“Every one of my teenage patients — and even many of my preteen patients — either uses e-cigarettes or has friends who use them.”
Those were the words from Jonathan P. Winickoff, M.D., M.P.H., FAAP, who represented the Academy at a recent hearing held by a U.S. House of Representatives oversight subcommittee. The two-day hearing focused on JUUL and its role in the youth e-cigarette epidemic.
According to data from the National Youth Tobacco Survey, current e-cigarette use among high school students increased by 78% over the last year and, among those in middle school, current use rose by 48%.
For the first time, the Academy called for JUUL to be removed from the market immediately as part of Dr. Winickoff’s testimony, deeming it a “fatally flawed product.”
JUUL pods are ubiquitous, come in appealing flavors such as mint, mango and crème, and are marketed as a healthier alternative to traditional smoking. Yet, one JUUL pod contains as much nicotine as 20 cigarettes. In a crowded hearing room, Dr. Winickoff outlined these concerns to the lawmakers who make up the subcommittee.
The Academy has been pursuing a multipronged advocacy strategy to protect children and adolescents from the dangers of e-cigarettes, including JUUL. While the House hearing received national media attention and spurred a conversation among lawmakers, the AAP and its members have been working behind the scenes to make progress on the issue.
A 'failed product'
“When so much of the product that JUUL profits from ends up in the hands of children, it is time we declare JUUL a failed product,” Dr. Winickoff said in his testimony, which was picked up by CNN and NBC News.
Dr. Winickoff, a past chair of the AAP Julius B. Richmond Center of Excellence Tobacco Consortium, told lawmakers that his patients often assume JUUL is harmless and that the products emit water vapor. They are not aware that JUUL contains high levels of nicotine and that an addiction to nicotine can form in only a few days, especially since developing adolescent brains are more vulnerable to addiction. Research shows that adolescents who use e-cigarettes are 3.5 times more likely to begin smoking cigarettes than adolescents who do not use them.
“Many of my patients find JUUL nearly impossible to stop,” Dr. Winickoff said.
The Academy has been calling for urgent action to protect children and adolescents from the dangerous health effects of e-cigarettes, including JUUL. In particular, the AAP has urged the Food and Drug Administration (FDA) to regulate the products to keep them out of the hands of children. In addition, there is a lack of research on youth tobacco cessation strategies and how to treat e-cigarette dependence in adolescents.
Dr. Winickoff was clear in his testimony: “The only surefire way to eliminate e-cigarette use in adolescents is to stop it before it starts.”
An advocacy victory
A recent federal court ruling, which came out of a lawsuit filed by the Academy, the AAP Maryland Chapter, several public health and medical organizations, and individual pediatricians, marked an important victory for children’s health.
The ruling from a federal district judge in Maryland ordered that all e-cigarette manufacturers submit premarket applications to the FDA by May 2020 or come off the market. Products that miss the deadline will be subject to removal from the market, and those that do submit applications will be allowed to remain on the market for no more than a year while the FDA considers the application. Any e-cigarette that remains on the market will need authorization from FDA based on a finding that the product is in the interest of the public health.
“It is critical that FDA use this legally required review process to remove from the market products that appeal to kids and have fueled the youth e-cigarette epidemic,” the groups said in a press statement.
In 2017, the FDA delayed the required premarket review for e-cigarettes until August 2022 and allowed all products to stay on the market indefinitely during review. The federal judge ruled that this delay was illegal. While the AAP and other health groups pushed for a deadline of 120 days from the court order for manufacturers to submit applications, the groups called the new May 2020 deadline “a dramatic improvement.”
Looking ahead, there is still much progress to be made when it comes to protecting children and teens from tobacco products. In addition to monitoring the 2020 deadline for e-cigarette manufacturers, the Academy is supporting bipartisan legislation that would raise the purchase age for tobacco products, including traditional cigarettes, e-cigarettes and cigars, to 21 years old.
The AAP also is urging action to ban flavored tobacco products, including flavored e-cigarettes and cigars. These products are designed to attract youths, and banning flavors is a critical step toward stemming epidemic level use of e-cigarettes among adolescents. The AAP supports bipartisan legislation to make that possible.
In the face of this urgent public health crisis, the Academy will continue to lead advocacy efforts across all three branches of the federal government to keep children safe.