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FDA Commissioner: Epidemic use of e-cigarettes among children

Staff Writer |
"The U.S. Centers for Disease Control and Prevention (CDC) released additional data from joint FDA/CDC 2018 National Youth Tobacco Survey.

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"These data are a sobering reminder of the initial results we shared last fall indicating a rampant rise of youth e-cigarette use, which has prompted the FDA to take a series of escalating regulatory actions as part of our Youth Tobacco Prevention Plan", says FDA Commissioner Scott Gottlieb.

"We are advancing those actions, and committing to some new steps.

"The epidemic use of e-cigarettes among children is one of the biggest public health challenges currently facing the FDA.

"According to the data released today, approximately 4.9 million middle and high school students were current users (used in the past 30 days) of some type of tobacco product in 2018, up from 3.6 million in 2017.

"This increase is driven by an alarming surge in e-cigarette use.

"More than 3.6 million middle and high school students were current (past 30 day) e-cigarette users in 2018, a dramatic increase of more than 1.5 million students in one year.

"The study authors suggest -- as the FDA also noted at the time of the initial release of this data in the fall – that the rise in e-cigarette use in the last year is likely due to the recent popularity of certain types of e-cigarettes, such as JUUL.

"Further, youth who use e-cigarettes also are using them more frequently and using flavored products more often than last year.

"Many youth tobacco product users are also using multiple products.

"Among current tobacco users, about 2 in 5 (1.68 million) high school students and 1 in 3 (270,000) middle school students used two or more tobacco products in 2018.

"The most commonly used tobacco product combination was e-cigarettes and conventional cigarettes among both middle and high school students.

"Similarly, data from the recent National Institutes of Health's Monitoring the Future study found comparable trends: From 2017 to 2018, current (past 30-day) e-cigarette use reportedly increased from 6.6 percent to 10.4 percent among 8th grade students; 13.1 percent to 21.7 percent among 10th grade students; and 16.6 percent to 26.7 percent among 12th grade students.

"In other words, more than a quarter of 12th graders in the U.S.

"are using e-cigarettes—exposing them to harmful effects of nicotine and other chemicals and putting them at risk of transitioning to other tobacco products.

"These risks were further reinforced in research recently published in JAMA Network Open, which showed that, compared with non-users, youth who use e-cigarettes are more likely to transition to conventional cigarettes ‒ risking a lifetime of addiction to smoking and resulting smoking-attributable disease and erasing the reductions in youth smoking rates that we've achieved in America.

"The bottom line is that kids using e-cigarettes aren't kids who "would have smoked cigarettes. Quite the opposite.

"As a society, we've made great strides in stigmatizing cigarette use among kids.

"The kids using e-cigarettes are children who rejected conventional cigarettes, but don't see the same stigma associated with the use of e-cigarettes.

"But now, having become exposed to nicotine through e-cigs, they will be more likely to smoke.

"I will not allow a generation of children to become addicted to nicotine through e-cigarettes.

"We must stop the trends of youth e-cigarette use from continuing to build and will take whatever action is necessary to ensure these kids don't become future smokers.

"Based on a growing body of evidence, I fear the youth trends will continue in 2019, forcing us to make some tough decisions about the regulatory status of e-cigarettes.

"The signs that we're seeing are not encouraging.

"They point to continued growth in youth use of these products.

"No child should be using any tobacco or nicotine-containing product.

"We'll continue to take steps to try to investigate the root causes of this spike in youth e-cigarette use and arrest the momentum of these trends, in particular, by ensuring these products are sold in ways that make them less accessible and appealing to youth.

"But, if these youth use trends continue, we'll be forced to consider regulatory steps that could constrain or even foreclose the opportunities for currently addicted adult smokers to have the same level of access to these products that they now enjoy.

"I recognize that such a move could come with significant impacts to adult smokers.

"The FDA has repeatedly affirmed our collective view that e-cigarettes may have promise as a tool for helping currently addicted adult smokers quit smoking.

"But, with the staggering data on youth trends, we're struggling to preserve these opportunities for adults while addressing the youth epidemic.

"I simply won't allow their sale to come at the expense of addicting a generation of kids to nicotine.

"To help address this growing use among kids, over the past year, the FDA has taken a rigorous enforcement stance, including a number of actions to combat the illegal sales of e-cigarettes to youth through our enforcement efforts at brick-and-mortar and internet storefronts, as well as taken steps to target companies engaged in kid-friendly marketing that increases the appeal of these products to youth.

"I've also appealed to the companies responsible for many of these products, and met with senior executives from five of the largest manufacturers of e-cigarette products.

"In addition, last week, I sent letters to the chief executive officers of Altria Group Inc. and JUUL Labs Inc.

"asking to meet with them to discuss my concerns that they don't seem fully committed to their written promises about the steps they'd take to stop youth use of their products.

"Just last week, the FDA escalated enforcement action against certain local Walgreens and Circle K retail locations for repeatedly selling tobacco products to minors by filing a complaint seeking to bar the two specific retail locations from selling tobacco products for 30 days.

"As part of that effort we're also writing the corporate management of a number of large, national retail chains to discuss whether there is a corporate-wide issue related to their stores' non-compliance and put them on notice that the FDA is considering additional corporate-wide enforcement avenues to address violative tobacco sales to youth, which have also included illegal sales of e-cigarettes to kids.

"This past fall, we marked a historic milestone of conducting a total of one million tobacco retailer inspections since we began doing so in 2010.

"To commemorate this, we're sending letters to governors and agencies across the country thanking them for their work to support our efforts to protect youth – and reminding them of the need for continued vigilance to make sure retailers aren't selling tobacco products to minors.

"Beyond enforcement and social responsibility, we've committed to meaningful policy changes.

"Notably, in November, I announced proposed new steps to protect youth by preventing access to flavored tobacco products, including e-cigarettes.

"This policy framework will both address the disturbing trend of youth e-cigarette use and advance the historic declines we've achieved in recent years in the rates of combustible cigarette use among kids.

"This framework reflects a re-doubling of the FDA's efforts to protect kids from all nicotine-containing products.

"It also reflects a very careful public health balance between steps to enable the opportunities to transition to non-combustible products to be available for adults; and our solemn mandate to make nicotine products less accessible and less appealing to children.

"In other words – a balance between closing the on-ramp for kids to become addicted to nicotine through combustible and non-combustible products, while maintaining the off ramp for adults through access to potentially less harmful forms of nicotine delivery for adult smokers seeking to transition away from combustible tobacco products."

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