FDA Takes New Action to Stop Flavored E-Cigarette Use Among U.S. Youth; Proposes Banning Menthol and Flavored Cigars

November 19, 2018
Estimated percentage of U.S. high school students who currently use E-Cigarettes 2011–2018

Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018. MMWR Morb Mortal Wkly Rep 2018;67:1276–1277. DOI: https://dx.doi.org/10.15585/mmwr.mm6745a5

On November 14, the Food and Drug Administration (FDA) announced new action to ban flavored e-cigarettes at convenience stores. The ban follows the agency’s September announcement of its new Youth Tobacco Prevention Plan to address the alarming rates at which children and young adults are using e-cigs.

The ban would include flavored electronic nicotine delivery systems (ENDS) products, including e-cigarettes, sold at in-person locations and online, other than tobacco, mint, and menthol-flavored products. This would mean that all fruity and sweet flavored e-cigarettes, often targeted at youth, will no longer be available at convenience stores for purchase and, if sold online, would be under new, heightened practices for age verification.

In addition, the FDA also indicated it plans to issue a proposed rule banning menthol cigarettes and flavored cigars, in a statement last week from FDA Commissioner Scott Gottlieb, M.D..

The FDA and the U.S. Centers for Disease Control and Prevention (CDC) also released new findings this week that more than 3.6 million middle and high school students were current (within the past 30-days) e-cigarette users in 2018, a stark rise of an additional 1.5 million students since 2017. The new FDA and CDC statistics from the National Youth Tobacco Survey (NYTS) show that children and youth are also using e-cigarettes more frequently and more often using the flavored products. Overall, the number of high school students who reported being current e-cigarette users increased by 78% since last year and rose 48% among middle school students.

Among high school users, there was a significant increase in the current use of flavored e-cigarettes, from 60.9% to 67.8%--use the new ban is designed to directly curb.

This summer, the FDA announced a series of critical enforcement actions that included issuing more than 1,300 warning letters and fines to retailers who illegally sold JUUL and other e-cigarette products to minors during a nationwide undercover effort of brick-and-mortar and online stores. The agency also sent letters to five e-cigarette manufactures including JUUL asking companies for plans to address the widespread use and access of their products among youth. JUUL responded this week stating that it will stop selling most of its flavored e-cigarette products in 90,000 retail outlets, including convenience stores and vape shops, and said it would halt its social media promotions of the products.

The health effects of ENDS, including e-cigarettes are not yet fully known. A congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine published in January of this year suggests that e-cigarettes are not without biological effects in humans and the consequences on long-term use on morbidity and mortality are not yet clear.

ASCO is committed to policies that will contribute to the reduced prevalence of tobacco use and prevent the occurrence of cancer and other smoking-caused diseases and commends the FDA for its latest actions. In the absences of clear data on ENDS aid to cessation, ASCO recommends the use of proven smoking cessation medications such as nicotine replacement therapies, bupropion, and varenicline. Additionally, behavioral counseling paired with cessation medication has been associated with increased cessation[ii].

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Learn more about the FDA’s latest actions.

[ii] Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008286. DOI: 10.1002/14651858.CD008286.pub3.