FDA to crack down on menthol cigarettes, flavored vapes

A man smokes an e-cigarette in New York U.S

A man smokes an e-cigarette in New York U.S

The U.S. Food and Drug Administration on Thursday announced sweeping new restrictions on flavored tobacco products, including electronic cigarettes popular among teenagers in an effort to prevent a new generation of nicotine addicts. Gottlieb emphasized in the statement that e-cigarettes, which contain fewer cancer-causing chemicals than traditional cigarettes and create an aerosol by heating a typically nicotine-packed liquid in a handheld vaporizer, can be a valuable tool for adults looking to quit smoking. In other words, 5.8 percent of high school students, about 845,000 teenagers, could be considered frequent vapers, up from 2.3 percent (346,000) past year.

"From 2017 to 2018, there was a 78 percent increase in current e-cigarette use among high school students and a 48 percent increase among middle school students", he said.

Battery-powered e-cigarettes are more popular among teens than regular smokes and are considered safer.

A large majority of adolescent vapers presumably are using Juul e-cigarettes, which account for more than 70 percent of the market.

"The increase in e-cigarette popularity (among kids) is nearly certainly not a function of flavors". Yes, in the sense that their numbers have risen sharply. Smoking rates among teenagers have continued to decline as e-cigarette use has surged, and that may be more than a coincidence.

Gottlieb worries that "some proportion" of adolescent vapers who "otherwise might never have initiated on tobacco" will "become long-term users of combustible tobacco". Recent research shows that kids and teens may be more likely to smoke cigarettes and use other tobacco products if they pick up vaping. In a world without e-cigarettes, those teenagers might eventually have started smoking anyway.

Gottlieb's proposal for e-cigarette flavorings also exempts menthol.

Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said "it is widely recognized that e-cigarettes are the gateway to smoking tobacco cigarettes for teens and young adults".

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The cigarette smoking rate is even lower among high school students - about 9 percent, according to the latest figures.

Juul's announcement followed reports last week that the FDA was planning to ban most flavored products.

In short, I think Gottlieb is overreacting to a problem that is not almost as dire as he makes it out to be.

"We won't let this pool of kids, a pool of future potential smokers, of future disease and death, to continue to build", he added. "However, every "speed bump" that FDA puts up on the off-ramp for adult smokers is a threat to public health". But leaving aside the ethics of that tradeoff, I can't see how it makes sense from a public health perspective.

Gottlieb acknowledged that he could have taken more aggressive steps, "but I don't want to foreclose opportunities for now addicted adult smokers" to access e-cigarettes as they try to quit regular smokes. He also proposed beefing up measures so that convenience stores and some other retailers don't sell e-cigarettes in kid-friendly flavors like cherry and vanilla.

He also said he hopes e-cigarette companies work to restrict kids from buying their products. If he is trying to minimize morbidity and mortality, Gottlieb must think that remote and speculative public health benefit outweighs the imminent and all but certain public health cost. And the bottom line is this: "I will not allow a generation of children to become addicted to nicotine through e-cigarettes", said Gottlieb. We did extend the compliance dates on the e-cigarettes when I initially came aboard, again, to try to give them time to come in with applications to the agency, to try to demonstrate what they need to demonstrate to remain on the market, because we do - we do recognize that there may be an opportunity for adults using these products.

Total prohibition is the approach the FDA is taking with menthol cigarettes and flavored cigars, which it says are so appealing to teenagers that they can not be tolerated at all, even in age-restricted outlets.

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