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Optimism among public health advocates regarding the Trump administration’s pending action on flavored e-cigarettes, which have put millions of our kids at risk of nicotine addiction and worse, has turned to alarm.

President Donald Trump and first lady Melania Trump echoed the concerns of millions of parents in September when they first addressed the skyrocketing rise of e-cigarette use among youths. At the time, Health and Human Services Secretary Alex Azar said the administration intends to “clear the market” of all flavored e-cigarettes to address the skyrocketing rates of e-cigarette use by youths and adolescents.

Since then, administration officials have made several statements that raise questions about how far the policy will go. The media have reported that the policy may leave menthol-flavored e-cigarettes on the market and continue to allow vape shops to sell potentially any type of flavored product. Last week, the president tweeted about meeting with the e-cigarette industry to devise an “acceptable solution” to the vaping “dilemma.”

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I am writing on behalf of six organizations that have been working for decades to prevent kids from using tobacco: the American Heart Association, American Academy of Pediatrics, Truth Initiative, Campaign for Tobacco-Free Kids, American Cancer Society/American Cancer Society Cancer Action Network, and American Lung Association. We commend the president and the first lady for bringing needed attention to a crisis that threatens to addict a new generation to nicotine. But we are deeply troubled by signals that the administration will fall well short of taking the bold action necessary to end this nationwide epidemic.

The administration must include all flavors — including menthol — and all places where e-cigarettes are sold — including brick-and-mortar and online retail outlets — for the policy to have its desired impact.

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Allowing the e-cigarette industry to continue targeting America’s children would be a historic mistake. There is no public health justification to allow any flavor to be exempt from a policy to remove flavored e-cigarettes from the market. In fact, evidence is clear that youths will turn to any e-cigarette flavor that is left. The 2019 National Youth Tobacco Survey shows that youth use of mint and menthol e-cigarettes soared between 2018 and 2019, following Juul’s move to restrict the availability of flavors except mint and menthol in stores. Decades of experience have demonstrated that menthol appeals to kids — in fact, more than half of current youth smokers use menthol cigarettes.

Exempting vape shops also would raise major concerns. A study published earlier this year in JAMA Pediatrics showed that tobacco and vape shops in California had a significantly poorer record of checking IDs and preventing underage sales compared to other retailers. The Food and Drug Administration itself has acknowledged that more youth e-cigarette users report obtaining e-cigarettes from vape shops than from gas stations or convenience stores. If vape shops are permitted to continue selling flavored e-cigarettes, evidence shows kids will continue purchasing them.

Decisive action is needed as more than 1 in 4 high school students report using e-cigarettes, and e-cigarette use among 8th, 10th, and 12th graders has more than doubled in the past two years. This is a direct result of the tobacco industry’s reprehensible targeting of kids with million-dollar marketing campaigns using social media and other youth-oriented platforms. The industry, which spent decades successfully hooking millions of kids onto combustible tobacco products, has resorted to the same playbook in luring many of today’s youth to e-cigarettes.

Flavors are central to the industry’s strategy. With more than 15,000 flavors currently available — from mango and mint to cotton candy and gummy bear — it’s little wonder that 97% of current youth e-cigarette users report using a flavored product. If flavors are the bait that attracts kids to e-cigarettes, nicotine is the hook. Some of the most popular e-cigarettes contain extraordinarily high levels of nicotine — as much a pack of cigarettes. As a result, some school administrators are hiring addiction counselors to contend with skyrocketing rates of nicotine use.

Despite the health risks posed by e-cigarettes, industry leader Juul marketed its products to high school students as “totally safe,” according to students’ testimony before the House Oversight and Reform Committee in July. This was disturbing news to concerned parents, many of whom have been shocked to find that what they thought was their child’s pen, flash drive, or eyeliner was actually an e-cigarette.

The stark reality is that e-cigarette companies such as Juul, which is partially owned by the manufacturer of Marlboro cigarettes and is now led by a former Altria executive, have done real harm to a generation of children. It’s no surprise the industry has been working to defeat the administration’s effort to restrict flavors or weaken it with unproven exemptions.

We call on the Trump administration to dismiss the industry’s misinformation and instead stand with an overwhelming majority of the public that supports protecting kids from a patently addictive and harmful product. That means removing all flavored e-cigarettes, including mint and menthol, from the market.

*Nancy Brown is the CEO of the American Heart Association. Mark Del Monte is the CEO of the American Academy of Pediatrics. Robin Koval is the CEO of the Truth Initiative. Matthew Myers is president of the Campaign for Tobacco-Free Kids. Gary Reedy is the CEO of the American Cancer Society/American Cancer Society Cancer Action Network. Harold Wimmer is the CEO of the American Lung Association.

  • The real problem to address is when people smoke real tobacco cigarettes and vape together. it’s going to cause Severe coughing and lung issues. People need to understand when you switch to vaping , put the tobacco to rest. You will cough in the beginning when you get all that build up out of your system, then you’ll feel better.
    Vaping is easier

  • As a former “real” cigarette smoker for 30 yrs ,I’m here to tell you to leave the flavors alone!! I switched to vaping almost 4yrs ago and feel the effects are positive. I hate any tobacco flavored Vape but give me something fruity and I’m good. I was having chest pains, arm pains and wheezing very badly when I smoked . Now that I’m vaping most of that has stopped. I can honestly say switching to vaping saved my life. And My clothes don’t smell, my breath doesn’t stink, ( well not from smoking anyway!) and I breath so much better. I haven’t had severe chest pain since I quit. So put labels on it all , treat vape liquid the same a tobacco. The problem is not the accessibility of the product but the parents ability to teach their children the guidelines, just like anything else.
    Kids are going to rebel, the more lawmakers advertise and push that it’s bad. It’s up to lawmakers to set the guidelines the same as those on cigarettes,it’s up to parents to teach their children responsibility and moderation with every single thing.
    Please don’t criticize vaping just cause it’s new. It saved my life And I’m sure there are many others that feel the same.

  • This proposed ban is about the stupidest reaction by legislators overreacting to placate the idiots who make public health claims based on six deaths that had nothing to do with general vape products. Rather than enforce the laws that are already in existence, let’s just create more laws based on prohibition and general societal ignorance. In the meantime, we’ll punish the millions of people who have found smoking alternatives many, many times safer than their previous habit. All of this because because several idiotic politicians needed to say that they “took action” to respond to the “crisis”. What an absolutely fascist and ignorant response to a problem that already has plenty of laws that aren’t designed to punish the millions of users who are entitled to use these products without this type of governmental interference. Just an absolutely idiotic response.

  • I smoked cigarettes for over 40 years and tried everything to stop but couldn’t until e cigarettes. I have tried numerous e cigarettes and found that the Juul mint was the one that worked well enough to keep me from smoking cigarettes at all. I have not touched a cigarette for almost 2 years now and I find it ridiculous that I as well as my adult children and nephew and many of my friends will not be able to buy a product that has improved my health because of teens using them. Teens are going to do what they want to do regardless. They drink alcohol, smoke pot, steal their parents xanax and text and drive. More people are killed by guns and alcohol but they aren’t illegal. I feel much better since I quit smoking cigarettes than I have in years, I rarely cough or get a cold.
    Banning e cigarettes in flavors will not stop teens from using black market vape products that there is no way of knowing what is in them. Is there going to be a ban on menthol flavored cigarettes and flavored vodkas since they seem to be pretty popular among teens to.

  • Of course flavors are strategic to the vape industry! If there are no flavors then there is NO VAPE INDUSTRY!… PERIOD! The industry flourishes on providing adult smokers with a large array of appetizing flavors which is crucial in helping smokers switch to vaping. Vapers don’t want only Tobacco and Menthol flavors because NO ONE likes those flavors for the plain and simple fact ex smokers don’t want to taste anything resembling the smoking habit they gave up. All these so called “Health Orgs” are only against vaping because they are afraid it may wipe away combustible cigarettes which would hit them hard financially not to mention if no one smoked anymore than these organizations would become irrelevant and would have no need to exist anymore and they know if they pressure the government for a flavor ban then if the government does enforce a flavor ban then it easily destroys the entire vape industry and they can make up more lies when smoking rates in the US surge by even blaming that on a devastated and dead vape industry. They are all liars and crooks that could care less about public health and only care about one thing and that is…. THEIR MONEY!

    • “If there was a product that addicted millions but killed no one I would be on board with that”
      Mathew Myers- President of The Campaign For Tobacco Free Kids
      Wow when money is at stake anyone will turn to a 2 faced liar even if the blood of hundreds of thousands of Smokers is on his hand.

  • this is the most absurd thing ever. it doesn’t matter if it tastes like strawberry or dirty feet, it is not about the flavor. I was 12 when I started smoking cigarettes and there was no flavored cigs. did not do it for the flavor. I did it for the nicotine. Alcohol does not taste good, yet millions of underage drinkers. Methamphetamine tastes like crap, yet people do it, same with heroin.
    why is no one asking the one question that needs to be asked, and when it is asked, garbage answers like this one is given.
    Why are underage kids seeking out nicotine? Common answers like flavors are given. again, this is a garbage answer and a made up reason; a smoke screen for approval on government over-reach. The reason kids seek out nicotine is because we train them to be from the time they are old enough to eat a french fry. Or tomatoes or any other vegetable in the Nightshade family.
    They contain nicotine. why do you think babies like french fries so much? they contain nicotine.
    Natures way of getting people to eat vegetables.
    It is not complicated. nicotine in small doses is good for the digestive track. It is used in some cases medically .
    If you want to keep nicotine out of underage kids hands, try holding parents (all adults) accountable for their kids actions. almost all underage people getting cigs or vapes get them from someone of age. hold those people accountable.
    Again, not difficult.
    Punishing all people for others mistakes is not an America I am proud to be part of.

  • If the concern is that flavored e-liquid used in vaping is enticing teenagers to start vaping then what about all the flavored alcohol, like Vodka??? Maybe get started on the battle of our enormous opioid epidemic which is taking lives right now as I’m commenting!!! But no hurry getting that under control because it’s not affecting your bank accounts!! Money has become the root of all evil; crooked politicians, government, Big Pharma & tobacco to just name a few but loss of human life on the daily is no concern to you as long as you’re not losing that mighty dollar bill!! May God have mercy on your souls!!!

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