Industry easily adapts to FDA’s limited action on e-cig flavors

In response to skyrocketing youth e-cigarette use, driven largely by Juul removable pod flavored e-cigs, in January 2020, FDA said they would “prioritize enforcement” against most flavored pod e-cigs. Not surprisingly, youth and young adults have shifted to menthol and disposable flavored e-cigs that FDA is not prioritizing. Now Shivani Gaiha and her colleagues at Stanford have published a national survey that quantifies the level of youth and young adult migration to these new devices.

Their paper, “E-cigarette devices, brands, and flavors attract youth: Informing FDA’s policies and priorities to close critical gaps” shows that by May 2020 most young people (54%) used disposables that were not covered by the FDA’s enforcement.

They also found that minty/menthol flavors were the most popular among young e-cigarette users of both pod/cartridges and disposable e-cigarettes (pod/cartridge-based: 48% for youth <21 and ≥21; disposables: 52% <21, 56% ≥21). This finding is particularly important because FDA continues to allow menthol to be used in e-cigarettes through its inaction on the issue.

They also found that 25% of current e-cigarette users used add-on flavor enhancers in their pod/cartridge devices, and 31% used flavor enhancers in their disposable devices. These flavor enhancers are attachments which allow people to add flavors to tobacco- or other-flavored products, another way they circumvented FDA flavor restrictions.

As senior author Bonnie Halpern-Felsher said in a Stanford press release (appropriately headlined Whack-a-mole vaping policies do not protect youth, Stanford Medicine study shows), “What we found was exactly what we were afraid of: Some young people were still using flavors and products that were purportedly restricted, and even more were using products that were completely uncontrolled. Unless we regulate all vaping products — and all nontobacco flavors of products, including menthol — young people will simply go to another nicotine-based product.”

This study adds to the evidence that FDA’s efforts to fine tune the e-cig market in a way that protects kids while preserving the products for adults just won’t work. Industry is just too creative and nimble.

It also adds to the case for state and local comprehensive bans on flavored tobacco products.

Here is the abstract from the paper:

Purpose: Identify e-cigarette devices, brands, and flavor types used by adolescents and young adults soon after the enactment of flavor restrictions, youth access laws, FDA’s enforcement prioritization against some flavored pod/cartridge-based e-cigarettes, and during COVID-19 pandemic-related school closures.

Methods: National cross-sectional online survey (N = 4,351) in May 2020 assessed popularity, ever- and past-30-day use of e-cigarette device types (pod/cartridge-based, disposables, others), brands, flavor types and flavor-enhancers, by age group (under age 21 and 21 and over).

Results: While pod/cartridge-based e-cigarettes had the highest ever-use (82.7% <21; 69.8% ≥21) and were most often-used (41.9% <21; 41.4% ≥21), most past 30-day-users (50.8% <21; 61.9% ≥21) and 7-day-users (36.0% <21; 56.7% ≥21) used disposables. Mint/menthol was the most-used flavor type (pod/cartridge-based: 48.2% <21, 48.1% ≥21; disposables: 51.6% <21, 56.4% ≥21), followed by fruit (pod/cartridge-based: 37.4% <21, 35.5%≥ 21; disposables: 51.6% >21, 46.2% ≥ 21), and sweet/dessert/candy flavor types (pod/cartridge-based: 24.4% <21, 24.7% ≥21; disposables: 29.7% <21, 33.8% ≥21). Participants reported using add-on e-cigarette flavor-enhancers (pod/cartridge-based: 24.6%; disposables: 31.3%).

Conclusion: Soon after FDA’s January 2020 announcement of prioritized enforcement against flavored pod/cartridge-based e-cigarettes and during the pandemic lockdown, adolescents’ and young adults’ past 30-day use included mostly flavored disposables rather than pod/cartridge-based e-cigarettes, mint/menthol flavors, and some used add-on flavor enhancers. To reduce youth use, comprehensive regulation of e-cigarette devices and flavors should be enacted and enforced at federal, state, and local levels.

The full citation is: Gaiha SM, Lempert LK, McKelvey K, Halpern-Felsher B. E-cigarette devices, brands, and flavors attract youth: Informing FDA’s policies and priorities to close critical gaps. Addict Behav. 2021 Nov 14;126:107179. doi: 10.1016/j.addbeh.2021.107179. Epub ahead of print. PMID: 34861522. It is available here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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