Leadership

Flavored e-cigarettes pose dire threat to youth and public health

Keeping candy- and fruit-flavored e-liquids and e-cigarettes out of the hands of young people will help prevent a lifetime of nicotine addiction.

By
Bruce A. Scott, MD , President
| 4 Min Read

AMA News Wire

Flavored e-cigarettes pose dire threat to youth and public health

Jan 29, 2025

The facts are clear: Tobacco products cause cancer. Overwhelming evidence demonstrates that multiple types of cancer are linked to tobacco products, including e-cigarettes, and that the longer someone uses these products the greater their health risks become. That’s why it is critically important that we prevent candy- and fruit-flavored flavored e-liquids and e-cigarettes from being marketed to young people, as evidence shows early use of these addictive products is more likely to trigger long-term or lifetime use.

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That prevention is at the heart of FDA v. Wages and White Lion Investments LLC, a case pending before the U.S. Supreme Court. The AMA joined 10 other leading medical, public health and community groups in filing an amicus brief (PDF) in this case that supports the Food and Drug Administration (FDA) decision to deny marketing approval for certain flavored e-cigarette liquids. The brief also urges justices to overturn an appellate court ruling that the FDA did not follow proper procedures in doing so. A decision is expected this term. 

Led by the AMA, the nation’s physicians have waged a public battle against tobacco use since the 1960s, when evidence in peer-reviewed medical journals first linked cigarettes to lung cancer and heart disease.

The use of tobacco in various forms remains the nation’s leading cause of preventable death. According to the Centers for Disease Control and Prevention (CDC), it claims the lives of 1,300 Americans every day, or about one in every five deaths annually. As an ear, nose and throat surgeon in Louisville for more than 30 years, I’ve seen up close the devastating damage that cigarettes and e-cigarettes cause—mouth and throat cancers that too often change lives forever or end lives prematurely. 

The case now before the Supreme Court is rooted in a 2009 law that gave the FDA the authority to regulate tobacco and other products containing nicotine. Under that law, the FDA can ban all types of vaping devices unless it can be shown that a particular product is more likely to cause more existing smokers to quit than it would be to induce new users to take up vaping and thus become addicted to nicotine.

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The introduction of e-cigarettes—aka vapes, vape pens or electronic nicotine delivery systems—in the early 2000s proved particularly popular with young people. Spurred by their manufacturers’ market research, newer e-cigarettes offer a greater variety of liquid and flavor options and sleek, highly colorful product designs that appeal to youthful users.

The defendants in this case produce and sell a range of flavored e-liquids under teen-friendly names such as “Chewy Clouds Sour Grape,” “Killer Kustard Blueberry,” “Juice Man Crème Brulee” and “Vapetasia Pink Lemonade.” Do these sound like products targeted to help current adult smokers quit, or to tempt youths to start vaping?

Worse yet, these products include more concentrated nicotine-delivery systems. The threat that nicotine addiction poses to young people is as grave as it is undeniable. People under 25 are at greater risk from nicotine due to its effects on the developing brain, particularly in the areas of impulse control, attention span and the ability to learn. 

The U.S. surgeon general has determined that nicotine use during adolescence can prime the brain for further addiction to other drugs. The FDA tells us that making flavored tobacco and nicotine-bearing e-liquids available to teens and young adults encourages initial use while setting the stage for lifetime nicotine addiction, disease and death.

The AMA and our amicus brief partners believe the FDA acted properly to ban these and other products marketed by the defendants, and did so by following the 2009 law’s directive to remove products that threaten the health and well-being of young people without a sufficient countervailing benefit to adult cigarette smokers.

While the FDA has not acted as quickly as it could have to take nicotine-containing products made to taste like candy, fruit or sweet desserts off the market, its market denials for more than a million of these products have helped reduce vaping and other tobacco use by teens to its lowest level in 25 years, according to the CDC. Even so, an estimated 1.63 million U.S. middle school and high school students used e-cigarette products in 2023—and nearly 90% of them chose flavored products. This is not the time to retreat from the life-saving FDA actions.

AMA policy sees the use of e-cigarettes and vaping for exactly what they are: an urgent public health epidemic. We will continue to work with the FDA and other stakeholders to counteract the marketing of these products and support strict bans on their sale to minors under age 21. Continued FDA regulation of flavored e-cigarettes will improve public health and help speed the welcome decline in youthful vaping already taking place.

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