Stub it out: A snapshot of America’s fatal affair with tobacco

In the lead up to the State of the Union, The White House noted that President Biden is prepared to address “the single biggest driver of cancer deaths in this country–smoking.” That’s heartening news, and the Administration can start by tackling the pervasive influence of flavored tobacco products on young people. 

The U.S. Food and Drug Administration (FDA) is already taking steps in that direction, albeit slow ones. The agency recently announced that two of Vuse’s menthol electronic cigarette products did not meet the agency’s standard for protecting public health and thus would be taken off the market. The agency’s decision is laudable, but  the FDA should move quicker to take flavored e-cigarettes, which threaten young peoples’ health and well-being, off of store shelves. 

 More than 30 million adult Americans smoked cigarettes in 2020, according to the Centers for Disease Control and Prevention. Knowing that many of their best customers may die young, and seeking longevity for their business, tobacco companies plant seeds for their next harvest among America’s youth. 

In 2022, 2.5 million middle and high school students in the United States reported using e-cigarettes. Young people prefer vaping to any other method of tobacco consumption, and 4 out of 5 of them use flavored e-cigarettes. They report that fruit, candy, mint and menthol flavors are a primary reason that they use e-cigarettes in the first place. 

E-cigarettes are not harmless. Most of the products contain high levels of nicotine, an addictive and toxic substance that can stunt adolescent and young adult brain development, which continues into the early to mid-20s. E-cigarette aerosol can also contain chemicals that are damaging to the lungs. Beyond direct risks associated with e-cigarettes, studies have identified “substantial evidence that e-cigarette use increases the risk of ever using combustible tobacco among youth,” meaning that young people who use e-cigarettes are more likely to become smokers. Evidence shows that the majority of e-cigarette users in the United States also smoke conventional cigarettes.

E-cigarettes have been on the market for years now without going through proper FDA review. As a tobacco product, e–cigarettes are required to submit premarket tobacco product applications (PMTA’s), which the FDA is supposed to review and approve for e-cigarette companies to legally sell their products. During this process, the FDA should examine the tobacco product’s components, its potential harms, and how it is made and sold. 

After reviewing Vuse’s application for two menthol e-cigarettes, the FDA determined that “the applications lacked sufficient evidence to demonstrate that permitting the marketing of the products would be appropriate for the protection of the public health” and they should be pulled from the market. Generally, e-cigarette companies such as Vuse (a subsidiary of longtime tobacco giant R.J. Reynolds) must demonstrate the benefits of flavored e-cigarettes as smoking cessation/reduction tools for adults are greater than the risks of youth initiation and use. So far, the jury is still out on that claim. 

It’s good news that the FDA is finally starting to enforce its PMTA review process, but during the agency’s methodical product by product analysis, many flavored e-cigarettes continue to be sold and find their way into the hands of kids. In the absence of federal action, it falls to the states to take all flavored tobacco products – not just e-cigarettes – off the market. Five states — Massachusetts, New Jersey, New York, Rhode Island and, most recently, California, have statewide restrictions or bans on flavored tobacco sales. Two more states — Maryland and Utah — restrict the sale of some flavored e-cigarettes. On a more micro level, 360 cities and towns across the country have passed their own restrictions. 

Inspired by those local actions, legislators are drafting and proposing state-wide bills in Maine, New Mexico and Oregon. The Supreme Court recently ruled against R.J. Reynolds’ attempt to block the California law, clearing the way for other states to take action.

Each day, about 1,500 Americans younger than 18 smoke their first cigarette. The CDC predicts that if youth smoking trends continue as they are, about 1 in 13 Americans under 18 alive today will die early from a smoking-related illness. As more states act to end the sale of flavored tobacco products it will embolden the Biden Administration to follow suit. 

Stamp out this hazard and hasten the federal government’s progress by contacting your state legislators and urging them to support laws to take all flavored tobacco products off the market.