Last week the CDC and FDA published the 2023 statistics on youth tobacco use from the National Youth Tobacco Survey (FDA press release). The good news is that high school student overall tobacco use is down significantly compared to 2022 (from 16.5% to 12.6%), driven in large part by a drop in e-cigarette use (from 14.1% to 10.0%), with smaller drops for cigars. At the same time, middle school student tobacco use increased significantly (from 4.5% to 6.6%), with significant increases in multiple product use (from 1.5% to 2.5). E-cigarette use among middle school students also increased (from 3.3% to 4.6%), but this change did not reach statistical significance. These results show that e-cigarettes continue to be the dominant form of youth tobacco use and that we are making some progress in reducing e-cigarette use, at least among older students.
Heavy use continues to be high, with 25.2% reporting they use e-cigarettes daily, about the same as in 2021.
Almost all kids who used tobacco (89.4%) used flavored products. While fruit was the most popular flavor among e-cigarette users (63.4%), mint and menthol (27.8%+20.1%=47.9% combined) ranked second.
2023 was the first year that the CDC and FDA asked about “ice” flavors; they found 57.9% of kids used ice flavors.
These “ice” flavors are created by adding synthetic cooling agents such as WS-3 to the products. WS-3 and similar compounds act by stimulating the cold receptors at the back of the throat without having a distinct aroma (nose) or taste (tongue). Cold and heat sensations are one of the three elements of “flavor;” the other two arise from elements are aroma (nose) and taste (tongue).
The tobacco companies are trying to use these cooling agents to get around bans on the sale of flavored tobacco products. A paper published recently in JAMA measured the presence and effects of the cooling agent WS-3 in several tobacco companies’ “non-menthol” cigarettes being sold in California and Massachusetts and found that the effects they have on cold receptor cells is similar to the same companies “menthol” cigarettes that used to be sold in California and Massachusetts. They found that, these synthetic cooling agents “can mimic menthol’s actions, making tobacco products more appealing and less irritating.”
The results of these two papers underscores the importance of including these synthetic cooling agents in the pending FDA product standards eliminating menthol (and state and local laws prohibiting the sales of flavored tobacco products) in cigarettes and cigars.
Fortunately, FDA laid the foundation for including these synthetic cooling agents in its proposed product standards on menthol in cigarettes and cigars. Specifically, although it does not explicitly define the term, “characterizing flavor” in its proposed product standard to prohibit menthol as a characterizing flavor in cigarettes, FDA stated that “among the factors that FDA believes are relevant in determining whether a cigarette has a characterizing flavor [is] … the multisensory experience (i.e., taste, aroma, and cooling or burning sensations in the mouth and throat) of a flavor during use of a tobacco product, including its components or parts…” The proposed rule (21 CFR 1166.5) that would prohibit characterizing flavors in cigars adopts identical language as the proposed menthol standard in cigarettes and states that FDA would consider a “cooling sensation” in the mouth and throat to be a relevant factor in determining whether a cigar has a characterizing flavor.
In addition, and we (and, hopefully others) suggested doing to in public comments that we submitted on the proposed standards. The fact that this information was in public comments submitted to the FDA on the proposed product standards is important because making changes to proposed product standards in response to public comments is permitted under the Administrative Procedures Act.
FDA completed its work on the two product standards and submitted them to the White House Office of Management and Budget for approval on October 13, 2023. If the submitted rules include these cooling agents, the White House should promptly approve them.
If not, FDA should pull the rules back and close this loophole before they are finalized to avoid creating an opportunity for industry to try an avoid regulation the way it has been in California and Massachusetts.
Stanton Glantz blog 