Restricting Flavors in ENDS Could Have Repercussions Beyond Youths’ Use.

Introduction:
This text is a summary of the current state of e-cigarette regulations, focusing on the Food and Drug Administration (FDA) guidance on removing flavored, cartridge-based electronic nicotine delivery systems (ENDS) from the market. The summary will cover the background of the FDA guidance, the key points of recent studies, and the main message of the text regarding the potential unintended consequences of the FDA guidance.

Key Points:

* The FDA guidance is a response to the reported increase in youth vaping, but estimates of past-month youth vaping vary.
* The FDA guidance targets Juul's flavored, cartridge-based ENDS, but excludes other types of e-cigarettes and THC products.
* Recent studies suggest that the major drivers of youths' ENDS use are curiosity and peer influence, not flavors.
* There are potentially more effective approaches to tackle youth vaping, such as marketing and access restrictions and improved enforcement of existing regulations.
* Many adults have used flavored ENDS to transition away from smoking, and removing this "off-ramp" could prevent additional adults from quitting and prompt some former smokers to resume smoking.
* The prohibition of popular flavored ENDS could lead to the emergence of an illicit market, with potentially deadly consequences.
* Countries where alternative, reduced risk products are widely available have seen rapid reductions in smoking prevalence.
* The greatest health impact any policy or regulation can have is to substantially reduce cigarette use.

Main Message:
The main message of the text is that the FDA guidance on removing flavored, cartridge-based ENDS from the market may not effectively address the issue of youth vaping, and could have unintended consequences, such as pushing consumers to the black market or preventing adults from quitting smoking. The text emphasizes the need for a comprehensive, risk-proportionate regulation of nicotine products that substantially reduces cigarette use and provides smokers with options for quitting. The text also highlights the importance of robust scientific evaluation of available data and public-facing messages about the limited risks of nicotine.

Erkkila BE, Kovacevic PI, Yach D. Restricting Flavors in ENDS Could Have Repercussions Beyond Youths’ Use. American journal of public health. 2020;110(6):777-778. doi:10.2105/AJPH.2020.305674