Tobacco use

FDA to restrict most e-cigarette flavors

The Food and Drug Administration on Thursday announced restrictions on the sale and manufacturing of all flavors of e-cigarette pods except tobacco and menthol (Source: “FDA to enact scaled-back e-cigarette flavor ban,” Modern Healthcare, Jan. 2, 2020).

FDA Commissioner Dr. Stephen Hahn said the policy was intended to limit youth e-cigarette use but maximize the potential benefit to adults trying to quit smoking combustible cigarettes. The flavor restrictions do not apply to tank vaping systems found at vape shops that HHS officials said are more often used by adults.

The Trump administration in September indicated it wanted to ban all e-cigarette flavors besides tobacco. Campaign for Tobacco-Free Kids President Matthew Myers said the exceptions were concessions to the vaping industry and vape shops that had furiously lobbied to water down the flavor ban.

"By leaving menthol flavored e-cigarettes widely available and completely exempting liquid flavored products, this policy will not stop the youth e-cigarette epidemic," the group said in a statement.

HHS officials justified leaving menthol-flavored e-cigarette pods on the market by pointing to the 2019 Monitoring the Future survey, which showed less than 1% of frequent youth e-cigarette users surveyed in the 10th grade most often used the classic tobacco flavor, compared to 4.8% who preferred menthol. Mint was the most popular flavor at 52.1%.


Congress approves raising age for tobacco, e-cigarettes to 21

The U.S. House and Senate have now passed a provision that would ban the sale of tobacco and e-cigarettes to anyone under 21 (Source: “Congress Approves Raising Age to 21 for E-Cigarette and Tobacco Sales,” New York Times, Dec. 19, 2019).

The rule comes at a time when Congress and the Trump administration are facing public pressure to reduce the soaring rates of teenage vaping. President Trump has spoken in favor of increasing the age limit, and is expected to sign the measure into law as part of the overall spending package.

Nineteen states, including Ohio, and more than 500 cities and towns have already raised the age to 21. Setting it as a national age limit is viewed as an effort to appease those who are calling for a full ban on e-cigarettes or a flavor ban to prevent addicting a new generation to nicotine.

While many lawmakers and public health experts welcomed a higher age limit for sales of cigarette items, others argue that tougher enforcement of sales laws, as well as higher taxes on products, are also needed to deter teenage use.

Doctors and public health experts have long been concerned about the effects of nicotine on the teenage brain. The National Academy of Medicine has estimated that 90% of adult smokers first start the habit before turning 19, when developing brains are most vulnerable to nicotine addiction. In a 2015 study, the academy reported that banning legal access to those under 21 would spur a 12% reduction in tobacco use by the time current teenagers became adults; with the biggest impact among 15-to-17-year olds.


Tough anti-vaping laws could have unintended public health consequences, experts warn

As new restrictions at the local, state and federal level are poised to wipe out thousands of fruit-, candy- and dessert-flavored vapes that have attracted teens, experts who study tobacco policy fear the scattershot approach of the clampdown could have damaging, unintended consequences, including driving adults who vape back to cigarette smoking, which remains the nation’s leading preventable cause of death (Source: “Clampdown on vaping could send users back toward cigarettes,” Associated Press via ABC News, Oct. 5, 2019).

“This could take us from potentially the single biggest improvement in public health in the United States toward a public health disaster in which cigarettes continue to be the dominant nicotine product,” said Jonathan Foulds, an addiction researcher and tobacco specialist at Penn State University.

The policy debate underscores the challenge of finding the right regulatory scheme for e-cigarettes, products for which there is little high-quality research.

More than 30 countries prohibit vaping products. In contrast, the United Kingdom has fully embraced them as a public health tool, urging doctors to promote them to help smokers quit. The U.S. FDA has been struggling to find the right approach since it gained authority over e-cigarettes in 2016.

Further complicating the picture is the fact that no e-cigarette brand has yet been shown to help smokers quit in rigorous studies. But large-scale surveys suggest smokers who use e-cigarettes daily are up to six times more likely to quit than those who don’t use them.


Teen vaping use continues to climb, new national study finds

About 25% of high school seniors surveyed this year said they vaped nicotine in the previous month, up from about 21% the year before (Source: “Teen vaping of nicotine jumped again this year, survey finds,” Associated Press, Sept. 18, 2019).

The University of Michigan study was published online Wednesday by the New England Journal of Medicine. Researchers surveyed more than 42,000 students across the country in grades 8, 10 and 12.

The study also found cigarette smoking declined in high school seniors, from about 8% to 6%. The researchers have not reported how many students said they vaped marijuana.

A government survey released last week showed similar trends.


Ohio to spend $4.1 million to combat youth e-cigarette use, feds mull banning all vaping products

The Trump administration and the Ohio Department of Health both shared new plans to reduce youth vaping, amid an urgent public health investigation into 450 cases of lung illness across the U.S. associated with e-cigarettes (Source: “Ohio to spend $4.1M on initiatives aimed to fight youth vaping,” Dayton Daily News, Sept. 11, 2019).

Dr. Amy Acton, director of the Ohio Department of Health, announced $4.1 million in new initiatives to prevent youth vaping. President Trump said Wednesday that his administration is working on a plan to ban all non-tobacco-flavors from vaping products.

State and local public health officials in Ohio have confirmed that 10 reports of severe pulmonary illness are likely due to vaping and are investigating an additional 14 reports of illness. In 33 states, the CDC says that it’s aware of more than 450 possible cases of severe pulmonary illness after vaping and six deaths.

The DeWine administration has already worked on several initiatives to curb teen vaping. This includes raising the purchase age to 21 starting Oct. 17 and placing an excise tax on e-cigarettes, which in the past were not subject to an excise tax. Raising the price of tobacco through an excise tax is an evidence-based way to reduce consumption.


Michigan to become first state to ban flavored e-cigarettes

Gov. Gretchen Whitmer of Michigan said Wednesday that her state would be the first to outlaw the sale of flavored e-cigarettes, part of a national crackdown on vaping amid a recent spike in illnesses tied to the products (Source: “Amid Vaping Crackdown, Michigan to Ban Sale of Flavored E-Cigarettes,” New York Times, Sept. 4, 2019).

Whitmer said the decision came in response to increased e-cigarette use among teenagers and marketing that she said targeted youths.

The move in Michigan is part of a wave of growing pressure from politicians around the country for more regulation of e-cigarettes and their use by teenagers. Several state attorneys general have called for the federal government to ban flavored e-cigarettes, and bills to stop sales of flavored vaping products have been introduced in California and Massachusetts.

In recent weeks, public health agencies have reported a number of serious illnesses believed to be tied to vaping, including a death in Illinois, raising questions about the products’ safety at any age. This week, Oregon health officials said they were investigating the death of another person, who had used a vaping device containing cannabis. The health department in Milwaukee and the Illinois attorney general have issued statements urging people not to use e-cigarettes. This year, San Francisco became the first American city to ban the sale of the products.


New state budget raises Ohio smoking age to 21

Ohioans must wait until age 21 to legally buy cigarettes, cigars, vape pens and other tobacco products, under a provision in the state budget bill signed Thursday morning by Gov. Mike DeWine (Source: “Ohio raises legal smoking age to 21,” Cleveland Plain Dealer, July 18, 2019).

The new law also applies to rolling papers, filters, blunt wrappers, liquids and other accessories involved with smoking or vaping. DeWine on Thursday vetoed a provision that would have phased the higher age in for anyone who turns 18 years old before Oct. 1.

The state budget also creates a new tax on vaping products assessed at 10 cents per milliliter.


U.S. Senate committee Oks bill aimed at lowering health costs

The U.S. Senate health committee approved a package of bills this week aimed at lowering the cost of medical care, from ending surprise medical bills to curbing prescription drug price surges, with a rare bipartisan vote that could vault it toward final passage (Source: “With Rare Comity, Senate Panel Advances Bills to Lower Health Costs,” New York Times, June 26, 2019).

The cost-cutting legislation is a priority of Senator Lamar Alexander of Tennessee, the health committee chairman who will retire next year and is seeking a victory after his bipartisan plan to stabilize the ACA insurance markets failed last year.

The new package includes a plan to eliminate surprise medical bills, which have become a hot political cause this year, targeted by President Trump and lawmakers from both parties. It also addresses the rising cost of prescription drugs, with a set of provisions that limit pharmaceutical companies’ ability to protect monopolies on the drugs they sell.

Other proposals seek to chip away at the opacity around medical prices, a goal that Mr. Trump also seized on with a new executive order this week intended to require insurers, doctors and hospitals to inform patients how much their care will cost before they receive it. The package also includes a measure from Senator Mitch McConnell of Kentucky, the majority leader, to raise the smoking age in every state to 21 from 18.


U.S. Senate takes up tobacco 21 legislation

Senate Majority Leader Mitch McConnell, whose home state of Kentucky was long one of the nation’s leading tobacco producers, introduced bipartisan legislation Monday to raise the minimum age for buying any tobacco products from 18 to 21 (Source: “Senate GOP leader would raise age for buying tobacco to 21,” Associated Press, May 20, 2019).

The chamber’s top Republican, who said he was making enactment of the bill “one of my highest priorities,” issued his proposal at a time when the use of e-cigarettes is growing and underage vaping has soared, raising concerns by health experts. The measure would apply to all tobacco products, e-cigarettes and vapor products and was co-sponsored by Sen. Tim Kaine, D-Va., whose state has also been a major tobacco producer.

Ohio Gov. Mike DeWine recently introduced a similar proposal to raise the legal age for tobacco purchases. Fourteen states, including Arkansas, California and Virginia, have enacted laws raising the minimum age for tobacco sales to 21, according to the anti-smoking Campaign for Tobacco-Free Kids. So have 470 municipalities, including New York City, Chicago, Boston and Minneapolis.


DeWine details plans to raising smoking age

Gov. Mike DeWine and his top administrators on Wednesday called for Ohio to increase the purchase age for tobacco and vape products to 21 (Source: “Gov. DeWine issues warning on vaping, wants to raise smoking age,” Dayton Daily News, April 17, 2019).

“This is a public health crisis,” DeWine said.

In his proposed two-year operating budget, DeWine included a provision to raise the tobacco purchase age, including vape materials, to 21. The current purchase age is 18, although more than 30 Ohio cities have passed local ordinances setting the age at 21.

Ohio ranks in the bottom quartile for adult smoking and children living in a household with a smoker, according to HPIO’s recently released 2019 Health Value Dashboard. Analysis of the rankings found that tobacco use and secondhand smoke exposure contribute to many of Ohio’s greatest health challenges, including infant mortality, cardiovascular disease, cancer and asthma.