A Policy Assessment of the Family Smoking Prevention and Tobacco Control and Federal Retirement Reform of June 22, 2009
This policy assessment covers the Family Smoking Prevention and Tobacco Control and Federal Retirement Reform of June 22, 2009 (Pub.L. 111–31, H.R. 1256)
o This assessment addresses cigarette smoking harm reduction and e-cigarette use in the United States.
o Cigarette smoking is responsible for more than 480,000 deaths annually in the United States. 1
o According to a 2017 study, between 1.6–6.6 million lives could be saved in the US over a 10 year period by switching cigarette smokers to e-cigarette use (’vaping’). 2
o While we could help adult smokers reduce harm associated with combustible cigarettes, we also want to prevent smoking initiation of cigarettes and e-cigarettes in adolescents. Adolescent e-cigarette use has increased substantially since the introduction of e-cigarettes in the US market in 2007. 3 Problems arise when we compare youth who do not smoke to smoking adults. 4
o Attitudes towards e-cigarettes are evolving. In a 2016 study, adolescents falsely believed that fruit-flavored e-cigarettes were less harmful to health than tobacco-flavored e-cigarettes. 4
o Based on the latest data from the Monitoring the Future Survey, the most popular flavors of JUUL used by youth in the US mint, mango, and fruit. Very few youth use menthol. Flavor bans would be a good strategy to address the youth prevention issue. 3
o While youth prevention is important and can be enhanced with flavor bans, harm reduction in adult smokers is also an important topic to address. Roughly 80% of African American smokers smoke menthol cigarettes, versus 50% among white smokers. 5
o If flavor bans included banning menthol flavor, these policies could prevent smokers who prefer menthol from switching to a less harmful product. Preferring more e-cigarette flavors is associated with e-cigarette use frequency among adolescents but not adults. 6
Suggested Policy Adjustments
o Meaningful differences exist between adult smokers and adolescents who may initiate e cigarette use that should be acknowledged in policy development.
o A more nuanced policy is needed to address the population of adult cigarette smokers in the US who are unable or unwilling to quit, while still preventing youth from initiating e-cigarette and cigarette use.
o Flavor bans that include menthol would disadvantage smokers in minority populations who disproportionately use menthol flavor. The absence of menthol flavor would make it more difficult for adult African American smokers to switch to a less harmful e-cigarette.
o Preventing our youth from initiating e-cigarette usage is important and could be accomplished through the banning of other flavors while leaving menthol as an option for adult smokers to switch to as a harm reduction strategy.
o This report proposes to prohibit flavored vaping products with an exemption for menthol flavor.
References
1. CDCTobaccoFree. Fast Facts. Centers for Disease Control and Prevention. Published May 21, 2020. Accessed September 16, 2020. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm
2. Levy DT, Borland R, Lindblom EN, et al. Potential deaths averted in USA by replacing cigarettes with e-cigarettes. Tobacco Control. 2018;27(1):18–25. doi:10.1136/tobaccocontrol-2017–053759
3. Leventhal AM, Miech R, Barrington-Trimis J, Johnston LD, O’Malley PM, Patrick ME. Flavors of e-Cigarettes Used by Youths in the United States. JAMA. Published online November 5, 2019. doi:10.1001/jama.2019.17968
4. Pepper JK, Ribisl KM, Brewer NT. Adolescents’ interest in trying flavoured e-cigarettes. Tob Control. 2016;25(Suppl 2):ii62-ii66. doi:10.1136/tobaccocontrol-2016–053174
5. Okuyemi KS, Ahluwalia JS, Ebersole‐Robinson M, Catley D, Mayo MS, Resnicow K. Does menthol attenuate the effect of bupropion among African American smokers? Addiction. 2003;98(10):1387–1393. doi:10.1046/j.1360–0443.2003.00443.x
6. Morean ME, Butler ER, Bold KW, et al. Preferring more e-cigarette flavors is associated with e-cigarette use frequency among adolescents but not adults. PLOS ONE. 2018;13(1):e0189015. doi:10.1371/journal.pone.0189015
