The FDA rightly observed that young people prefer these cheap, cartridge-based e-cigarettes that deliver a jolt of nicotine because the devices look appealing — many resemble a USB drive — and are easily concealed.
But policymakers struggle to keep up with the rapidly changing preferences of young people, and the new rules appear to have overlooked different devices that are gaining popularity with kids.
The ban is also something of a victory for Juul: The company’s products account for an estimated 59 percent of high-schoolers’ vaping, and 54 percent of middle-schoolers’, but Juul had already removed its kid-friendly fruity flavors before that survey and pulled mint after the results came out. The new policy mainly affects the company’s nearest competitors, Njoy and Vuse, which have a comparatively small market share.
Still, the FDA’s action is significant. It just needs bolstering.
The need for additional measures is urgent. Data from the 2019 National Youth Tobacco Survey shows that about 5 million young people in grades six to 12 had tried e-cigarettes in the past 30 days — an increase from about 3.6 million in 2018. And more of these teens are becoming regular users, with nearly 1 million vaping daily. That’s how addiction crises take root. Casual use turns into constant use, and before you know it, a new generation of kids is hooked on nicotine.
First, policymakers should quickly implement and enforce newly passed legislation that mandates a minimum age of 21 to purchase tobacco products, including e-cigarettes and vaping products that deliver nicotine.
If the 2020 National Youth Tobacco Survey, which begins in March, is going to show a decline in minors’ use of e-cigs, the new age restriction is the best hope. Why? Because most kids get their e-cigs through social sources: the 18-year-old high school senior, say, who legally purchases e-cigs and resells them to younger students.
To fully enforce the new law, the FDA should also update regulations governing the sale of tobacco products to account for the higher age restriction. The agency can accelerate enforcement by directly issuing a final rule that conforms these regulations to the age-21 restrictions and gives states and retailers immediate guidance on how to apply the new constraints.
Second, the FDA should speed up its process for reviewing e-cigarette applications by manufacturers. The announcement on Thursday said companies had until May to apply. Under current conditions, most manufacturers would then have at least a year to remain on the market while the FDA reviews the submissions. The agency can hasten things by triaging its review to prioritize applications for products that are more appealing to minors — particularly cartridge-based systems and flavored vapes.
Manufacturers are required to show their products have a net public-health benefit, for example, by helping current adult smokers quit; if the kid-appealing products can’t do that, as seems likely, they should be the first ones permanently removed from the market.
Third, in my reading of the FDA’s new policy, it could exempt certain self-contained, disposable e-cigarette products, including those that are flavored. These sleek devices — including one called Puff Bar — deliver a high nicotine hit, come in fruity flavors and are rapidly gaining popularity among kids.
The FDA may have carved out these devices because it didn’t have enough historical data on how young people use them. Or the agency may have inadvertently overlooked them because the policymakers are one step behind a social trend. It wouldn’t be the first time for federal regulators, and may be true here.
The new policy deliberately carved out open-tank vaping systems as a way to help preserve the adult vape stores that primarily sell this hardware. These devices require users to refill embedded tanks with e-liquids that are bought separately, and they are popular with adults. But they are also gaining traction with kids. One survey found that, after Juul, the open-tank vaping products Suorin and Smok are the most popular e-cigarette devices among high school students. The FDA should prioritize these two products for review.
Finally, the agency should take a cue from its remarkably successful “The Real Cost” public-service campaign targeting traditional cigarettes and redouble its efforts to inform young Americans about the harmful effects of e-cigarettes and nicotine addiction.
The FDA’s actions this week were months in the making and unveiled after uncertainty and delay. While at the agency, I, too, faced challenges advancing restrictions on e-cigarettes. Trying to use policy tools to fight a rapidly evolving addiction crisis is difficult. The lesson was learned with tragic consequences when it came to opioids. If we’re going to end the epidemic of nicotine addiction among kids, we need to meet its troubling twists and turns with speed and strength.