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FDA Proposes Regulations as Teen E-Cigarette Use Skyrockets 78% in 1 Year

infographic showing that youth e-cigarette use is rising

Use of e-cigarettes (also known as vaping) by high school students has jumped 78% since last year, according to the US Centers for Disease Control and Prevention (CDC). And it has jumped 48% among middle schoolers. The US Food and Drug Administration (FDA) is responding with a proposal to restrict youth access to flavored nicotine products, which the CDC blames for contributing to the surging popularity of vaping. The report was published November 15, 2018 in Morbidity and Mortality Weekly Report.

Cliff Douglas, American Cancer Society Vice President, Tobacco Control, said, “The unprecedented 78 percent increase in e-cigarette use among our kids in just one year, from 2017 to 2018, threatens to create a new generation of addicted tobacco users, making it paramount that the FDA act as aggressively and expeditiously as possible to stem this dangerous turn of events.”

E-cigarettes in schools

Since e-cigarettes hit the US market in 2007, they have become more and more popular with American adolescents and teens. By 2014, e-cigarettes were the most commonly used tobacco product among high-school and middle school students.

The CDC report analyzes results from the National Youth Tobacco Survey, a cross-sectional, voluntary, school-based, self-administered, pencil-and-paper survey of US middle and high school students. It asks the students whether they have used a variety of tobacco products, how recently, and how often.

The survey shows that among high school students, current e-cigarette use increased from 1.5% in 2011 to 20.8% in 2018. During 2017-2018 alone, e-cigarette use currently reported by high schoolers increased from 11.7% to 20.8% -- a 78% increase. Among middle school students, current e-cigarette use increased from 0.6% in 2011 to 4.9% in 2018. During 2017-1018 alone, e-cigarette use currently reported by middle schoolers increased from 3.3% to 4.9% -- a 48% increase.

The CDC report attributes this dramatic rise in vaping to the popularity of JUULs and other e-cigarettes shaped like a USB flash drive. They are easy to hide, have a high nicotine content, and come in fruit, candy, and other flavors that appeal to youth.

The new statistics show that students who vape are using flavored e-cigarettes more often than ever. Use of flavored e-cigarette liquid increased from 60.9% to 67.8% among high school students just last year. High school students who currently vape are also doing so more frequently. The proportion who reported use of e-cigarettes on more than 20 of the past 30 days increased from 20% in 2017 to 27.7% in 2018.

FDA response

The FDA is responding to the report with a series of proposals aimed at limiting sales of e-cigarette products to minors. “E-cigarettes have become an almost ubiquitous – and dangerous – trend among youth that we believe has reached epidemic proportions. This troubling reality is prompting us to take even more forceful actions to stem this dangerous trend, said FDA Commissioner Scott Gottlieb, MD. “Based on our evidence, we believe the presence of flavors is one component making these products especially attractive to kids. The mandate to reverse this trend in youth addiction to nicotine is one of my highest priorities.”

The proposals include:

  • Ending sales of e-cigarette products in flavors that appeal to kids, such as cherry, vanilla, crème, tropical, and melon, by banning their sale in many retail locations and manufacturers’ online stores that are accessible to minors. Tobacco, mint, and menthol flavors, however, would not be included because Gottlieb says he wants adults to be able to use them as a quit-smoking tool.
  • Banning flavors in cigars, including little cigars – which look just like cigarettes and are popular with adolescents and teens.
  • Banning the marketing of e-cigarette products to children, such as using popular children’s cartoon or animated characters, or names of products favored by kids like brands of candy or soda.
  • Banning menthol flavor in cigarettes and cigars.

The proposals follow an action by the FDA in September 2018, in which the FDA issued more than 1,300 warning letters and fines to retailers who illegally sold e-cigarette products to minors, the majority of which were blu, JUUL, Logic, MarkTen XL, and Vuse.

Health and advocacy groups have been critical of the FDA for not going far enough. In a statement on the American Academy of Pediatrics website, President Colleen A. Kraft, MD, MBA, FAAP writes, “FDA action to prohibit menthol cigarettes and flavored cigars, proven starter products for young people, will save thousands of today’s children from death and disease due to smoking. But just as flavored cigarettes appeal to children and teens, so do flavored e-cigarettes. FDA can and must do more to protect children and teens from these dangerous products.”

No youth should use e-cigarettes

The American Cancer Society and the FDA warn that no youth should use nicotine products. Most e-cigarettes contain nicotine. And, some that claim to be nicotine-free have been found to contain nicotine. There is evidence that nicotine harms the brain development of teenagers. Nicotine is also highly addictive. Studies have shown that vaping by youth is strongly linked to later use of regular cigarettes and other tobacco products.

JUUL is now the overwhelming favorite e-cigarette product among young people. They are small and easy to hide. They look like USB flash drives and can be charged in a computer. They give off very little vapor or odor. Adolescents and teens are known to use them in school restrooms and even in the classroom. JUULs have a higher amount of nicotine per puff than some other types of e-cigarettes and that may make them even more addictive. Scientists are still learning about how e-cigarettes affect health when they are used for long periods of time.

Research has found that the vapor in e-cigarettes contain some harmful and cancer-causing chemicals, although in significantly lower amounts than cigarette smoke. Secondhand vapor may also contain harmful substances, and scientists are still learning about the effects of exposure to secondhand vapor.

The smoke-free and tobacco-free policies at schools, businesses, healthcare institutions, and other organizations should also cover e-cigarettes. This will help non-users avoid being exposed to potentially harmful e-cigarette vapor.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018. Published November 15, 2018 in Morbidity and Mortality Weekly Report. First author Karen A. Cullen, PhD, Centers for Disease Control and Prevention, Atlanta, Ga.