More evidence that e-cig flavors hurt kids with no “benefit” to adults

Samir Soneji and colleagues’ new paper “Use of Flavored E-Cigarettes Among Adolescents, Young Adults, and Older Adults: Findings From the Population Assessment for Tobacco and Health Study” adds to the overwhelming case  that flavors are an important reason that kids use e-cigarettes.  They also specifically debunk the claim – made in all the debates over local laws banning the sale of flavored tobacco products -- that flavors are necessary to encourage adults to use e-cigs to quit smoking. 

This argument also ignores the fact that, for most smokers, using e-cigs makes it less not more likely that they will successfully quit smoking.

The authors provide a nice plain English summary of the findings at the beginning of their Discussion section:  “Four central findings emerged from this analysis of nationally representative data. First, the availability of appealing flavors was a more salient reason for e-cigarette use among adolescent users and young adult users than for older adult users. Second, adolescent users and young adult users were more likely to use fruit- and candy-flavored e-cigarettes than were older adult users. Older adult users and cigarette smokers were more likely to use tobacco- or other-flavored e-cigarettes than were adolescent and young adult users and nonsmokers, respectively. Third, adolescent users and young adult users were more likely to concurrently use multiple flavor types than were older adult users. Finally, current cigarette smokers who tried to quit smoking within the past year were more likely than never cigarette smokers to use tobacco- or other-flavored e-cigarettes.”

This paper also adds to the evidence that the FDA should use its authority to remove all these flavored e-cigarettes and tobacco products from the market now until the companies making them can make a successful case that allowing them would be good for the public health, the standard the FDA is required to apply to issue an order to allow new tobacco products on the market.  Even since the deeming rile was issued in 2016 these products have been illegally on the market.  The only reason that they are still available for legal sale is because the FDA is using “enforcement discretion” not to enforce the law in order to give the companies time to submit the necessary applications for approval of the product.

The deeming rule set this enforcement suspension period to 2 years, ending in August 2018.  When he took office FDA Commissioner Scott Gottlieb extended this nonenforcement period to 2022.  Now, in the face of exploding e-cig use by kids, he is talking about moving it back a year, to 2021.  That still leaves flavors out there to attract millions of kids in the meantime.  FDA should end the enforcement discretion now.

Here is the abstract:

OBJECTIVES:  The use of flavored electronic cigarettes (e-cigarettes) is common among e-cigarette users, but little is known about the potential harms of flavorings, the extent to which the concurrent use of multiple flavor types occurs, and the correlates of flavor type use. The objective of this study was to assess the types of e-cigarette flavors used by adolescent (aged 12-17), young adult (aged 18-24), and older adult (aged ≥25) e-cigarette users.

METHODS:  We assessed the prevalence of flavored e-cigarette use within the past month by flavor types and concurrent use of multiple flavor types among past-month e-cigarette users sampled during Wave 2 (2014-2015) of the Population Assessment for Tobacco and Health Study among 414 adolescents, 961 young adults, and 1711 older adults. We used weighted logistic regression models for the use of fruit-, candy-, mint/menthol-, tobacco-, or other-flavored e-cigarettes and concurrent use of multiple flavor types. Covariates included demographic characteristics, e-cigarette use frequency, cigarette smoking status, current use of other tobacco products, and reasons for e-cigarette use.

RESULTS:  The leading e-cigarette flavor types among adolescents were fruit, candy, and other flavors; among young adults were fruit, candy, and mint/menthol; and among older adults were tobacco or other flavors, fruit, and mint/menthol. Compared with older adults, adolescents and young adults were more likely to use fruit-flavored e-cigarettes (adjusted odds ratio [aOR] = 3.35; 95% confidence interval [CI], 2.56-4.38; and aOR = 2.31; 95% CI, 1.77-3.01, respectively) and candy-flavored e-cigarettes (aOR = 3.81; 95% CI, 2.74-5.28; and aOR = 2.95; 95% CI, 2.29-3.80, respectively) and concurrently use multiple flavor types (aOR = 4.58; 95% CI, 3.39-6.17; and aOR = 2.28; 95% CI, 1.78-2.91, respectively).

CONCLUSIONS:  Regulation of sweet e-cigarette flavors (eg, fruit and candy) may help reduce the use of e-cigarettes among young persons without substantially burdening adult e-cigarette users.

The full citation is Soneji SS, Knutzen KE, Villanti AC.  Use of Flavored E-Cigarettes Among Adolescents, Young Adults, and Older Adults: Findings From the Population Assessment for Tobacco and Health Study. Public Health Rep. 2019 Mar 12:33354919830967. doi: 10.1177/0033354919830967. [Epub ahead of print].  It is available here.