As youth e-cigarette use skyrockets, the Food and Drug Administration (FDA) is asking Americans their thoughts about its plans to address this national epidemic. Public health advocates overwhelmingly say the agency needs to act boldly and quickly to protect youth.
Nearly 95 percent of all tobacco users started before age 21. Millions of young people are already using e-cigarettes and decisions made soon will determine whether millions more get addicted to nicotine.
As doctors have now known for decades, smoking tobacco carries significant health risks. Despite a steady decline, smoking is still the leading cause of preventable death in the United States, claiming more than 480,000 lives every year.
Just when we started to see record lows in tobacco use among young people, the 2018 National Youth Tobacco Survey (NYTS) showed that e-cigarette use among high schoolers jumped 78 percent between 2017-2018. According to the Centers for Disease Control and Prevention, the increase in e-cigarette use has “erased recent progress in reducing overall tobacco product use among youths.”
Many misinformed young people think that e-cigarettes contain harmless water vapor with flavoring. However, e-cigs almost always contain nicotine, a highly addictive chemical that can cause health problems, especially for youth.
One JUUL pod, the popular vaping product among young people, contains as much nicotine as a pack of 20 cigarettes. Nicotine exposure in adolescence can alter brain development, impact learning, affect memory and increase potential for mood disorders and addiction to other substances.
These known health impacts justify drastic measures to curb the appeal and access of e-cigarettes to young people. The unknown effects are equally worrisome. There’s limited research about the long-term repercussions of e-cigarette use because it’s a relatively new phenomenon.
Furthermore, the FDA allowed e-cigarettes to remain on the market without going through the agency’s required public health review. The FDA chose not to scrutinize e-cigarettes’ public health risks and potential for youth appeal because it believed the products could help adult smokers trying to quit. However, that judgment call left the door open for tobacco product companies to aggressively market these products to non-smokers, especially kids.
Research indicates that e-cigarette use may be a gateway to smoking combustible cigarettes. A meta-analysis of recent studies shows that young adults who vape are more than 3 times as likely as non-users to start smoking cigarettes. According to the NYTS and the Behavioral Risk Factor Surveillance System, among never smokers, adolescents are approximately 10 times more likely to vape than adults. Pandora’s box opened because the FDA let the fox guard the hen house.
Although the FDA’s efforts to restrict some flavored products and limit their availability are steps forward, they’re not enough. According to a Surgeon General’s report, 81.5 percent of current youth e-cigarette users said they use them because “they come in flavors that I like.”
The FDA is proposing to move its application deadline for reviewing e-cigarettes earlier, to August 2021. But that review could take years, while flavored e-cigarettes will remain on the market. When he was still FDA Commissioner, Scott Gottlieb said that if the next NYTS shows e-cigarette use still rising among young people, then the FDA would consider more drastic regulatory actions. That’s also not good enough. These products should not have bypassed FDA review. Young people need immediate remedies to facilitate a drastic decrease in e-cigarette use now, not a wait-and-see approach.
At this point, almost all parents of adolescents know a child, often their own, who has tried vaping. One-and-a-half million more young people started using e-cigarettes in 2018. Research indicates that flavors attract young people, so the FDA should immediately ban all flavored tobacco products including mint and menthol. The agency should also start the process of taking any product off the market that has not undergone the FDA’s required public health review.
The FDA has the authority to act. It should use that authority now. As we’ve all heard from adults who are addicted to tobacco, their biggest regret is that they ever started using.
Matthew Wellington directs U.S. PIRG’s End the Nicotine Trap Campaign to address the rise in youth e-cigarette use. For more than four years he has directed public health campaigns to implement policy solutions to critical health threats, including antibiotic resistance. Jonathan Winickoff M.D., MPH is a practicing physician at MassGeneral Hospital for Children and Professor of Pediatrics at Harvard Medical School. With over 100 peer-reviewed publications, his research focuses on strategies to address tobacco use and exposure in families and further regulating access to tobacco products.