Friday, April 05, 2013

American Legacy Foundation Sounds Alarm About Electronic Cigarette Use Among Young People, Calling for a Ban on Flavored E-Cigarettes, But Fails to Document a Single Youth Using These Products

In a press release issued this week, the American Legacy Foundation sounded the alarm about electronic cigarette use among young people, arguing that new data show that electronic cigarette companies are targeting youngsters with their flavored varieties. The press release concludes and recommends that the FDA ban flavored electronic cigarettes in order to protect young people.

According to the press release, entitled "FDA Should Extend Ban on Flavors to Other Products to Protect Young People" (Legacy includes electronic cigarettes among these "other products"):

"In 2009, the U.S. Family Smoking Prevention and Tobacco Control Act banned the sale of flavored cigarettes, except for menthol, largely because of their wide appeal to young people. A new study from Legacy researchers published in the American Journal of Preventive Medicine, reveals the effects of the tobacco industry’s continued efforts to sell other flavored tobacco products, such as cigars and smokeless tobacco. The study is the first to examine the prevalence of flavored tobacco products in a nationally representative sample following the 2009 ban on flavored cigarettes, and shows that flavored tobacco products remain popular among U.S. young adults aged 18-34." ...

"“While most candy-flavors – such as chocolate, vanilla and peach – were banned in 2009 from cigarettes, flavored tobacco products like cigars, hookah, snus and e-cigarettes persist in more than 45 flavors and are still legally on the market,” said Andrea Villanti, PhD, MPH, CHES, Research Investigator for Legacy. “These products can be just as appealing to young people as flavored cigarettes, offering a product appearing to be more like candy to those most at-risk of becoming lifelong tobacco users,” she added." ...

"The tobacco and e-cigarette industries deny that flavored tobacco products are aimed toward young, minority consumers; however, these study findings suggest that flavored tobacco product use was more likely in those who were younger, black, and used a menthol product. Meanwhile, it was less likely among those with lower education. “The tobacco industry is using the same marketing tactics on new products to lure new and young people to their products. We hope this research showing that it is working – and young people are using these products at high rates – will signal the FDA to extend the flavor ban beyond cigarettes, and to also include menthol flavored products in that ban” said Cheryl G. Healton, President and CEO of Legacy."

The Rest of the Story

I don't contest the American Legacy Foundation's conclusions or recommendations as they relate to flavored cigars or cigarillos. The use of such products by youth has been documented in other studies. However, I have to question the Foundation's conclusion that electronic cigarettes are being targeted towards youth and/or nonsmokers and its recommendation that flavored electronic cigarettes should be banned on the basis of the findings it reports in this study.

To be honest, when I first read the press release, based on Legacy's recommendation to ban flavored electronic cigarettes, I thought that the study found a high prevalence of flavored electronic cigarette use among youth. Then I went to the actual article and was shocked to find that the study did not find a single youth who reports using electronic cigarettes, flavored or otherwise. In fact, the study sample consisted only of adults. The subjects were young adults ages 18-34. Thus, the study fails to document a single minor using electronic cigarettes.

It is entirely possible that the young adults who are buying electronic cigarettes are using them in an effort to quit smoking. There is evidence that many young adult smokers want to quit but are not particularly enamored with the idea of using the nicotine patch or taking a drug like Chantix or Zyban. Thus, many young adult smokers have tried electronic cigarettes in an attempt to quit. The flavored versions indeed aid to the appeal of these products as a smoking cessation aid.

How the American Legacy Foundation can call for a ban on flavored electronic cigarettes based on these data - which merely show that some young adults are using these products - is beyond me. First show me at least one youth who is using flavored electronic cigarettes. Then we can begin a discussion about whether this is a substantial problem and whether it is appropriate to promulgate a ban on the product. But to justify such a regulation, you need to provide scientific evidence that this is a problem among youth.

Again, I don't contest Legacy's findings or conclusions regarding traditional smokeless tobacco products because there is evidence that a significant proportion of youth are using those products. But to lump electronic cigarettes in with these other "actual" tobacco products is not evidence-based. It is just another example of how Legacy has some sort of ideological opposition to electronic cigarettes.

The article fails to disclose any conflict of interest. However, I have previously documented that Legacy has received funding from pharmaceutical companies that produce competing products to electronic cigarettes. Thus, there is a conflict of interest and it should have been reported in this article.

The bias that is apparent in the article has the appearance of being related to this conflict of interest. This makes the failed disclosure doubly problematic.

There is no evidence that electronic cigarette companies want youth to use their products. In fact, this is the last thing in the world that they want. They know that if youth begin to use these products, the future of the entire electronic cigarette industry will be in jeopardy. There is bountiful evidence that adult vapers enjoy the various flavors that are available. Banning these flavors would reduce the appeal of electronic cigarettes to adult smokers who desire to quit and therefore would substantially harm the public's health.

I do not question the need to balance the benefits of enhancing smoking cessation among adult smokers with the costs of youth beginning to use this nicotine-containing product. But show me at least one youth using the product before you call for a ban. This recommendation makes a mockery out of the idea of science-based or evidence-based policy making in tobacco control.

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