Recently, the Centers for Disease Control and Prevention grabbed headlines with eye-popping figures on use of e-cigarettes by middle school- and high school-age children from their National Youth Tobacco Survey. The survey found that e-cigarette use among high school students tripled in the last year. It isn’t every day that the public takes note of trends in youth tobacco use. So it would be a shame if the Obama administration didn’t take some courage from that concern and attention.
Do we have reason to think they wouldn’t? After all, it can be awfully hard to find someone on the “pro” side of the argument for youth tobacco use in 2015. But federal action to move beyond cigarettes, roll-your-own tobacco and smokeless tobacco to regulate all manner of tobacco and nicotine products has been painfully slow going. The Family Smoking Prevention and Tobacco Control Act of 2009 granted authority to the Food and Drug Administration that they have yet to exercise, leaving broad categories of products unregulated, including the products that made headlines last week.
It took five years for the Obama administration to circulate draft regulations that would allow them to control the formulation and sale of what we call e-cigarettes as well as lethal combustible products such as hookah and cigars. FDA took that first step in April 2014 — the one year mark was Saturday. But still the regulations are “pending.”
It would be fair to ask at this point: Will the much anticipated regulations make a difference? That’s where last week’s CDC survey release is most illuminating. The same survey that showed a jump in e-cigarette and hookah use last week showed a more than 25 percent drop in cigarette use by high school students in just the past year. The survey was an honest to goodness tale of two trajectories. And what it says loud and clear is that regulations on cigarettes, along with clean air laws and taxes at the local and state level, and public education campaigns that speak the truth about tobacco have together driven down youth cigarette use to new lows.
So why wouldn’t we want government to take action to bring the same forces to bear on a bigger universe of tobacco and nicotine products — particularly e-cigarettes and hookah — that young people seem to be trying in ever increasing numbers? Hard to gin up an answer to that question given what we know about youth tobacco and nicotine use and the negative health effects of both on youth. And with e-cigarettes, hookah and cigars dancing on the precipice of being regulated since the FDA released draft regulations last year, perhaps the better question is: What’s the holdup?
We don’t mean to suggest the draft regulations were perfect, or even that they covered the full sweep of what’s needed to end youth tobacco use. The FDA has stayed far away from the party when it comes to regulating flavored tobacco products other than candy or fruit-flavored cigarettes that are insidiously appealing to youth, and seem to leave the impression on some young people that if a product doesn’t smell bad like a traditional cigarette it isn’t as bad for you. Hookah is a good example: Although it smells like fruit and is smoked via a water pipe, the product is the lethal smoke and carbon monoxide form of combustible tobacco. One hookah session is estimated to be the health equivalent of smoking between 50 and 100 cigarettes — that’s up to four packs of cigarettes in one sitting.
If you doubt the appeal of flavors, you need only look at menthol. Used for decades to take the bite out of cigarettes, we know that half of all young people use menthols, and in the African-American community 90 percent of all cigarette smokers use menthol products. Regulation of flavors is the obvious next step if the FDA is going to get serious about youth tobacco and nicotine use.
But first, let’s finish what they’ve started. The steep increase in youth use of e-cigarettes and hookah should reinforce how important it is that the FDA finalize the regulations that are in process and move swiftly to get them into practice. While the steep drop in cigarette use should reinforce that we can make this the generation that ends the tobacco epidemic if we harness the power of regulation, clean air laws, taxes, public education and rigorous science. If we focus, this is a problem we can fix.
Sen. Richard Blumenthal is a Democrat from Connecticut; Robin Koval is the president and CEO of Legacy.