The FDA Wants To Make It Harder For Kids To Get E-Cigarettes– Are They Doing Enough?

The proposal is designed to address a big increase in kids smoking E-cigarettes. “The most recent data show more than 3.6 million middle and high school students across the country were current (past 30 day) E-cigarette users in 2018,” Scott Gottlieb, commissioner of the FDA, said in a statement. “This is a dramatic increase of 1.5 million children since the previous year. The data also showed that youth who used E-cigarettes also were using them more frequently and they were using flavored E-cigarette products more often than in 2017. This is particularly troubling given that research shows that kids using E-cigarettes are more likely to take up combustible cigarettes.”

According to Dr. Donna Shelley, Professor in the Department of Population Health and Department of Medicine at NYU Langone Health, because of the increase in children smoking, some people want flavors to be banned. But there are drawbacks to that too. “The reluctance to ban the flavors completely is interesting, and I think it's something worthy noting,” she says. “[Gottlieb] was really trying to walk this line between reducing the appeal to kids, and using these to help adults quit. And a lot of the adults who are trying to quit tobacco say they like the flavors. Are we going to try and maintain some of that type of product for that particular population? People were calling for the ban of flavors, but [the FDA is] really trying hard to walk that line."

“[E-cigarettes] are great for people who are trying to quit smoking but are addicted to the nicotine. It's not the nicotine that's killing them,” she says. “[E-cigarettes] work just like the patch and the gum. But the problem was we suddenly started seeing kids use these products. And then there was a battle between the prevention community, who wanted to prevent kids from smoking E-cigarettes, and the treatment community, which is trying to help adults.”

According to Dr. Shelley, it’s mostly a problem with misinformation. Kids understand cigarettes are bad for them, so they don’t smoke. “Kids are really under the misconception that this is just a cool thing to do the same way we were with cigarettes fifty years ago. Back then nobody thought cigarettes were going to be dangerous,” she says. “But if [the FDA] continues on the path, kids are smart, we are hoping kids will see these ads.”

What worked best with cigarettes was a campaign about telling the truth, according to Dr. Shelley. “It worked for cigarettes because it was really a truth campaign. That's what was so successful – ‘this industry is manipulating you.’ ‘Real cost’ is very much about the truth, just like the truth campaign which was remarkably successful. We have a lot of information about product regulation and counter advertising.”

But it’s a difficult process, and a lot of steps that were taken for cigarettes have yet to be implemented for E-cigarettes. “For cigarettes we have a ban on any advertising having cartoon characters, advertising directed specifically toward kids. They haven't banned that yet [for E-cigarettes], but I think we're moving toward that,” she says.

And now, the tobacco industry could be getting involved with E-cigarettes. “We're playing catch up with this product, and I think the most concerning thing is that the tobacco industry is getting into this business. Altria just invested $12 million in JUUL. They know how to get kids addicted to nicotine. JUUL was definitely advertising to kids. It really escalated the problem because of the brilliant design and the ad campaigns.” Altria is the manufacturer that makes Marlboro and Virginia Slims.

Through social media and other tools, the anti JUUL campaign has had some success, according to Dr. Shelley. “The FDA has actually done an amazing job, given how long it can take for the government to act, moving programs out the door. They have in a very short time developed a very effective campaign, using trials, research, etc. called the ‘real cost.’ They put that together pretty rapidly and they are finding that the reach is high. Through social media and other tools they are really getting the message out.”

But it’s important not to make vaping or JUUL a point of shame for people who do have lung cancer, according to Dr. Brendan Stiles, Thoracic Surgeon at Weill Cornell Medicine and NewYork-Presbyterian. "I certainly don't give my patients a hard time if they're vaping; I actually don't give them a hard time if they're still smoking," says Dr. Stiles. "It's very, very hard to quit, and they've got so many things going through their mind and so much anxiety at the time of their surgery that I don't have a policy, 'hey, gotta stop smoking.' I think surgery is a great learning opportunity, it's a great time for them to be in the hospital where hopefully they'll stop after that. But, it's tough to really beat people up about that in my opinion."

Efforts to stem vaping among young people, though, are important and difficult to pursue. Likening the process to “whack-a-mole,” Dr. Shelley says that the government is pleading with big vendors. “Every time they send someone to a particular company, they are telling that companyEbay, Walgreens– to stop selling these products to kids. It's like whack-a-mole, but they are very aggressively trying to get companies to stop selling.”

Dr. Shelley emphasized the role that local governments can have in the campaign against E-cigarettes for kids. “We have a law in New York City now that cigarettes have to be behind the counter now, so kids can't lift them, and there have been other measures in the city too. We have a 21 year old law for cigarettes, and thats true for E-cigarettes too,” she says. “The FDA cannot solve this alone. It has to be at a grass roots level as well. We have a license law in New York City, and if [vendors] are caught in stings, they can lose their license. And now the city has put a tax on the cigarette juice as well. So there are state and city laws that can be passed. But it's best when the government does it because it’s one fell swoop.”

But she also called for more research, which would help the government parse out which flavors put kids at the highest risk, and which might be useful for adults. “We really need more science on which flavors attract kids, and don't attract kids so that maybe adults could keep those flavors… Flavors are whats attracting them to kids there's no questions.”

“I was disappointed that the commissioner stepped down, because they are trying very aggressively to restrict JUUL," says Dr. Shelley about commissioner Scott Gottlieb’s sudden retirement announcement. “I don't know what's going to happen with the change in leadership, but the team that is working on the product is extremely experienced.”

 

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