Dr. Richard Feldman: More regulations needed to curb youth vaping

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Dr. Richard FeldmanWe have made significant progress in the battle against tobacco use and nicotine addiction since the 1960s, with tremendously falling rates of smoking among both adults and children.

Reducing the smoking rates and progressively making smoking socially unacceptable has been a comprehensive effort involving prevention and cessation programs, media campaigns, smoke-free air laws, increased cigarette taxation and FDA oversight. But all this progress is threatened with the introduction of e-cigarette use, commonly referred to as “vaping,” especially among youth; it’s nothing less than an epidemic among middle and high school students.

We are facing a public health crisis with the potential of new generations of youth risking lifelong nicotine addiction with eventual disease and premature death. Vaping has been demonstrated to be far from harmless and commonly also leads to tobacco use.

We are in a battle to reclaim our children from vaping. My last column focused on taxation to curtail e-cigarette use. Let’s look at another crucial action to discourage vaping among children.

In recent years, renewed attention of the public and policymakers has considerably focused on sweet-flavored vaping products that entice youth to initiate and sustain their use. Examples include gummy bear, fruit, cotton candy, menthol, peanut butter cup and cookies n’ cream.

Most flavorings were prohibited in cigarettes by federal regulation in 2009 but have been permitted in other tobacco products, including smokeless tobacco, pipe tobacco, cigars and, most worrisome, e-cigarettes. The tobacco industry knows well that these flavorings lure children into use, and their marketing continues today by the vaping industry, largely controlled by tobacco companies.

Eighty percent of youth who use tobacco products initiated with a flavored product. Seventy-two percent of youth tobacco users use a flavored tobacco product. Two-thirds of youth tobacco users report using tobacco products primarily because they come in flavors.

The Trump administration pushed for federal restrictions on flavored vaping products, resulting in legislation signed into law. What started out as appearing as a substantial and meaningful prohibition eventually resulted in federal regulation with huge gaps, which will potentially result in relatively little effect.

There are plenty of exemptions, including disposable and refillable products and e-liquids found in vaping shops. The limited restrictions apply essentially only to self-contained “closed pod” cartridges in products like Juul. Menthol flavoring is also exempted. Over 50% of children initiate and maintain their use with menthol-flavored products.

Only five states have comprehensive flavoring bans in effect to bolster the current weak federal legislation. To the credit of a number of more public-health-minded Indiana legislators, there has been genuine interest in placing a permanent ban on flavored products during past legislative sessions; it should be of no surprise that nothing was enacted.

The federal Food and Drug Administration finally stepped up to potentially restrict flavored vaping products. Recently, the FDA began to exercise its authority with the denials of applications by certain companies to market their flavored vaping products. The applications must include evidence that their products have overall public health benefits, which were lacking. How far-reaching this prohibition will be is still unknown.

Don’t assume that the recent federal legislation increasing the legal age of tobacco and vaping products to 21 will solve the problem of youth vaping. Although the action was important, just as with alcohol, youth will achieve access to these prohibited products.

Vaping products are today’s candy cigarettes. Candy cigarettes didn’t harm children’s health, but vaping is a different story.•


Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.

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