific actions to “advance the rights of unborn children and their mothers.”

One year into his presidency, three of those items remain undone. Nevertheless, opponents of abortion have made significant progress in changing the direction of federal and state policies.

Indeed, on Friday, as anti-abortion protesters gathered in Washington for the 45th annual March for Life, the Trump administration announced two new policies. One is a letter to states aimed at making it easier for them to exclude Planned Parenthood facilities from their Medicaid programs; the other is a proposed regulation to allow health care providers to refuse to perform services that conflict with their “religious or moral beliefs.”

“In my administration, we will always defend the very first right in the Declaration of Independence, and that is the right to life,” President Trump said in a video address from the Rose Garden to the marchers.

Marjorie Dannenfelser, president of the anti-abortion group the Susan B. Anthony List, led the Trump campaign’s Pro-Life Coalition. The then-candidate said he was committed to “nominating pro-life justices to the U.S. Supreme Court,” which happened with the nomination and confirmation of Justice Neil Gorsuch in April.

Despite many attempts, Congress did not pass a federal ban on abortions occurring after 20 weeks, didn’t cut off Planned Parenthood’s federal funding and didn’t write into permanent law the Hyde Amendment, which bans most federal abortion funding but needs annual renewal.

Still, there was progress on scaling back abortion and, in some cases, access to contraception at the federal level.

The administration made myriad changes. It reinstituted and expanded the “Mexico City” policy, which forbids funding of international aid programs that “perform or promote” abortion. It issued rules aimed at allowing religious-affiliated and other employers to not offer contraceptive services if they have a “religious belief” or “moral conviction” against them, although federal courts have blocked the new rules from being implemented. And just last week the administration created a new “conscience and religious freedom” division in the Department of Health and Human Services’ Office of Civil Rights. That new division is designed to enforce both existing laws protecting the rights of conscience for medical personnel as well as the new regulations.

Most important, according to many in the anti-abortion movement, the president nominated and the Senate confirmed a dozen and a half federal district court and appeals court judges who are considered likely to rule in their favor.

Abortion rights supporters concede that while the priorities on their opponents’ wish list weren’t accomplished, plenty still happened.

“This administration is the worst we’ve ever seen for women and families,” says Kaylie Hanson Long of NARAL Pro-Choice America in a statement. “Its attacks on reproductive freedom are relentless, under the radar, and aren’t supported by the majority of Americans who believe abortion should remain legal.”

Dannenfelser says one of the biggest changes is the number of anti-abortion advocates now working in the Department of Health and Human Services in key roles. “I can say there is more unity in this administration than there has been in any presidency on this,” she says.

Abortion opponents know their biggest obstacle is the Senate, where they don’t have the 60 votes required for most legislation. “Without making advances in the Senate, it’s going to be really tough,” says Dannenfelser.

Meanwhile, outside Washington, states continued their efforts to restrict access to abortion and family planning. States have passed 401 separate measures since Republicans took over most state legislatures in 2011, according to the Guttmacher Institute, a reproductive rights research and advocacy group.

During 2017, 19 states enacted 63 separate restrictions, says Elizabeth Nash, who tracks state legislation for Guttmacher. Among the notable laws was one in Ohio to outlaw abortions of fetuses diagnosed with Down syndrome. Arkansas and Texas passed laws to ban “dilation and evacuation” abortions, a procedure that uses suction and medical instruments to remove the fetus and is the most common procedure for abortion after the first trimester of pregnancy. Both bans have been blocked by federal courts.

Some of the new restrictions came from states that haven’t been active on the issue in recent years. A Wyoming law requiring ultrasounds to be offered to pregnant women seeking an abortion was that state’s first in 30 years, Nash says.

But 2017 was also notable for states seeking to widen or ensure access to abortion and other reproductive services. For example, Delaware passed a law enshrining abortion rights, while Oregon and New York require private health plans to cover abortion without patients’ cost sharing. Legislators in California, which has a long history of protecting abortion rights, have been pushing a bill that would require public universities to provide abortion pills to female students who are less than 10 weeks pregnant. The bill stalled last year, but it is being picked up again this year.

As a result, says Nash, “we are really living in a bifurcated country. The states that are progressive are looking to protect access” to abortion and contraception. “The states that are conservative are looking to restrict it.”

In other words, a nation that looks a lot like it did 45 years ago, when the Supreme Court legalized abortion nationwide in Roe v. Wade.

Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. California Healthline reporter Ana B. Ibarra contributed to this story.

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Please stories from WBUR’s “This Moment In Cancer” series