The Food and Drug Administration's e-Cigarette Flavor Restrictions Have Not Gone Far Enough to Curb the Youth e-Cigarette Use Epidemic

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.