2021 Survey Shows Over 2 Million… | Campaign for Tobacco-Free Kids
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2021 Survey Shows Over 2 Million Kids Used E-Cigarettes Even During Covid-19 School Shutdown and 85% Used Flavored Products – FDA Must Eliminate All Flavored E-Cigarettes to Prevent Resurgence of Youth Epidemic

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
September 30, 2021

WASHINGTON, D.C. – The results of the 2021 National Youth Tobacco Survey (NYTS) released today show that over 2 million middle and high school students reported using e-cigarettes in the first half of this year, even as many schools remained closed because of the Covid-19 pandemic. This survey reinforces that flavored products continue to drive youth use as 85% of youth e-cigarette users report using flavored products, with fruit, candy/desserts/other sweets, mint and menthol reported as the most popular flavors. In a clear sign of the addictiveness of the products now dominating the market, an alarming percentage of youth e-cigarette users report frequent or daily use – 43.6% of high school users report frequent use (on at least 20 days a month) and 27.6% report daily use.

This survey underscores both that youth e-cigarette use remains a serious public health problem, even during the pandemic, and that it is being driven by flavored products, including menthol. It is noteworthy that the survey finds higher rates of e-cigarette use among high school students who took the survey in school compared to those participating at home or some other place (15% to 8.1%), raising concern that rates would be much higher if the survey had been conducted entirely in schools as in previous years. As kids return to school, we face the real risk of a resurgence of the youth e-cigarette epidemic unless the FDA quickly eliminates all flavored e-cigarettes. With 85% of youth e-cigarette users using flavors, our kids will remain in jeopardy as long as any flavored products remain on the market.

Administered January to May 2021, this NYTS was the first to be fully conducted amid the COVID-19 pandemic. In releasing the results, the CDC and the FDA cautioned that the 2021 results cannot be compared to previous years because of pandemic-related changes in methodology. But a decline in the number of youth reporting e-cigarette use would not be surprising as half of participating kids completed the survey from home and kids faced less peer pressure and reduced access to e-cigarettes because of additional time at home, remote learning and other pandemic restrictions. The decisions the FDA is making right now about whether to allow the sale of any flavored e-cigarettes will be critical in determining whether real progress can be made toward ending the youth e-cigarette epidemic.

The FDA has recently taken positive steps by denying marketing applications for more than 1 million flavored e-cigarette products. However, the agency has yet to issue decisions about e-cigarette brands that have the largest market shares or are most popular with kids, such as Juul, Vuse, NJOY, blu, SMOK and Suorin. And the FDA is still considering whether to authorize the sale of any menthol-flavored e-cigarettes. Today’s survey results show why the FDA should not authorize the sale of ANY flavored e-cigarettes given the overwhelming evidence that flavored products, including menthol, attract kids. Among high school students who reported using flavored e-cigarettes in the new survey, 30% used menthol-flavored products.

In contrast to the clear evidence that menthol and other flavored products fueled the youth e-cigarette epidemic, every major U.S. public health authority – including the U.S. Surgeon General, the U.S. Preventive Services Task Force, the CDC and even the FDA itself – has found there is inadequate evidence to conclude that e-cigarettes are effective at helping smokers quit. The 2020 Surgeon General’s Report on Smoking Cessation concluded, “there is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation.” The World Health Organization reached a similar conclusion in a July 2021 report, finding that “evidence on the use of ENDS [electronic nicotine delivery systems] as a cessation aid is inconclusive.” The evidence is even weaker that flavored e-cigarettes, including menthol-flavored products, are effective at helping smokers quit.

The 2021 NYTS also shows that Puff Bar, a brand of disposable e-cigarettes sold in a variety of kid-friendly flavors, has become the most popular e-cigarette brand among kids, with 26.8% of middle and high school e-cigarette users reporting it as their usual brand. Puff Bar in February announced that it has switched to using synthetic nicotine in its products, a step a growing number of e-cigarette makers are taking to evade FDA regulation as tobacco products. The Campaign for Tobacco-Free Kids and other public health groups have urged the FDA to crack down on synthetic nicotine products as illegal drugs that have not been approved by the FDA. FDA inaction on synthetic nicotine will allow e-cigarette manufacturers to further widen this loophole and continue marketing flavored e-cigarettes to kids.

The survey findings on Puff Bar are consistent with sales data from the CDC Foundation that shows sales of disposable e-cigarettes have increased by 249% and the market share of disposable devices more than doubled, to 40.8% of total e-cigarette sales, since February 2020, when the FDA restricted flavors other than tobacco and menthol in cartridge-based e-cigarettes like Juul. 

Today’s survey results point to clear actions the FDA must take to end the youth e-cigarette epidemic for good: It must eliminate all flavored e-cigarettes, including menthol-flavored products, and stop manufacturers from evading FDA regulation with synthetic nicotine.