About 3.6 million youth in the United States reported current e-cigarette use in 2020, reflecting a decline from 5.4 million in 2019, according to the National Youth Tobacco Survey (NYTS) conducted in partnership with the US Food and Drug Administration.
Meanwhile, the FDA moved into action against vaping businesses that have not complied with a new Pre Market Authorisation system that came into effect on 9 September 2020, aimed at clamping down on vaping products that it considers too appealing to young people, writes VapingPost.
The US Centers for Disease Control and Prevention (CDC), in collaboration with various partners, released two papers on 9 September in its Morbidity & Mortality Weekly Report (MMWR) highlighting recent changes in US e-cigarette use and sales. ‘Current use’ refers to e-cigarette use in the past 30 days.
The survey also found that the types of e-cigarette products young people are using has shifted Among youth e-cigarette users, pre-filled cartridges remained the most commonly used product type; however, disposable e-cigarette use has increased 1,000% among high school students and 400% among middle school students since 2019.
NYTS findings also showed that most (eight in 10) current youth e-cigarette users reported using flavoured e-cigarettes. While the use of fruit and mint flavoured e-cigarettes was common among users in 2020, the use of menthol flavoured e-cigarettes was also prominent.
“Although the decline in e-cigarette use among our nation’s youth is a notable public health achievement, our work is far from over,” said CDC Director Dr Robert R Redfield. “Youth e-cigarette use remains an epidemic, and CDC is committed to supporting efforts to protect youth from this preventable health risk.”
These findings were consistent with a second report released on 9 September in the Morbidity & Mortality Weekly Report, which assessed trends in US e-cigarette sales.
Pre-filled cartridges remain the leading type of e-cigarettes sold, but disposable product sales increased within the past year. Moreover, among pre-filled cartridge sales, menthol flavoured products comprised more than three-fifths (61.8%) of all flavoured products sold.
Disposable e-cigarette use rises, popular flavours
The CDC and FDA analysed data from the 2020 NYTS, a survey of US middle (grades 6-8) and high (grades 9-12) school students conducted during 16 January to 16 March 2020.
In 2020, 19.6% of high school students and 4.7% of middle school students currently used e-cigarettes, a decline from 27.5% and 10.5% respectively in 2019.
Consistent with 2019 findings, pre-filled pods/cartridges were the most commonly used device type among youth e-cigarette users. However, from 2019 to 2020, disposable e-cigarette use increased from 2.4% to 26.5% (1,000%) among high school e-cigarette users and from 3.0% to 15.2% (400%) among middle school e-cigarette users.
A majority of youth e-cigarette users reported using flavoured e-cigarettes in 2020, including 82.9% of high school e-cigarette users and 73.9% of middle school e-cigarette users.
Among high school students who currently used any type of flavoured e-cigarettes, the most common flavours were fruit (73.1%); mint (55.8%); menthol (37.0%); and candy, desserts or other sweets (36.4%). Among middle school students, the most common flavours were fruit (75.6%); candy, desserts, or other sweets (47.2%); mint (46.5%); and menthol (23.5%).
Second study – Trends in sales
For the second study the CDC, in collaboration with the CDC Foundation and Truth Initiative, analysed retail scanner data during 14 September 2014 to 17 May 2020 to assess trends in US e-cigarette sales.
The retail sales data are consistent with the NYTS data. While pre-filled cartridges remained the leading product type sold, disposable sales increased from 10.3% in August 2019 to 19.8% of total sales by May 2020.
Among pre-filled cartridge sales, the proportion of mint sales declined beginning in August 2019, and by May 2020, menthol (61.8%) dominated the market.
What more can be done about youth tobacco use?
“These findings reinforce the importance of continuing to focus on the strategies that work to reduce youth tobacco product use while keeping pace with emerging trends in tobacco products,” said Dr Karen Hacker, Director of CDC’s National Center for Chronic Disease Prevention and Health Promotion.
“Implementing these strategies at the national, state and local levels is integral to preventing and reducing youth tobacco product use, including e-cigarettes.”
In addition to regulating the manufacturing, marketing and sale of e-cigarettes by FDA, strategies to reduce e-cigarette use among youth include: increasing price, implementing comprehensive smoke-free policies that include e-cigarettes, restricting young peoples’ access to e-cigarettes, licensing retailers, developing educational initiatives targeting young people, curbing youth-appealing marketing, and implementing strategies to reduce youth access to flavoured tobacco products.
FDA issues warnings to businesses selling flavoured disposable vapes
The US Food and Drug Administration has issued warning letters to 10 vape businesses, insisting that they stop selling flavoured disposable vape devices and youth-appealing e-liquids, which have not yet been granted the required pre-market authorisation, writes Diane Caruana for Vaping Post on 15 September 2020.
While the recent national FDA survey in the US indicated a significant drop in teen vaping rates, the report also showed an increase in the use of disposable e-cigarettes, which is believed to result from the fact that the ban on flavours vaping exempts disposable products.
Before the release of this data, the FDA had already sent warning letters to 10 vape businesses including Cool Clouds Distribution Inc (doing business as Puff Bar), asking them to remove flavoured disposable e-cigarettes off the market since they do not have the required pre-market authorisation. These actions are part of the agency’s efforts to remove from the market products that it considers appealing to teens.
“The FDA continues to prioritise enforcement against e-cigarette products, specifically those most appealing and accessible to youth,” said FDA Commissioner Stephen M Hahn.
“We are concerned about the popularity of these products among youth and want to make clear to all tobacco product manufacturers and retailers that, even during the ongoing pandemic, the FDA is keeping a close watch on the marketplace and will hold companies accountable.”
E-cigarette Use Among Middle and High School Students – United States, 2020
Morbidity & Mortality Weekly Report. Early release on 9 September 2020.
Teresa W Wang, Linda J Neff, Eunice Park-Lee, Chunfeng Ren, Karen A Cullen and Brian A King.
The use of any tobacco product by youths is unsafe, including electronic cigarettes. Most e-cigarettes contain nicotine, which is highly addictive, can harm the developing adolescent brain, and can increase risk for future addiction to other drugs.
E-cigarette use has increased considerably among US youths since 2011. Multiple factors have contributed to this increase, including youth-appealing flavours and product innovations.
Amid the widespread use of e-cigarettes and popularity of certain products among youths, on 6 February 2020, the FDA implemented a policy prioritising enforcement against the manufacture, distribution and sale of certain unauthorised flavoured prefilled pod or cartridge-based e-cigarettes (excluding tobacco or menthol).
In 2020, 19.6% of high school students (3.02 million) and 4.7% of middle school students (550,000) reported current e-cigarette use.
Among current e-cigarette users, 38.9% of high school students and 20.0% of middle school students reported using e-cigarettes on 20 or more of the past 30 days; 22.5% of high school users and 9.4% of middle school users reported daily use.
Device types and flavours
Among all current e-cigarette users, 82.9% used flavoured e-cigarettes, including 84.7% of high school users (2.53 million) and 73.9% of middle school users (400,000).
Among high school current e-cigarette users, the most commonly used device type was prefilled pods or cartridges (48.5%; 1.45 million), followed by disposables (26.5%; 790,000), and tanks (14.8%; 440,000). Among middle school current e-cigarette users, the most commonly used device type was prefilled pods or cartridges (41.3%; 220,000), followed by tanks (21.5%; 110,000), and disposables (15.2%; 80,000).
Among high school students who currently used any type of flavoured e-cigarettes, the most commonly used flavour types were fruit (73.1%; 1.83 million); mint (55.8%; 1.39 million); menthol (37.0%; 920,000); and candy, desserts, or other sweets (36.4%; 910,000). Among middle school students who currently used any type of flavoured e-cigarettes, the most commonly used flavour types were fruit (75.6%; 290,000); candy, desserts, or other sweets (47.2%; 180,000); mint (46.5%; 180,000); and menthol (23.5%; 90,000).
Among current users of flavoured prefilled pods or cartridges, the most commonly used flavour types were fruit (66.0%; 920,000); mint (57.5%; 800,000); menthol (44.5%; 620,000); and candy, desserts, or other sweets (35.6%; 490,000). Among current users of flavoured disposable e-cigarettes, the most commonly used flavour types were fruit (82.7%; 650,000), mint (51.9%; 410,000); candy, desserts or other sweets (41.7%; 330,000); and menthol (23.3%; 180,000).
Need for continued prevention strategies
In 2020, approximately one in five high school students and one in 20 middle school students currently used e-cigarettes. By comparison in 2019, 27.5% of high school students (4.11 million) and 10.5% of middle school students (1.24 million) reported current e-cigarette use.
Although these data reflect a decline in current e-cigarette use since 2019, 3.6 million US youths still currently used e-cigarettes in 2020, and among current users, more than eight in 10 reported using flavoured e-cigarettes.
Consistent with 2019, prefilled pods or cartridges were the most commonly used device type in 2020; however, during 2019-2020, disposable e-cigarette use increased approximately 1,000% (from 2.4% to 26.5%) among high school current e-cigarette users and approximately 400% (from 3.0% to 15.2%) among middle school current e-cigarette users.
Although use of fruit flavoured e-cigarettes was common among users in 2020, findings also suggest prominent menthol e-cigarette use, including among nearly one half of flavoured prefilled pod or cartridge users and one quarter of flavoured disposable product users.
Comprehensive implementation of evidence-based strategies at the national, state and local levels, in coordination with FDA regulation, can prevent and reduce youth tobacco product use. Strategies to address factors driving youth e-cigarette use are particularly critical.
In addition to FDA’s enforcement policy that prohibits the sale of prefilled pod or cartridge-based e-cigarettes in any flavour other than tobacco or menthol, several states and communities have restricted all flavoured e-cigarette sales, including menthol.
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[link url="https://www.cdc.gov/mmwr/volumes/69/wr/mm6937e1.htm"]E-cigarette Use Among Middle and High School Students – United States, 2020[/link]
E-cigarette Use Among Middle and High School Students – United States, 2020