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.”
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.