Could e-cigarettes be banned altogether?
Alarmed by a 78% increase in e-cigarette use among teens, FDA Commissioner Scott Gottlieb, MD, said they could be banned outright if manufacturers don’t take steps to limit marketing to young people. The FDA announced a number of proposals last fall to reduce sales to teens, such as eliminating flavors that appeal to kids and not marketing them to children.
Gottlieb and U.S. Surgeon General Jerome Adams, MD, recently answered questions about their efforts to stem the skyrocketing increase in popularity among teens. The conversation was edited for brevity.
WebMD: Should the FDA consider raising the legal age for e-cigarettes from 18 to 21?
Gottlieb: If Congress wanted to take action we would work with them on that for sure. … I think there’s growing interest on Capitol Hill in exploring this. I think it would … cut down the availability of these cigarettes to kids.
Adams: It’s important for folks to understand, too, that there’s federal levers, there’s state levers, and then there’s local levers. And so Dr. Gottlieb and I are working to use our federal levers, but that doesn’t mean in the meantime that states and localities shouldn’t or can’t look at look at tobacco 21 policies on their own, look at regulatory and retail policies and enforce them.
WebMD: Is there evidence that secondhand vaping is as much of a risk as secondhand tobacco smoke?
Adams: Personally I would say it’s not been studied well enough yet. It’s going to be less harmful in general than exposing folks to combustible tobacco, but less harm does not equal harmless. And again, if folks are vaping marijuana then the dynamic changes substantially. I think it’s just a best practice to not use these products in a enclosed space around other people.
WebMD: What about plans for a broader public health campaign about e-cigarettes?
Gottlieb: We launched the first-ever campaign [in the] fall focused exclusively on e-cigarette use by kids. … It was the second-highest campaign we’ve ever put forward in terms of shaping perceptions. … But we are very carefully targeting it to kids. … We don’t want this advertising to bleed into the adult population and discourage adults from using these products. So we very carefully targeted to children and the ads are out there and we think that they’re going to have an impact…
We saw a 78% rise last year, we’re going to see another rise this year. There’s no question it’s going to go up before it starts coming down. We can’t turn this around on a dime. But if you ask me what’s the most impactful thing we can do over a short period of time, it’s going to be the youth campaigns, the education and probably enforcement action. The regulatory tools that we put in place to restrict access, they’re going to be slow to get into place and they’re going to be slow to have their effect.
Adams: He and the FDA are really, really trying to find the right balance between leaving this option open for adults. They could have just put this ad out and blasted it everywhere, but they very specifically said ‘No, we’re not going to do that.’ We’re only going to target youth using the technology that we have available because we don’t want to scare adults away from these products.
Gottlieb: It was a 78% increase last year. … If we see a 40-to-50% increase this year, I’m not sure you’re going to still have the popular support among the political class and just regular consumers to allow these products to be maintained in the market. … I see an existential threat to this entire product category. And if the trends continue to go up I could see a day when these products come off the market entirely, not necessarily by us, but by congressional action and by popular demand of consumers who are tired of seeing kids use these products. In fighting to try to reduce the youth use we’re also fighting to try to preserve access for the adults who can benefit from these products — currently addicted adult smokers.
Adams: The biggest message for consumers is to have a conversation with your young people. … I’ve talked to my kids about it around the dinner table. Just start that conversation on a local level and realize again that there are unique things that can only happen at the community level, in the house, in the community and the schools to help turn this around.