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New Survey Results Show E-Cigarette Epidemic Threatens Progress in Reducing Youth Smoking and Other Tobacco Use – FDA Must Step Up Efforts to Protect Kids

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
February 11, 2019

WASHINGTON, DC – Results of the 2018 National Youth Tobacco Survey (NYTS) released today are deeply concerning for several reasons. After years of progress in reducing youth cigarette smoking, today’s report shows that the rise in youth electronic cigarette use to epidemic levels in 2018 was accompanied by a stall in progress in reducing youth cigarette use and possibly even an uptick among high school students (the high school smoking rate went from 7.6 percent in 2017 to 8.1 percent in 2018). Driven by the surge in e-cigarette use, the total number of middle and high school students reporting current use of any tobacco product rose by nearly 1.3 million, from 3.6 million in 2017 to 4.9 million in 2018. Percentage-wise, 27.1 percent of high school students reported current use of at least one tobacco product in 2018 – the highest rate in 14 years.

These survey results are deeply troubling. They add to mounting concerns that the rise in youth use of e-cigarettes, especially Juul, is vastly expanding the number of kids addicted to nicotine, could be leading kids to and not away from cigarettes, and directly threatens the decades-long progress our nation has made in reducing youth smoking and other tobacco use. As FDA Commissioner Scott Gottlieb stated in a tweet on Sunday, “With the advent of e-cig products – like Juul – that are capable of delivering nicotine to the brain as efficiently as conventional cigarettes but without as many barriers to use, we could be looking at more kids addicted to nicotine than we’ve seen in a long time.”

These results are strong evidence that e-cigarettes are not helping to drive down youth cigarette use. Indeed, if anything, the evidence to date indicates that e-cigarettes could increase the number of kids who smoke cigarettes. A growing number of studies – including a study published this month in the journal JAMA Network Open – show that young people who use e-cigarettes are more likely to become smokers later, and many of these are low-risk youth who would not have otherwise used cigarettes. In addition, a comprehensive 2018 report by the National Academies of Sciences, Engineering and Medicine concluded, “There is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults.”

The e-cigarette results of the 2018 NYTS were released in November and showed that, from 2017 to 2018, current e-cigarette use increased by 78 percent among high school students (to 20.8 percent) and by 48 percent among middle school students (to 4.9 percent). Commissioner Gottlieb tweeted on Sunday, “There is no reason to believe that these trends have abated, and the numbers won’t increase.”

The youth e-cigarette epidemic is a public health emergency that demands the strongest possible action by the FDA and policy makers are all levels, starting with a ban on the flavored products that have made e-cigarettes so popular with kids.

The FDA took a first step to address this crisis in November when it announced plans to restrict sales of some flavored e-cigarettes in stores, but it didn’t include mint or menthol e-cigarettes despite the fact that more than half of all high school e-cigarette users report using these two flavors (according to the 2018 NYTS). The FDA must go further. It should prohibit all flavored e-cigarettes that have not been subject to public health review by the agency, halt online sales of e-cigarettes until stronger safeguards are in place to prevent sales to kids, restrict marketing that attracts kids, and enforce rules prohibiting the sale of new products without FDA authorization.

The FDA must also take several critical actions to accelerate progress in reducing smoking and other tobacco use. These include implementing the agency’s proposals to prohibit menthol cigarettes and flavored cigars and to limit nicotine in cigarettes to minimally addictive or non-addictive levels (it should also apply this limit to other combustible tobacco products). The FDA should expeditiously issue and finalize the regulations needed to implement these life-saving proposals. Until the FDA stops the sale of all flavored tobacco products, states and localities should continue their growing efforts to do so.

In addition, policy makers at all levels must fully implement other proven strategies to reduce youth tobacco use. These include significant tobacco tax increases, comprehensive smoke-free laws, well-funded tobacco prevention and cessation programs, hard-hitting mass media campaigns, and laws raising the tobacco sale age to 21.

Today’s survey results show that our nation is at a critical juncture in the fight against tobacco use. Policy makers at all levels must take the actions necessary to reverse the youth e-cigarette epidemic and put us back on track to create the first tobacco-free generation.

The National Youth Tobacco Survey results were published in a Vital Signs report by the Centers for Disease Control and Prevention.