Statewide Banning of Flavored E-Cigarettes and Other Strategies to Reduce E-Cigarette Use

September 19, 2019|3:11 p.m.| Marcus Plescia MD, MPH | ASTHO Chief Medical Officer

The use and regulation of e-cigarettes continues to be a major news item across the country as federal agencies take strong action to regulate e-cigarette products. Following public comments from HHS Secretary Alex Azar and President Donald Trump, HHS issued a press release on Sept. 11 announcing that the agency intends to remove all flavored e-cigarette products from the market until manufacturers of those products file premarket tobacco product applications with FDA. This comes at the heels of preliminary findings from the 2019 National Youth Tobacco Survey (NYTS), which indicate that over one quarter of U.S. high school students report using an e-cigarette product in the past 30 days, an increase from 2018 when the rate of past 30 day use was 20.8 percent.

Regulating flavored e-cigarette products as the Trump Administration is proposing is an important strategy to reduce youth e-cigarette use and protect all people across the nation from the potential harms of e-cigarette use and nicotine addiction. According to FDA, 96.1 percent of youth who initiated e-cigarette use between 2016 and 2017 did so with a flavored e-cigarette product. Analysis of 2018 NYTS data found that 67.8 percent of current high school e-cigarette users reported using a flavored e-cigarette product in the last 30 days, a figure that increased from 60.9 percent in the 2017 wave of NYTS data. Simply put, kids prefer flavored e-cigarettes products and removing them from the shelves will make their initiation and ongoing use less appealing.

As is typically the case in tobacco prevention and control, states are taking a leading role in implementing strong action to protect consumers from the harms of e-cigarette product use. Michigan became the first state to announce an executive action to ban the sale of all flavored e-cigarettes statewide, which will go into effect in the coming weeks. New York has also banned most flavored vaping products, but will allow mint and menthol flavorings to remain on the shelves. California announced a crackdown on illegal and counterfeit vaping products and allocated funds into a public awareness campaign on vaping harms. A bill proposed by the Washington, D.C. Council would prohibit the sale of all flavored e-cigarette products.

Despite the recent announcement from HHS, these state actions are important steps forward in the regulation of youth-appealing tobacco products that are getting millions of new consumers hooked on nicotine. The Trump Administration has not yet formally acted to remove flavored e-cigarettes from the market, promising additional information from FDA in the coming weeks. Once implemented, their enforcement action would eventually let products back onto the market after passing a premarket application process with FDA. Thus, all states should continue to consider their own bans of flavored e-cigarette products through executive action or passing of legislation as the federal government moves ahead with its own regulatory plan.

Additional policy options are also available to states to reduce the use of all e-cigarette products. States can implement or increase e-cigarette taxes and pass comprehensive clean indoor air laws that prohibit e-cigarette use in public indoor spaces. These strategies have long been effective at reducing combustible cigarette use and would do the same for e-cigarettes. State-level pricing strategies in particular are effective at making tobacco products less appealing to younger consumers. With the national conversation focusing on flavored tobacco products, states should also consider including menthol cigarettes in any executive action or legislative policy, as these products continue to appeal disproportionately to youth and racial/ethnic minority consumers. Finally, states with tobacco policy preemption in effect should lift those restrictions to empower localities to implement the tobacco control policies that will best serve their communities.

Between the increasing youth use of e-cigarettes and the high-profile deaths and disease cases of severe pulmonary illness linked to vaping, tobacco control is receiving a lot of attention from lawmakers at all levels and the American public. States health agencies are equipped with the data, scientific evidence, and policy options that are needed to protect young people from the harms associated with e-cigarette use and nicotine addiction. They should continue to use these tools to ensure that all people have the opportunity to live healthy lives free from the harms of tobacco use.