It is good news that the results of 2020 National Youth Tobacco Survey (NYTS) released today show a significant decline in youth e-cigarette use after two years of alarming increases. However, youth e-cigarette use remains unacceptably high at nearly 20 percent of high school students and more than 3.5 million kids altogether, and new data released today shows kids have shifted dramatically to menthol and disposable e-cigarettes, two categories of products that were exempted from the Trump Administration’s policy on flavored e-cigarettes earlier this year.
These results demonstrate that the Administration missed the opportunity to make far greater progress when it broke its promise to clear the market of all flavored e-cigarettes. They also show that the progress to date is fragile and can quickly be reversed unless the FDA acts now to eliminate all flavored e-cigarettes, including the menthol products and cheap, disposable e-cigarettes to which kids have rapidly migrated. The evidence couldn’t be clearer: As long as any flavored e-cigarettes are left on the market, kids will get their hands on them and we will not solve this public health crisis. With today’s deadline for e-cigarette makers to apply to the FDA to keep their products on the market, the Administration and the FDA have another chance to get this right and eliminate all flavored e-cigarettes.
The COVID-19 pandemic makes bold action even more critical. With growing evidence about the impact of smoking and vaping on COVID-19, we cannot afford more delays and half measures in protecting the health of America’s young people.
The data also contains a serious warning sign. The percentage of youth who use e-cigarettes frequently has grown every year since 2015. It is deeply disturbing that 38.9 percent of high school students who use e-cigarettes use them more than 20 days a month. The message is clear: Unless we reverse that trend quickly and decisively, we are condemning this generation of youth to a long-term addiction.
The CDC today published two new reports in its Morbidity and Mortality Weekly Report: the e-cigarette results of the 2020 NYTS and a separate study examining trends in e-cigarette sales. Taken together, the data clearly shows how kids quickly migrated to menthol e-cigarettes when mint-flavored products were removed from the marketplace and how disposable e-cigarettes, which are marketed to youth with flavors like banana ice and pink lemonade, have also grown in popularity among kids, with the market share of disposable products nearly doubling in only 10 months.
2020 NATIONAL YOUTH TOBACCO SURVEY RESULTS
The 2020 National Youth Tobacco Survey results show that e-cigarette use among high school students declined from a record-high 27.5% in 2019 to 19.6% in 2020. However, this progress falls far short of reversing the alarming increase in youth e-cigarette use since 2017, when 11.7% of high school students used e-cigarettes. The survey also shows that 82.9% of current e-cigarette users use flavored products, 37% of high school e-cigarette users use menthol products, and use of disposable e-cigarettes increased an astounding 1,000% among high school e-cigarette users and 400% among middle school e-cigarette users from 2019 to 2020. This data provides a roadmap for action by the FDA to ban all flavored e-cigarettes, including menthol and disposable products.
STUDY ON TRENDS IN E-CIGARETTE SALES
The separate study that examines e-cigarette sales data shows that flavored e-cigarettes continue to account for the majority of total e-cigarette sales. It also shows that since sales of mint and other flavored, pre-filled cartridge products were restricted, there has been a meteoric rise in the sale of both menthol e-cigarettes and flavored disposable products and, as a result, overall e-cigarette sales rose in March, April and May. This data shows that as of May 2020, menthol-flavored products account for more than half (51.6%) of total e-cigarette sales, an increase from 11.4% in August 2019. From August 2019 to May 2020, the proportion of pre-filled cartridge sales that were menthol increased from 10.7% to a whopping 61.8%, while sales of mint-flavored cartridges fell from 47.6% to 0.3%. This shift largely occurred first after Juul announced it was ending sales of its mint cartridges in November 2019 and then after the FDA implemented the Administration’s new policy prohibiting sales of flavored cartridge products except for menthol in February 2020. During the same August 2019 to May 2020 time frame, sales of disposable products increased from 10.3% to 19.8% of the e-cigarette market.
FACTORS DRIVING PROGRESS
The progress in reducing youth e-cigarette use is due to a combination of public education and cessation efforts and public policy actions, with the strongest actions taken by state and local governments. For example, Truth Initiative’s national truth youth anti-vaping public education campaign reaches millions of young people and its first-of-its kind, text message e-cigarette quit program called This Is Quitting has helped nearly 200,000 young vapers on their e-cigarette quit journeys. There has also been significant debate and progress at the state and local level and in the U.S. House of Representatives to end the sale of flavored e-cigarettes and other flavored tobacco products, subsequent to the September 10, 2019, announcement by Bloomberg Philanthropies of its new initiative to reverse the youth e-cigarette epidemic.
State and local governments have taken the policy lead along with the U.S. House of Representatives. Last fall, several state governors took emergency action to halt the sale of flavored e-cigarettes. In November 2019, Massachusetts became the first state to pass a law prohibiting the sale of all flavored tobacco products, including flavored e-cigarettes and menthol cigarettes. In first four months of 2020, New Jersey, New York and Rhode Island enacted bans on the sale of flavored e-cigarettes, and just last week California became the second state to prohibit the sale of both flavored e-cigarettes and menthol cigarettes. In February, the U.S. House of Representatives passed legislation that would prohibit all flavored tobacco products, including flavored e-cigarettes, menthol cigarettes and flavored cigars although no action has been taken by the Senate. This marks the first time that a house of Congress has voted to prohibit all flavored tobacco products.
When the Administration’s new policy was issued in January 2020, HHS Secretary Azar, FDA Commissioner Hahn and FDA Center for Tobacco Products Director Zeller each said that FDA would continue to monitor e-cigarette use trends among youth and take swift and decisive action if use patterns changed and kids were found to be using products not covered by the Administration’s new policy. The NYTS results and new sales data published today clearly make the case for just such action.
The study on e-cigarette sales was published in the CDC’s Morbidity and Mortality Weekly Report with research and support from the Centers for Disease Control and Prevention, Truth Initiative, CDC Foundation and Bloomberg Philanthropies. The data is from Information Resources, Inc., which includes data from convenience stores, gas stations, grocery stores, drug stores/pharmacies, mass merchandiser outlets, retail store chains, club stores, dollar stores, and military sales. Sales from the internet and tobacco-specialty stores, including vape shops, are not included.