FDA announces new actions to limit sale of e-cigarettes to youth

The University of Texas MD Anderson Cancer Center applauds new actions announced today by the U.S. Food and Drug Administration (FDA) to limit the sale of most flavored electronic cigarettes (e-cigarettes) to age-restricted locations and require age-verification for online sales to lower the use of these products in children. In addition, the FDA plans to restrict the marketing of these products toward youth.

"Today's actions by the FDA represent a significant step toward protecting the health of our future generations," said Peter WT Pisters, M.D., president of MD Anderson. "These flavored products often are appealing to children and adolescents, and we support measures to prevent young people from developing a lifetime of addiction to nicotine, which can lead to a variety of health problems and potentially future tobacco use."

According to data today from the Centers for Disease Control and Prevention (CDC), more than 3.6 million middle and high school students were current e-cigarette users in 2018, up more than 1.5 million relative to 2017. Recognizing this as an epidemic among young people in this country, the FDA proposed actions to curb youth appeal in September 2018.

"While we have been encouraged by the progress made in lowering tobacco use, we remain troubled by the epidemic rates of e-cigarette use among our young people," said Ernest Hawk, M.D., division head and vice president of Cancer Prevention & Population Sciences. "It's especially concerning because of the wide variety of products available, each with different ingredients and nicotine concentrations. We can't really be sure what these products contain, what they deliver to users or what the corresponding health concerns may be."

According to the U.S. Surgeon General's report on e-cigarettes, the aerosol produced by these products is not a harmless vapor, but contains a number of volatile chemicals and known carcinogens. Further, the Surgeon General has affirmed a strong association between the use of e-cigarettes and conventional tobacco products. Nicotine itself is a highly addictive chemical that can disrupt adolescent brain development, impacting learning, mood and anxiety.

Recognizing the importance of educating youth about tobacco use and its harms, MD Anderson has a variety of programs designed to prevent tobacco initiation. Researchers led by Alex Prokhorov, M.D., Ph.D., professor of Behavioral Science, developed A Smoking Prevention Interactive Experience (ASPIRE), a youth-oriented tobacco prevention and cessation curriculum. The online program is designed to provide an engaging way for teens to learn about the dangers of tobacco products. Since its web-based launch in 2008, ASPIRE has reached 100,291 students in 8 countries. In 2018, the team launched an updated version of the curriculum, including new content focused on alternative tobacco products, such as e-cigarettes and hookah.

Further, as founding partners of the CATCH Global Foundation, MD Anderson and UTHealth School of Public Health support distribution of a youth e-cigarette prevention curriculum, CATCH My Breath, to middle schools across the country.

MD Anderson also has served as a resource for statewide tobacco control policies to protect the health of future generations. Through MD Anderson's EndTobacco® program, MD Anderson collaborated with The University of Texas System to launch the system-wide Eliminate Tobacco Use initiative in 2016, which supports a variety of collaborative actions designed to advance a tobacco-free culture on all UT System campuses. This effort led to all 14 institutions of the UT System becoming tobacco-free as of June 2017.

Additionally, EndTobacco has served as an educational resource to policy makers considering actions to limit youth tobacco exposure, such as raising the minimum legal sale age for tobacco products from 18 to 21 and a law adopted in 2017 to prohibit the sale of e-cigarettes to minors under 18. EndTobacco is an initiative of the cancer prevention and control platform, part of MD Anderson's Moon Shots Program™, a collaborative effort to accelerate the development of scientific discoveries into clinical advances that save patients' lives.

"Tobacco use remains the leading cause of cancer in the United States and, unfortunately, the leading preventable cause of death," said Hawk. "We would encourage parents and educators to learn more about the health risks associated with e-cigarettes and talk to children about avoiding these products. Together, we remain committed to advancing evidence-based programs and policies that will lower current and future tobacco use, with the goal of saving lives and reducing current and future suffering from tobacco-related conditions."