Vape shops will be allowed to continue selling all tobacco- and menthol-flavored e-cigarette items as well as all flavors for bulkier tank-based vaping systems. The policy decision has been presented as a compromise for those concerned with soaring teen e-cigarette use and those who support the sale of vaping products to adults, many of whom may turn to e-cigarettes as a way to quit smoking. “By prioritizing enforcement against the products that are most widely used by children, our action today seeks to strike the right public health balance by maintaining e-cigarettes as a potential off-ramp for adults using combustible tobacco while ensuring these products don’t provide an on-ramp to nicotine addiction for our youth,” said Secretary of Health and Human Services Alex Azar in a press release. The FDA has given businesses 30 days to cease the manufacture, distribution, and sale of unauthorized products before they begin enforcement.
A Promising Start, But More to Be Done
Patricia Folan, RN, the director of the Northwell Health Center for Tobacco Control in Great Neck, New York, views the new restrictions as a promising start in the right direction but stresses that more needs to be done. “The new regulations have the potential to curb some initiation and continued use by youth, but without the ban on menthol flavoring, I do not think it will have the impact it could or might have,” she says. This partial ban on e-cigarette cartridges (or pods) has been viewed by some as a concession to the vaping industry, which has lobbied intensively against restrictions. An article published January 2, 2020, in The New York Times reported that tobacco and vaping businesses have spent more than $20 million on lobbying efforts in the first three quarters of 2019.
A Health Crisis for America’s Youth
Although tobacco use by adolescents has declined substantially in the last 40 years (according to the U.S. Department of Health and Human Services), the 2019 National Youth Tobacco Survey on e-cigarette use, published in November 2019 in the Journal of the American Medical Association, showed that more than five million U.S. middle- and high school students are current e-cigarette users (having used within the last 30 days) — with a majority reporting cartridge-based products as their usual brand. Those numbers add up to 27.5 percent of high school students and 10.5 percent of middle school students. A separate Monitoring the Future study from the National Institute on Drug Abuse of more than 42,000 middle- and high school students indicates that cigarettes that tasted of mint and fruit were much more popular than tobacco or menthol flavored e-cigarettes.
Illness, Deaths Raised Alarm Over Safety
Many have turned to vaping because it has been sold as a safer alternative to standard combustible cigarettes. Because e-cigarettes have only been on the market for just over a decade, their long-term health risks are relatively unknown. Recent research (such as studies published in August 2019 in American Journal of Medicine and in October 2019 in BMC Pulmonary Medicine) suggests that these products may have a serious impact on cardiovascular and respiratory health. A recent rash of vaping-related lung illnesses and deaths has raised health concerns even further. In an interview with Everyday Health, Enid Neptune, MD, an associate professor of medicine at Johns Hopkins Medicine in Baltmore, pointed out the irony that many e-cigarette users may now be going back to traditional tobacco smoking because they view that as less dangerous. “Some young people are thinking cigarettes may be safer than vaping now, and that’s not a message we want to promote,” says Dr. Neptune, who specializes in chronic obstructive pulmonary disease (COPD) and has a history in advocacy for tobacco control. Folan adds that for the initiative to be successful, treatment to address withdrawal is needed because teens are reporting high levels of addiction with these products. “If teens do not find help to stop, they may continue with the menthol-flavored cartridge-type e-cigarettes or transition to the tank-based vaping devices, which provide customized flavors and varying levels of nicotine,” says Folan.
Cartridges vs. Tank-Based Systems
The FDA is specifically targeting cartridge-based products because they have been especially appealing to teens, who find them “both easy to use and easily concealable,” according to Stephen M. Hahn, MD, the FDA commissioner. In general, cartridge-based vaping devices can look more like regular cigarettes or USB flash drives, notes the CDC, making them harder to detect for parents and school administrators. With these devices, a battery heats e-liquid in a prefilled cartridge and creates a vapor. The new FDA ban does not affect tank systems. Because they are larger than cartridge-based devices, these products are more difficult to conceal but they hold more e-liquid and output more vapor. They are less convenient than cartridge devices because they require users to refill the tanks themselves. This provides flexibility, however, for vapers who want to vary their nicotine strengths and their flavors. Folan and other health experts hope this new policy will clear the path for a wider ban in the future. “The vaping epidemic has the potential to reverse the amazing work that has been done to reduce adult and youth smoking in this country, and stricter regulations are needed,” she says.
