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.

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.

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  • YOU know you’re working for the devil to kill millions of innocent people that you need to be able to treat as second class victims. You know vaping has allowed MILLIONS of tobacco users to QUIT. You try to say that the minute I turned 18 – I stopped liking flavors – because parents can’t be held to task to PARENT their children? What about THIS fact: there is NO honest scientific evidence that vaping is harmful. After what, 15 years of spinning your LACK OF EVIDENCE into obvious lies in your battle against us? We can plainly see – you STILL have no evidence, not even manufactured lie ‘evidence’. NONE. AT ALL. Against the evidence of millions of EX-cigarette smokers – vaping has done NO HARM. TO ANYONE. UNDER ANY CIRCUMSTANCES. EVER. EVEN CHILDREN. EVEN if the vaping e-juice DOES contain nicotine! THAT’S RIGHT! Go ahead! TRY to claim that nicotine is harmful! Go on! I’m all ears! (Jeopardy music plays)…NO! It actually has MANY PROVEN benefits! You can only try to demonize nicotine for being addictive. We don’t want our children that we don’t want to have to PARENT getting addicted to something that harms NO ONE. NO! We’d rather over-reach (because entitlement to abuse those second-class types) and abuse our positions of presumed authority to LIE if need be – to put all our victims BACK ON TOBACCO?!! Oh, and THAT’S another thing. Stop with the lie of trying to associate vegetable glycerin or propylene glycol as a tobacco product. Stop using the word “Smoking” in reference to vaping – there’s no combustion…and you KNOW it. And my vape coil is made of WIRE. That wire does NOT contain nicotine. Why does it say on its box that it does? We are the ones with the power. We know what’s right and wrong. When you abuse your presumed power and over-reach and lie in an effort to harm us: we will dispose of YOU. Remember: that’s how Trump got elected. We rebuke that which we find distasteful and backwards and we strike back BIG. If you feel the need to be such a busy-body: I hear Burger King is hiring.

  • Yeah keep spreading your propaganda and lies we all know you are pushing against flavored vapes so hard because you are all losing money from decreased combustible cigarette sales. Teens don’t care about flavors they are attracted to the buzz they get from high nic salt content in devices like Juul. And you are bald face lying about vape shops being worse than convenience stores at requiring ID Scott Gottlieb himself said convenience and chain stores were the worst offenders. You guys don’t seem to care less about the black market that will take over if flavors are banned do you? This black market, as already seen with illegal THC carts, will be way more dangerous to teens then the legal flavored vapes on the market ever would. But as long as combustible cigarettes sales increase you will be happy cuz that’s all you really care about. #stoplying

  • Would you rather kids start smoking cigarettes instead? I started smoking at 13 and now was only able to quit using e cigs. No matter what is out there, the 13 yr olds will get ahold of but which is worse? The tar and formaldehyde that I was putting into my 13 yr old lungs was not good either! I think more research needs to be done before you force kids to get hooked on cigarettes because you take vaping flavors away from them and everyone trying to quit! If i didnt have cola flavored e cigs, i would still be smoking Marlboro! So think before you work for the tobacco companies! Because in truth, this is only helping them get kids hooked on Marlboro and camels again instead of the not as unhealthy e cigs and vapes! Dont work for the tobacco companies!!! Please!

  • You state all the organizations have fought for decades to prevent kids from using tobacco products.This tells me you all have failed for if you had been successful there would be no epidemic.Now you want to throw this problem into politicians laps.Oh and while you are at it please ask them to stop the sales of heroin,cocaine,pot,opium, meth and whatever else they use to get high which should be easy because the sellers don’t have stores and don’t sell online.

  • Truth!! Don’t forget to blame everyone else too. Anyone who is benefitting from Juul will likely lose it as apparently the government is now responsible for raising everyone’s kids.

  • Stop with this fearmongering and look at facts for starters almost all of this vaping illness “epidemic” is caused by black market thc oils. With that being said put a ban on flavored e liquid, it will create a black market for said flavored e liquid it’s not hard to make and there will be no regulations on it and probably will cause more problems

  • It’s strange- these days people in the US will crawl over each other to congratulate you for growing or smoking cannabis, yet want to burn tobacco users and producers at the stake. Kind of an inversion of the last generation’s mores.

  • I don’t smoke (never have, never will) but I see merits in e-cigs and vapes for one reason: to aide in smoking and nicotine addiction cessation. Totally abolishing vapes defeats that original goal. What is needed is crystal-clear legal regulation for vape-content (limits) and against any selling to minors, with brutally harsh consequences for those who tamper with this. And …. NO MORE TOBACCO LOBBYING MONEYS !!!!!!! Politicians need to clean up too !

    • The problem with opposing the tobacco lobby is that no one opposes lobbying AGAINST tobacco. The companies need to be able to defend themselves from the onslaught of political busybodies who expect society to control their children.

  • The unfounded moral panic over vaping on this site is unbelievable. First of all, there are no demonstrated health hazards from vaping. Secondly, vaping helps many people quit smoking cigarettes and is a (probably) innocuous pleasure and stimulant for others. Lastly, this obsession with flavor is ludicrous.

    High schoolers drink Old English out of bottles duct-taped to their fists, swill Burnett’s vodka and toilet wine mixed with hot dashboard Gatorade, bump Ritalin ground up with what they were informed is probably Xanax, snort coke cut with veterinary dental anesthetic and laxative, pound bottles of liver-melting cough syrup, eat fistful after sandy fistful of hallucinogenic nutmeg, sniff glue, huff whipped cream propellant, and smoke moldy brick weed covered in pocket lint, Febreze, and a stale grape Dutch that looks like (and may comprise) a Band-Aid.

    Does that sound like amuse bouche to you? A quest to sate palatal yearnings for the subtle intermingling of flavor and aroma? Are they taking up vaping to get more of that sweet, artisanal Juul savor?

    • Amen! Not only that, but add in their opioid use which has put true patients in real danger of being severely reduced or taken off completely.

      This may come as a surprise but WHAT ABOUT the PARENTS?? Aren’t they ultimately responsible for their own kids? It’s not everyone else’s fault that your kid is making bad choices. I had strict parents and they didn’t let me do crap without repercussions. There will always be temptation in this world.

      Try talking to your kid. Make some rules. Be a damn parent.

  • Nancy, so good to see this piece. And now what is next? What are you and your other cohorts willing to do to save the lives of our next generation. I am still shocked that this was ever allowed to happen. My mother was a 3 pack a day smoker until she decided to quit on her father’s death anniversary. The first year in cold turkey withdrawal was hard on her and all of us. I was perhaps ten? She told me decades later she stilled dreamed of smoking. She died of lung cancer after not smoking for forty years. This a process that young people should never have to go through never. And so many of the next generation deal with withdrawal in some many ways. You need to do more.

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