ABSTRACT
Driven by targeted marketing, high nicotine content, and the availability of flavors appealing to youths,1 past 30-day use surged among high school students from 1.5% in 2011 to 27.5% in 2019.2 To curb youth access and use, the US Food and Drug Administration (FDA) issued an enforcement policy against any flavored, cartridge-based e-cigarettes with tobacco and menthol flavor exemptions in February 2020. Because of the concern of the comparability of the August 2020 data collected during the pandemic, Hammond etal. did not assess the potential impact of the policy on the accessibility of vaping devices or e-cigarette use prevalence. Studies that exploited the variation in the comprehensiveness of flavor restrictions between state and local jurisdictions indicated a reduction in flavored and total e-cigarette sales associated with more stringent flavor restrictions.9 However, other studies have raised an important concern that reducing youth access to flavored e-cigarettes may motivate substitution of e-cigarettes with traditional cigarettes.10 Moreover, flavor is also a primary driver of e-cigarette initiation among adult cigarette smokers and may be critical for adult smokers who are otherwise unable to quit cigarette smoking to switch to a potentially safer alternative.
ABSTRACT
Over the past decade, the landscape ofyouth e-cigarette use has been dynamic.1,2 E-cigarettes have been the most commonly used tobacco product among US youths since 2014,1 and in 2019, current (past30-day) e-cigarette use prevalence reached a peak among middle-school (10.5%) and high-school (27.5%) students.3 During 2020 to 2021, the COVID-19 pandemic resulted in virtual learning for students, which impacted youth access to e-cigarettes, including from social sources;in 2020, before COVID-19 was declared a pandemic, more than half of youths who currently used e-cigarettes reported getting their e-cigarettes from a friend.3 Nonetheless, in 2021, more than 2 million US middle- and high-school students used e-cigarettes.2 POLICIES TO REDUCE YOUTH E-CIGARETTE USE Flavors remain a major driver ofyouth e-cigarette use.2 A majority of youths who currently use e-cigarettes report flavors are a reason they used the products, and, in 2021,84.7% of youths who used e-cigarettes reported using a flavored product2;the most commonly used flavor types among youths were fruit (71.6%), followed by candy, desserts, or other sweets (34.1 %);mint (30.2%);and menthol (28.8%).2 Public health concerns over youth e-cigarette use have fueled the adoption of policies focused on flavored e-cigarettes. [...]as of February 2022, seven statesand more than 300communities have enacted restrictions on the sale of at least some flavored e-cigarettes;many of these laws include mentholflavored products.4 Research suggests these local laws are associated with reduced availability, marketing, and sales of restricted products.5 However, there is variation inthe specificproducts, flavors, and store types covered by these laws.4 FACTORS THAT DIMINISH POLICY IMPACT Noncomprehensive policies, such as those that exempt certain flavors, can lead to shifts in behaviors by consumers that might diminish the policy's intended effects.5 For example, following the January 2020 national restriction on the sale of certain flavored cartridge-based e-cigarettes (excluding menthol and tobacco), increases occurred in US sales of mentholflavored e-cigarettes and disposable e-cigarettes, the latter of which were still available for sale with fruit, candy, mint, and other flavors.6 Disposable e-cigarette use increased among US youths during 2019 to 2020, and in 2020, among youths who used flavored e-cigarettes, menthol use was 34.3% among those who used disposable e-cigarettes and 48.4% among those who used prefilled cartridges or pods.3 Actions by manufacturers can diminish the impact of flavored e-cigarette restrictions. CORRESPONDENCE Correspondence should be sent to Brian A. King, PhD, MPH, Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS S107-7, Atlanta, GA 30341 (e-mail: baking@cdc.gov).
ABSTRACT
In 2020, the Centers for Disease Control and Prevention recommended the use of the National Institute for Occupational Safety and Health-certified Elastomeric Half Mask Respirators equipped with N95 or P100 respirator filter cartridges for protection against the SARS-CoV-2 viral agent, as a viable alternative to N95 filtering facepiece respirators. Additionally, the Centers for Disease Control and Prevention recommendations stated that based on current practice, it was acceptable to repeatedly use these filter cartridges for up to 12 months as a contingency capacity strategy during anticipated respirator shortages. To validate this recommendation, an investigation was undertaken in which Elastomeric Half Mask Respirators equipped with P100 respirator filter cartridges were deployed and used by healthcare professionals in clinical settings (i.e., inpatient nursing units, operating rooms) for extended periods. These filter cartridges were subsequently tested to accurately quantify their filtration efficiency and breathing resistance to determine if they continued to meet National Institute for Occupational Safety and Health's performance requirements. Findings from this investigation confirmed that an Elastomeric Half Mask Respirator when equipped with a P100 filter cartridge continues to provide a high level of aerosol filtration performance (≥99.97%) and exhibits little change in breathing resistance even after 12 months of repeated use (i.e., wear, cleaning, and disinfection between patient use and at the end of work shift) in healthcare settings.