Teen vaping has skyrocketed in just a few years: Between 2017 and 2018, the share of high school students using e-cigarettes rose by 78 percent, to one in five. Unlike other tobacco products, e-cigarettes have not been subject to a government health and safety review because of multiple decisions by FDA delaying that review. At long last, the FDA now says it wants to end this regulatory limbo, and move up a deadline for manufacturers to show that their products meet basic standards by two years – requiring action in 10 months, rather than by 2022.
Even that is too long to wait.
When the FDA assumed oversight of the e-cigarettes in 2016, it gave manufacturers until 2018 to apply for review, at which point the agency would evaluate the products’ design, ingredients, health risks and impact on youth use. Shortly after President Donald Trump took office, the agency moved that deadline back four years. In the meantime, manufacturers could continue to advertise and sell products already on the market. The thinking was that e-cigarettes could serve as a stop-smoking aid for adult smokers, or at least as a safer alternative to traditional cigarettes. “We must recognize the potential for innovation to lead to less harmful products,” the FDA’s then-director Scott Gottlieb said in 2017.
The problem is that while the evidence on adult substitution is ambiguous, the growing threat to teenagers is not. Young people have taken up vaping in vast numbers: As of last year, more than 3 million high schoolers and 500,000 middle schoolers were using e-cigarettes. In December, the surgeon general called youth vaping an “epidemic,” noting that since 2014 e-cigarette use has overtaken traditional smoking among children. Public-health advocates fear the rise could reverse years of progress in cutting youth smoking rates.
E-cigarettes are not harmless. In the U.S., many contain sky-high levels of addictive nicotine – often three times above the legal limit for Europe. There’s strong evidence that they are habit-forming; that most contain potentially toxic substances; that they may cause cardiovascular damage; and that shoddy products can explode and cause injury. Research also suggests that e-cigarette use increases the risk that young people will go on to smoke traditional cigarettes.
The FDA’s proposed new 10-month deadline came after the American Academy of Pediatrics and other public-health groups sued the agency over the issue, and a federal judge ruled in their favor. The political landscape is changing, too: Vaping is now the subject of multiple congressional investigations, and San Francisco recently banned the sale of e-cigarettes until the FDA reviews their safety. Belatedly, a new consensus is emerging: Youth e-cigarette use is a serious public-health concern.