September 27, 2019 03:13 pm News Staff – For decades, the AAFP has championed tobacco prevention and cessation efforts and encouraged family physicians to advocate on this issue at every opportunity. These efforts have undoubtedly borne fruit over the years, but with every day seeming to bring a new headline about rising teen use of e-cigarettes or more cases of life-threatening lung injury linked to vaping, it can be difficult to perceive the very real progress being made.
Given the events of recent days, however, it's clear the message is getting through at the highest levels.
Citing remarks President Donald Trump and federal health officials made Sept. 11 about the continuing increase in adolescents' use of e-cigarettes, particularly flavored products, the Academy praised the administration's announcement that it will "take decisive action by severely curtailing access to flavored e-cigarette products."
In a Sept. 20 letter signed by (then) AAFP Board Chair Michael Munger, M.D., of Overland Park, Kan., the AAFP called for the swift removal of all flavored e-cigarettes, including mint- and menthol-flavored products, from retail brick-and-mortar stores and online outlets.
According to HHS Secretary Alex Azar, the FDA intends to "finalize a guidance document that would commence enforcement to require that all flavors, other than tobacco flavor, would be removed from the market."
"We would allow tobacco flavoring to remain, subject to their filing -- the manufacturers of the tobacco-flavored e-cigarette products -- filing for premarket tobacco approval with the Food and Drug Administration to assure that the availability of their product is consistent with the public health under the standards set by the Tobacco Control Act."
Products removed from the market under this action, Azar noted, would be allowed to apply for reentry via a similar regulatory pathway but would be subject to the same rigorous standard.
"The AAFP urges the U.S. Department of Health and Human Services and the Food and Drug Administration to quickly implement this plan to help reverse the current youth e-cigarette epidemic," the AAFP said in its letter.
Just days later, the Academy joined more than 50 health professional, consumer advocacy and other stakeholder groups in petitioning both the president and the first lady to follow through on the Sept. 11 announcement despite any resistance tobacco manufacturers and distributors might put up.
"We urge you to reject tobacco industry pleas to weaken your proposal," the groups wrote. "It is critical to issue the revised compliance policy as announced on September 11, which included a prohibition on all non-tobacco flavors, including mint and menthol."
Citing a more than 20 percentage point rise between 2017 and 2019 in the proportion of high school e-cigarette users who reported using mint and menthol flavors -- to nearly 64% -- as well as a dearth of evidence that these flavors play any role in helping adults quit smoking, "there is no public health justification to exempt them from any policy proposal," said the groups. "If the goal is to remove the e-cigarettes that are most attractive to youth, any proposal that ignores mint and menthol flavors falls short."
In conclusion, they stated, "We must do everything we can to prevent e-cigarettes from becoming an on-ramp to nicotine addiction for a generation of youth. We strongly support your proposal to swiftly remove all non-tobacco flavored e-cigarettes from the marketplace and urge you to move forward to implement this proposal without delay."
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