Partial FDA Restrictions on E-Cigarettes Not Effective in Discouraging Use among Youth, According to New Study

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Findings from a new longitudinal cohort study suggest restrictions placed by the US Food and Drug Administration (FDA) in 2020 on e-cigarette flavors and products was not effective in discouraging US youth from using e-cigarettes.

Results showed that more than 75% of youth who started or continued e-cigarette use in 2021 used flavor/device combinations and brands that were not included in the FDA’s enforcement priorities.

In January 2020, the FDA’s Center for Tobacco Products (CTP) released enforcement guidance that “prioritized enforcement efforts against ‘any flavored, cartridge-based ENDS [electronic nicotine delivery system] product (other than a tobacco- or menthol-flavored ENDS product),’” wrote study authors in JAMA Network Open. The CTP’s enforcement guidance was published to dissuade children and young adults from using these products, which have gained popularity in the past several years.

In the original 2020 enforcement guidance, the CTP excluded disposable and tank e-cigarette products, however, in July of the same year, the agency issued warning letters to several disposable e-cigarette brands that called for the removal of their “youth-appealing e-liquid products from the market,” wrote first author Karin A. Kasza, PhD, a researcher in the department of health behavior at Roswell Park Comprehensive Cancer Center in Buffalo, New York, and colleagues.

To determine whether e-cigarette use among US youth changed following CTP’s prioritization enforcement efforts, investigators analyzed data from the Population Assessment of Tobacco and Health (PATH) study, which examines tobacco use among persons aged ≥12 years in the US.

For the current study, Kasza and coauthors analyzed PATH data collected in 2019 and 2021, before and after the CTP’s e-cigarette enforcement, among participants aged between 12 and 17 years, according to the study.

The main outcomes were transitions in e-cigarette use, flavor/device combination used, brand used, nicotine use, and frequency of use between 2019 and 2021 among a longitudinal sample of 9088 participants aged 12-17 years in 2019, and the prevalence of e-cigarette use, flavor/device combination used, and brand used in 2019 (n=8771) and 2021 (n=5574) among those aged 14-17 years in each year.

According to the results, among the 9088 participants aged 12-17 years in 2019, the majority were boys (51%) and approximately 15% were Black, 24% Hispanic, 76% non-Hispanic, 69% White, and 16% another race.

FINDINGS

E-cigarette initiation. Researchers observed that among youth aged 12-17 years who did not use e-cigarettes in 2019 (n=8315), 6.5% (n=531) initiated use in 2021 (95% CI 5.9%-7.1%); among them, 76.8% (n=415) initiated with a combination other than a sweet cartridge (95% CI 72.2%-80.8%).

E-cigarette continuation. Among participants aged 12-17 years who used e-cigarettes in 2019 (n=773), 47.8% (n=360) continued use in 2021 (ie, used e-cigarettes during the past 30 days in 2019 and during the past 30 days in 2021). Researchers observed that continuation rates were similar among youths who used sweet-cartridge e-cigarettes (n=144 [51.5%]) and those who used any other known flavor/device combination (n=204 [47.6%]) and were lower among those who did not know the flavor/device combination that they used (n=12 [24.6%]) in 2019.

E-cigarette flavor/device combination switching. Among participants who continued to use e-cigarettes in 2021, 84% (n=121) of those who used sweet-cartridge e-cigarettes in 2019 switched to a different combination, according to the study results.

“These findings provide what is to our knowledge the first longitudinal evidence that CTP’s partial e-cigarette enforcement efforts left open an avenue through which youth continued use of flavored e-cigarettes through using devices not covered by the enforcement guidance,” wrote authors.

“Restrictions and enforcement efforts that only cover a subset of products do not appear to be associated with preventing youth flavored e-cigarette use,” concluded Kasza et al.

Reference: Kasza KA, Hammond D, Reid JL, Rivard C, Hyland A. Youth use of e-cigarette flavor and device combinations and brands before vs after FDA enforcement. JAMA Netw Open. 2023;6:e2328805.