A new National Institutes of Health-funded study published Tuesday said that menthol flavoring is one of the least popular e-cigarette flavors among teenagers, amid speculation that the Trump administration may not include menthol in the flavored e-cigarette ban it proposed in September.
That proposal cleared the White House Office of Management and Budget on Monday afternoon, which is the last step before public release.
Representatives from anti-smoking groups and the tobacco industry who met with OMB on Monday speculated that the administration would soon release guidance from the Food and Drug Administration that will detail how manufacturers and retailers should comply with the flavor ban.
The study published on Tuesday in the Journal of the American Medical Association was based on an NIH-backed “Monitoring the Future” survey, which asks 8th, 10th and 12th graders about their tobacco, alcohol and drug use.
Of the approximately 42,500 participants in the nationally representative survey, one-third was asked additional questions about their preferred flavors of the popular e-cigarette brand Juul.
Among those 14,191 respondents, 18.8 percent reported nicotine vaping in the past 30 days. About two-thirds of those people reported using Juul.
Menthol was preferred by less than 6 percent of 12th-grade Juul users, and was even less popular in younger grades. In all grades, an average of less than 2 percent of vapers said their favorite flavor was tobacco.
Forty-seven percent of 12th-grade Juul users said their preferred flavor was mint, followed by 24 percent who said mango. Similar proportions of 10th graders preferred mint and mango, while 8th-graders preferred mango to mint. Those who used Juul on 20 or more days in a month were more likely to prefer mint than those who vaped less frequently.
The survey was administered from February to June 2019 — after Juul’s November 2018 decision to stop selling flavors like mango and fruit in brick-and-mortar stores. Physical stores continued to sell tobacco, mint and menthol flavors, while the fruit flavor sales continued online until last month. Flavors of other similar e-cigarette products are still widely available, except in a handful of states that have banned them.
“The current findings raise uncertainty whether regulations or sales suspensions that exempt mint flavors are optimal strategies for reducing youth e-cigarette use,” the study’s authors wrote.
When the ban was initially announced in September, the FDA said that a growing share of young users are trying menthol or mint flavors, citing data from the 2019 National Youth Tobacco Survey, which has not yet been fully released.
Among the 27.5 percent of high school students who reported vaping nicotine in the past 30 days, 63.9 percent reported using menthol or mint flavors, up from 51.2 percent the year before.
Meanwhile, the number of users reporting fruit flavors dropped to 65.9 percent in 2019, down from 75.5 percent in 2018.
“These products are still getting to kids and we cannot let a whole generation get addicted to them through mint and menthol and other flavors,” Health and Human Services Secretary Alex Azar said when the ban was first proposed.
Allowing menthol-flavored e-cigarettes to stay on the market could help Juul preserve a big chunk of its sales, and might provide a loophole for them to sell the popular mint flavor by another name, according to former FDA Commissioner Scott Gottlieb.
“If menthol is exempted from a flavor ban on e-cigs, Juul will immediately re-name their candy mint flavor (the top flavor preferred by kids) to ‘menthol plus’ and sell it as a menthol,” Gottlieb said in a series of tweets on Saturday.
He said that the FDA likely doesn’t have the power to stop Juul from making that change, and argued that the administration should pursue an earlier proposal that would have limited flavor sales to stores with age-verification protocols.
That policy was still under review when Gottlieb left the FDA in April and the Trump administration opted for the more aggressive flavor ban when it became clear that youth e-cigarette use was continuing to climb.
“The March 2019 policy to restrict the sale of flavored e-cigs in convenience stores, but allow them in adult only vape shops, was aimed at preserving the adult segment for adult smokers seeking to quit, while taking products most widely used by kids out of the leakiest channel,” Gottlieb wrote.
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