November 7, 2019

New research questions whether Trump admin's flavored e-cigarette ban will go far enough

Daily Briefing
     As the Trump administration and federal lawmakers consider a ban on flavored e-cigarettes, research published Tuesday in JAMA shows most adolescents who use e-cigarettes say they prefer to use products with fruit, mint, and menthol flavors.

    Background

    The studies come as FDA works on a plan announced in September to clear the market of unauthorized, non-tobacco-flavored e-cigarettes in response to growing numbers of children using the devices. HHS said the policy would effectively mean that only FDA-approved flavored e-cigarette products would be allowed on the market. It is unclear if the policy would ban sales of mint- and menthol-flavored e-cigarettes, but FDA in September noted a growing number of adolescents are using menthol- or mint-flavored e-cigarettes.

    Adolescents prefer to use flavored e-cigarette products, studies show

    In one study published Tuesday in JAMA, CDC and FDA researchers analyzed data from the 2019 National Youth Tobacco Survey (NYTS) to estimate how frequently U.S. middle and high school students use e-cigarettes and which e-cigarettes they use. The survey, which FDA and CDC conducted from Feb. 15, 2019, to May 24, 2019, included responses from a nationally representative sample of 10,097 high school and 8,837 middle school students.

    Overall, the researchers found an estimated 27.5% of high school students, or 4.1 million, and 10.5% of middle school students, or 1.2 million, reported being current e-cigarette users.

    The researchers wrote, "The popularity of e-cigarettes shaped like USB flash drives and other similar devices likely has contributed to youth uptake. These devices can be used discreetly, may have a high nicotine content, and come in flavors that appeal to youth."

    The researchers found an estimated 59.1% of high school students and 54.1% of middle school students who identified as current e-cigarette users said in the past 30 days they most frequently used e-cigarettes produced by Juul. Nearly 14% of high school students and 17% of middle school students reported not having a go-to e-cigarette brand.

    In addition, the researchers found more than half of middle and high school current e-cigarette users reported exclusively using e-cigarettes. Of those students, the researchers found an estimated 72.2% of high school students and 59.2% of middle school students reported using favored flavored e-cigarettes. The researchers found:

    • 67.7% of middle school and 66.1% of high school students reporting using fruit-flavored e-cigarettes;
    • 57.3% of high school and 31.1% of middle school students reporting menthol- or mint-flavored e-cigarettes; and
    • 38.3% of middle school and 34.9% of high school students reporting using candy-, dessert-, or other sweet-flavored e-cigarettes.

    For a separate study published Tuesday in JAMA, researchers from the University of Southern California-Los Angeles examined data from the federal Monitoring the Future survey to estimate how frequently adolescents used Juul's flavored e-cigarettes. The Monitoring the Future survey—which officials conducted from Feb. 13, 2019, to June 3, 2019—included responses from 42,531 U.S. eighth graders, 10th graders, and 12th graders. The researchers randomly assigned 14,191 of the respondents a module with questions related to Juul, including which Juul flavor they used most often. The researchers focused on the subset of students who received the Juul-related questions.

    Overall, the researchers found 18.8% of the students reported vaping any nicotine product in the past 30 days, and 12.6% reported using Juul products. Specifically, the researchers found:

    • 7% of 8th grade respondents reported using Juul's e-cigarettes;
    • 15% of 10th grade respondents reported using Juul's e-cigarettes; and
    • 16% of 12th grade respondents reported using Juul's e-cigarettes.

    The researchers found the most commonly reported flavor Juul e-cigarette users reported using varied by grade. For example, the researchers found 33.5% of 8th grade Juul e-cigarette users reported using a mango-flavored Juul product, whereas 43.5% of 10th-grade and 47.1% of 12th-grade respondents reported using a mint-flavored Juul product.

    The researchers also found 6% of 12th-grade respondents preferred menthol e-cigarettes, and fewer than 6% of respondents in 8th and 10th grade preferred menthol e-cigarettes. An average of fewer than 2% of respondents across the three grades reported preferring tobacco-flavored e-cigarettes.

    The researchers wrote, "The current findings raise uncertainty whether regulations or sales suspensions that exempt mint flavors are optimal strategies for reducing youth e-cigarette use."

    Reaction

    Matthew Myers, president of the Campaign for Tobacco-Free Kids, said, "These findings underscore why the Trump administration must stand strong and implement its plan to clear the market of all flavored e-cigarettes. If menthol or any other flavors are left on the market, the evidence is clear that kids will move to them and this epidemic will continue" (Owens, "Vitals," Axios, 11/6; Hellmann, The Hill, 11/5; Siddons, Roll Call, 11/5).

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