By Emma Goodson
Medill Reports
The Food and Drug Administration is preparing to move on stricter regulation of e-cigarettes – electronic nicotine delivery systems – if youth usage of these products continues to rise in 2019.
Commissioner Scott Gottlieb voiced the agency’s concerns at a recent public hearing focused on eliminating youth use of electronic cigarettes.
“In recent years, we’ve appeared poised to slay one of the most pernicious public health challenges of our times – the death and disease caused by cigarette smoking,” Gottlieb said at the hearing in Silver Spring, Maryland. “Sadly, this progress is being undercut – even eclipsed – by the recent, dramatic rise in youth vaping.”
E-cigarettes’ popularity among youth eclipsed combustible cigarettes a couple years before the rise of products such as JUUL in 2017, the commissioner added. Though JUUL markets itself as an alternative for adult smokers, the device has been even more popular with teenagers and minors.
E-cigarette use rose 78 percent among high school students and 48 percent among middle school students from 2017 to 2018, according to the FDA’s 2018 National Youth Tobacco Survey. Similar increases occurred among students across Illinois by the University of Illinois Center for Prevention Research and Development’s Illinois Youth Survey.
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“I’ll tell you this. If the youth use continues to rise, and we see significant increases in 2019, on top of the dramatic rise in 2018, the entire category will face an existential threat,” Gottlieb said at the hearing.
Popular flavorings added to products – already the target of FDA crackdowns – added to the wave of vaping.
A 2016 survey, conducted by the Centers for Disease Control and Prevention, found that 31 percent of middle and high school students reported that they use e-cigarettes because of the fruity and candy flavors available. This was the second most common reason, with 39 percent reporting use resulting from exposure to the products by other users such as a family member or friend.
Nicotine “delivery by one of the e-cigarettes, JUUL, is 10 times as efficient as other vaping systems,” said Dr. Bonnie Spring, professor of preventative medicine, psychiatry and behavioral science, and psychology at Northwestern University’s Feinberg School of Medicine. “This means a person can self-administer nicotine very efficiently – getting a full cigarette’s dose of nicotine in just a couple of puffs.”
In November 2018, the FDA announced that it was seeking changes to the agency’s tobacco manufacturing compliance policy that would only allow flavored e-cigarette products – excluding tobacco, mint and menthol flavors or non-flavored products – to be sold “in age-restricted, in-person locations or if sold online, under heightened practices for age verification.”
“Restricting kid-friendly flavors may reduce one of the temptations to start, but probably won’t be sufficient,” Spring said. “Price is a potent barrier for youth, so taxation and increased pricing could help.”
In terms of early prevention, educating teens on the content of these products is the first step, said Dr. Maria Rahmandar, attending physician in the Potocsnak Family Division of Adolescent and Young Adult Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago, adding that some teens think e-cigarettes contain only water vapor or flavoring.
“But once addiction and regular use has taken over, just knowing it is bad isn’t enough to change habits,” Dr. Rahmandar said. “Those who use e-cigarettes have a higher rate of using traditional cigarettes down the road.”
Rahmandar suggests that parents of teenagers have “clear and consistent messages about your values and expectations of substance use in your house,” and that a loving and supportive relationship with children can lower the likeliness of usage.
