A new report jointly prepared by CDC and FDA researchers(www.cdc.gov) found that although fewer high school and middle school students overall used any tobacco product in 2017 compared to 2011, e-cigarettes remained the most commonly used tobacco product among those who did use such products.
Published in the June 8 Morbidity and Mortality Weekly Report (MMWR), "Tobacco Use Among Middle and High School Students -- United States, 2011-2017," found that, in 2017, 19.6 percent of high school students and 5.6 percent of middle school students reported using a tobacco product at least once in the previous month.
Among these users, 46.8 percent of those in high school and 41.8 percent of those in middle school used two or more tobacco products. E-cigarettes were the most commonly used tobacco product among high-schoolers (11.7 percent) and middle-schoolers (3.3 percent).
The MMWR article's findings, which coincide with an FDA initiative to combat underage smoking, verify the continuing dominance of e-cigarettes in the adolescent marketplace.
In a statement(www.fda.gov) about the 2017 National Youth Tobacco Survey, on which the new report was based, FDA Commissioner Scott Gottlieb said, "Protecting our nation's youth from the dangers of tobacco products is among the FDA's most important responsibilities, and we're taking aggressive steps to make sure all tobacco products aren't being marketed to, sold to, or used by kids."
- A report published in the June 8 Morbidity and Mortality Weekly Report found that fewer high school and middle school students used any tobacco product in 2017 compared to 2011.
- The report highlighted the critical role of sustained population-based strategies.
- The AAFP continues to call on the FDA to toughen regulation of nicotine delivery devices.
From 2016 to 2017, whereas middle school students reported decreases in the use of any tobacco product (7.2 percent to 5.6 percent), e-cigarettes (4.3 percent to 3.3 percent) and hookahs (2 percent to 1.4 percent), high school students reported decreases only in the use of hookahs (4.8 percent to 3.3 percent) and pipe tobacco (1.4 percent to 0.8 percent). No change was seen in the percentage of high-schoolers who used e-cigarettes during this period.
"It's too soon to tell whether this represents a leveling off, following a steep decline from 2015 to 2016," Gottlieb said in his statement. "But this bears watching."
Essential Role of Regulation
The report notes that "sustained implementation of population-based strategies, in coordination with FDA regulation of tobacco products, are critical to reducing tobacco product use and initiation among U.S. youths." But the FDA has exempted e-cigarettes and other electronic nicotine delivery system (ENDS) products from agency review until 2022, despite the 2016 deeming rule(www.gpo.gov) that established the agency's oversight of ENDS, cigars and other products that were not previously subject to regulation.
The AAFP strongly supports(5 page PDF) the deeming rule. And on March 27, 2018, the American Academy of Pediatrics and several co-litigants sued the FDA, HHS and the heads of those agencies, contending that the exemption poses a public health risk and illegally circumvents correct agency procedure.
The FDA's Gottlieb, in his statement regarding the survey results, said his agency was "taking every opportunity to disrupt the cycle of successive generations of nicotine and tobacco addiction."
He added, "While fewer youth are using cigarettes and other combustible tobacco products, we must do more to address the disturbingly high number of youth who are using e-cigarettes and vaping products. We must not lose sight of the fact that for the past several years, e-cigarettes have been the most commonly used tobacco product among both middle and high school students, and a total of 2.1 million youth used e-cigarettes in 2017."
Gottlieb touted a recent "nationwide blitz of brick-and-mortar and online retailers," conducted by the FDA "that led to warning letters to businesses that sold Juul brand products to minors," referring to a type of e-cigarette that is popular among young people but is new enough that it was not specifically named (as other brands were) in questions for the 2017 National Youth Tobacco Survey.
The FDA and the Federal Trade Commission, Gottlieb said, have sent written warnings to manufacturers and distributors of the liquids used in e-cigarettes, as well as to retailers who carry these products, aiming to halt what the agencies call "false or misleading labeling and/or advertising that cause them to resemble kid-friendly food products such as juice boxes, candy or cookies, and some of them with cartoon-like imagery."
Furthermore, the statement noted, "We're also adding JUUL as a specific e-cigarette example in future tobacco use surveys to ensure we're accurately capturing patterns of youth use of e-cigarette products."
Calls for Research, Regulation
Much evidence is already in. A research letter(truthinitiative.org) published April 18 in Tobacco Control notes that just 25 percent of people who recognized JUUL and 37 percent of recent JUUL users understood that the product always contains nicotine. And a 2016 surgeon general's report(www.cdc.gov) cautions that any form of nicotine is unsafe for youth.
In April, the Academy outlined its position on ENDS products in a letter(3 page PDF) to the FDA that called on the agency to undertake "more robust research" on the health effects of these devices.
The AAFP's letter reminded the agency that "many manufactures are still not currently required to submit the ingredients list to the FDA," a loophole that "could result in unsafe and inconsistent levels of nicotine and other chemicals within each cartridge."
The Academy told the FDA: "The tobacco industry should respond to the same regulatory forces that govern other similar industries and should not be able to choose the amount of regulation they accept. Further, the FDA should have authority to regulate the manufacture, sale, labeling, distribution and marketing of tobacco products and nicotine delivery devices."
Related AAFP News Coverage
AAFP Voices Support for FDA Tobacco Regulation
Academy Comments on Tobacco Flavors, Cigars, Nicotine in Cigarettes