Youth tobacco survey shows illegal flavored e-cigarettes are still the most popular

Caption

Esco Bar disposable vaping pen devices are displayed, Monday, June 26, 2023, in Washington. The number of electronic cigarette devices sold in the U.S. has nearly tripled since 2020, driven almost entirely by a wave of unauthorized disposable vapes from China, according to sales data obtained by The Associated Press. Recently U.S. health regulators have begun trying to block imports of several of the biggest brands, including Elf Bar and Esco Bar.

Credit: AP Photo/Andrew Harnik

While celebrating what is considered a public health win in the fight against youth tobacco use, the U.S. Food and Drug Administration is warning and fining manufacturers, distributors, importers, and retailers of illegal e-cigarettes, especially those most used by teenage smokers.

Overall, the Centers for Disease Control and Prevention’s 2023 National Youth Tobacco Survey report is good news, said FDA Center for Tobacco Products Director Brian King.

Among U.S. high school students, current overall tobacco product use declined from 16.5% to12.6% last year. That number represents roughly 580,000 fewer high school students who reported using of e-cigarettes. Declines in current use were observed for cigars as well as overall combustible tobacco smoking, representing all-time lows.

"That said, it wasn't all good news," King said. "We also did see a slight increase in overall tobacco product use among middle school students. So it's a good reminder that we've got to redouble our efforts to make sure we continue that downward trajectory of tobacco product use among all kids in the coming years."

King noted the slight uptick in overall tobacco use among middle school students did not correlate with an increase in any specific product use.

"Ultimately, when you look at the high school student data and the middle school student data together, it was still a net gain in terms of hundreds of thousands of fewer kids using (tobacco) products within the past year," King said. "Since there are, ultimately, more high school students in the country than middle school students, (we see) a slight uptick on middle (school students using tobacco products)."

Kids prefer the flavored products

About a quarter of underage smokers said they use e-cigarettes every day, nearly all of whom reported using fruit, candy, mint and menthol flavored products (89.4%).

This is the 10th year in a row that students between sixth grade and senior year said they prefer flavored, disposable e-cigarettes.

The top brands used were Elf Bar (56.7%), Esco Bars (21.6%), Vuse (20.7%), JUUL (16.5%) and Mr. Fog (13.6%), according to the FDA.

Only 23 e-cigarettes, products, and devices have been approved for sale, none of which are flavored.

"We are taking action to remove illegal products from the marketplace," King said. "And that includes a variety of different actions, including warning letters, as well as the round of civil money penalties we issued."

In September, the FDA announced civil money penalty actions against more than a dozen retailers for the sale of unauthorized Elf Bar/EB Design e-cigarettes and sent hundreds more warning letters to retailers for selling the same products.

Taxing tobacco can slow youth use

Though the FDA has the authority to regulate manufacturing, marketing and sale as part of a comprehensive approach to reducing underage tobacco use, actions must be taken at the state and local level as well, King said.

"There have been studies over many years showing that places that increase price, whether that be through taxation or minimum price laws, see corresponding declines in the use of products," King said.

So far efforts to do that in Georgia have failed. Tobacco taxes here remain some of the lowest in the nation. 

The state tax on a pack of cigarettes has not changed since former Gov. Sonny Perdue was in office, 20 years ago.

Over the past two decades, Georgia received more than $3 billion from its share of The Tobacco Master Settlement Agreement money related to lawsuits against the four largest tobacco companies.

The purpose of the settlement money is to reduce smoking, especially among young people, which in turn reduces Medicaid health care costs paid by the state.

The state brought in $150 million in fiscal year 2019, but lawmakers that year used 80% of the settlement money to pay Medicaid for direct health care in the federal/state program, Georgia Health News reported.

Georgia owes Medicaid $650 million a year for health care costs directly related to smoking, Georgia Budget and Policy Institute analyst Danny Kanso said in 2020.

"We can get to an adequate level where right now we're only raising about $230 million a year from those 450 million packs of cigarettes that are sold," he said. "We could bump that number up significantly to at least cover the direct costs associated with smoking and to help fill part of that hole in our budget."

Research shows smoking harms the entire body — not only the lungs. Georgians who use tobacco are also more vulnerable to stroke and vascular disease, said Dr. Michelle Au, who represents District 50 in the state House.

Not raising the tax on cigarettes amounts to a tax on nonsmokers, Au said.

"Taking care of the health care costs of patients who do smoke amounts to something like $900 per household," Au said. "So, this is money that we are paying because of our high smoking rates, and it basically amounts to a subsidy incentivizing bad health behaviors."

Au initially proposed House Bill 191 to raise Georgia’s tax on cigarettes from 37 cents to $1.91 a pack, but the bill stalled after criticism from opponent like the Georgia Association of Convenience Stores, which represents about 2,200 stores in the state.

Rep. Jason Ridley, who represents Georgians in the northwest corner of the state, near Alabama and Tennessee, argued the state would lose money if smokers crossed state lines to buy their tobacco.

He suggested that raising the tobacco tax is a "tax on the poor."

"If everybody quit smoking, then it don't generate any income; that's where I'm getting lost," Ridley said. "How is it generating any income?"