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Tobacco

Tobacco Group Takes Stance on E-Cig Flavors

NATO says bans not the answer to teen vaping

LAKEVILLE, Minn. -- Proponents of flavored-tobacco bans suggest that the existence of flavored tobacco products causes teenagers or young adults to initiate or continue tobacco use; however, there is no scientific basis for such a conclusion, and prohibiting the sale of flavored tobacco products will not solve the issue of youth tobacco use.

Teenagers begin to use tobacco for many reasons. They naturally want what adults have, whether that be using tobacco products, consuming alcohol, experimenting with drugs or engaging in other adult behavior. These are behaviors that teenagers engage in, whether caused by peer pressure, experimentation, curiosity, assertion of independence or any number of other reasons. At the same time, a body of research points to peer relationships and brain development in teenagers as a key factor in teen behaviors and suggests teens are more susceptible to influence by their friends and have a strong need not to be excluded by those in their peer group. This influence and aversion to exclusion combine to affect teen behavioral choices to fit in with and not be rejected by their peers.

The U.S. Centers for Disease Control and Prevention (CDC), Atlanta, biannually quantifies these activities in its Youth Risk Behavior Surveillance Survey (YRBSS) of high school students. The 2017 YRBSS results show that 19.5% of high school students said they had used some kind of tobacco product on any given day, even a single puff, in the most recent 30-day period prior to the survey. Similarly, 29.8% of youth reported that they had consumed alcohol products in the same period. Bearing in mind that legal age to purchase and consumer alcohol 21 nationwide, and that in 41 states (including Minnesota) the legal age to purchase and use tobacco legal is 18, this is a significant finding because being of legal age does not prevent youth from engaging in these otherwise adult behaviors.

The survey also indicates that slightly more high schoolers (19.8%) said they had used marijuana in the 30 days prior to the survey, even though it is a product that is federal contraband everywhere for all age groups and illegal for all under most states’ laws.

Use of tobacco products by underage youth should also be considered in their long-term context. Past 30-day high school cigarette use has declined from 12.7% to 2.6% since 1991; cigar use from 22.0% to 8.0% since 1997 (its first survey year); and e-cigarette use from 24.1% in its first survey in 2015 to 13.2% in the 2017 survey. These statistics show tobacco use in any form is in a long-term decline among high school students.

From this survey data, two conclusions can be reached. First, a small and declining number of youth are using tobacco products of any kind, flavored or otherwise. Second, the scientific evidence does not support the assumption and claim by advocates that flavors, rather than other factors, cause teens to use tobacco products. Since the National Association of Tobacco Outlets (NATO), Lakeville, Minn., began monitoring local tobacco ordinances in 2012, to our knowledge not one single local government that has considered restricting flavored tobacco products has also suggested the need for a ban of flavored alcohol products, even though more underage youth drink alcohol than use tobacco products. This is despite the fact that for virtually every flavored tobacco product, there is an identical flavored alcohol product. In short, there is no evidentiary basis that adding flavors to tobacco products is the reason why teens use tobacco.

Another important study sponsored by the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH) results in a similar conclusion. This study, called the Population Assessment of Tobacco and Health (PATH) Study, is a long-term study of 46,000 people ages 12 and older that is tracking tobacco use and behaviors. The first set of data from the PATH Study, known as Wave 1 data, found that among 12- to 17-year-olds, 1.8% said they used flavored cigars; among young adults 18-24, that figure was 3.9%. In either case, the use of flavored cigars is a very small percentage of young people who use tobacco products. That is, at this point, the data from the PATH Study does not support a conclusion that flavors actually cause tobacco use.

Proponents claim that because young people report that they use flavored tobacco products, then flavors in cigars must have caused them to try cigars; however, no study has asked young people why they started to use flavored tobacco products. Rather, the questions are more basic, such as whether or not they use flavored tobacco products and which products are used. This is significant because a correlation is not the same thing as causation, and to suggest that because a small percentage of underage persons used flavored tobacco products, given the many reasons that might cause them to experiment with tobacco products, it does not follow that the flavors are the reason why they use tobacco.

Moreover, a blanket flavor ban is contrary to the scientific evidence that does exist. The FDA’s Office of Science has recognized that some flavors in tobacco products are not likely to appeal to youth. In a process that approved the marketing of certain flavored smokeless tobacco products, the Office of Science said, “The proposed products are reported to have flavors such as mint, wintergreen or tobacco character with citrus. While flavored smokeless tobacco products are a potential concern of youth initiation, these proposed flavors are consistent with traditionally available [smokeless tobacco] flavors and are not novel flavors that likely increase appeal to youth.”

This finding from the FDA’s Office of Science demonstrates that a blanket prohibition on all flavors does not target youth initiation and use. 

In conclusion, local government officials should focus on responding to the underlying causes of risky teenager behavior rather than adopting an ordinance that simply bans all legal tobacco products. A policy that outright prohibits flavored tobacco products is not necessarily the solution to the issue of minors using tobacco. Instead, understanding youth behavior and continuing to educate youth as to why they should not initiate tobacco use may be the more prudent and, ultimately, the more successful approach.

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