Adolescents, Young Adults, and Adults Continue to Use E-Cigarette Devices and Flavors Two Years after FDA Discretionary Enforcement

Abstract

This study assesses the use of e-cigarette devices and flavors using a large, cross-sectional survey of adolescents, young adults, and adults (N = 6131; ages 13–40 years old; Mage = 21.9) conducted from November to December 2021, 22 months after the FDA announced its prioritized enforcement policy against some flavored pod/cartridge-based e-cigarettes. We analyzed the patterns of use by age group: adolescents and young adults (AYAs) under 21 (minimum age of e-cigarette sales), young adults (21–24 years old), and adults (25–40 years old). The participants reported using e-cigarettes ever (44.2% < 21; 67.1% 21–24; 58.0% > 24), in the past 30 days (29.8% < 21; 52.6% 21–24; 43.3% > 24), and in the past 7 days (24.5% < 21; 43.9% 21–24; 36.5% > 24). Disposables were the most used e-cigarette device type across age groups (39.1% < 21; 36.9% 21–24; 34.5% > 24). Fruit, sweet, mint, and menthol flavors were popular across age groups; however, chi-squared tests for trends in proportions revealed age-related trends in past 30-day flavor use by device type. Findings suggest current AYA e-cigarette use may be higher than recorded by the NYTS 2021. The FDA, states, and localities should adopt more comprehensive restrictions on flavored e-cigarette products in order to reduce adolescent and young adult e-cigarette use.

Examining the Comprehensiveness of Amended Flavored Tobacco Product Sales Restrictions

“…A growing body of research demonstrates the role of policy comprehensiveness. While federal flavor policies have reduced tobacco product use and sales overall, menthol exemptions and major product exemptions in these policies have been followed by increased sales and use of exempted flavors and products and widened disparities 5–7,19. At the state and local levels, studies evaluating the impact of FTP sales restrictions have found that more comprehensive policies reduced flavored tobacco availability, advertising, and sales to a greater extent than less comprehensive policies 13–15.…”

“…While federal flavor policies have reduced tobacco product use and sales overall, menthol exemptions and major product exemptions in these policies have been followed by increased sales and use of exempted flavors and products and widened disparities. [5][6][7]19 At the state and local levels, studies evaluating the impact of FTP sales restrictions have found that more comprehensive policies reduced flavored tobacco availability, advertising, and sales to a greater extent than less comprehensive policies. [13][14][15] In several jurisdictions, retailer exemptions such as those for adult-only and tobacco-only retailers have led to increased tobacco retailer density, increased disparities in flavored tobacco access, policy enforcement challenges, and continued flavored tobacco advertisement exposure in convenience stores.…”

“…The gaps in this policy have contributed to a dramatic increase in menthol e-cigarette and flavored disposable e-cigarette use among youth and young adults. 6,7 State and local jurisdictions have increasingly attempted to fill these regulatory gaps by enacting FTP sales restrictions. As of March 31, 2022, a total of 7 states, 354 local jurisdictions, and 3 Native American tribes have passed restrictions on FTPs, covering nearly 20% of the US population.…”

“…Furthermore, in 2020, the FDA issued an enforcement policy on flavored e-cigarettes, which prohibits flavors (except menthol) in pod-based devices only, permitting flavors in all disposable and refillable devices. The gaps in this policy have contributed to a dramatic increase in menthol e-cigarette and flavored disposable e-cigarette use among youth and young adults 6,7…”

The effects of dual IQOS and cigarette smoke exposure on airway epithelial cells: implications for lung health and respiratory disease pathogenesis

“…Currently e-cigarette use is at an all-time high both in adolescents and adults [ 8 ], while the vaping epidemic continues with the public being largely unaware of the detrimental effects of using new nicotine-containing products. Moreover, tobacco companies continue to introduce newer products with taglines such as “safer alternatives” or “less harmful” that are designed to have public appeal.…”