White Coat Notes

Martha Coakley, attorneys general urge FDA to regulate e-cigarettes

Massachusetts Attorney General Martha Coakley has joined the growing list of consumer and health advocates who are urging federal regulators to ban sales of electronic cigarettes to minors and to clamp down on youth-oriented advertising of the increasingly popular product.

A letter sent Tuesday to the Food and Drug Administration by Coakley and Ohio Attorney General Mike DeWine, and signed by 38 other attorneys general, urges the agency to “move quickly to ensure that all tobacco products are tested and regulated to ensure that companies do not continue to sell or advertise to our nation’s youth.”

Electronic cigarettes, known as e-cigarettes, resemble traditional smokes but use batteries to heat nicotine-laced liquid, producing a vapor that is inhaled.

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Unlike traditional tobacco products, however, there is no federal age restriction on buying or using e-cigarettes, nor are there federal rules about advertising to youth.

The three big US tobacco companies, buffeted by decades of declining sales, have recently entered the national e-cigarette market already awash in independent purveyors. The smaller companies have typically hawked their wares online, promoting them through lower-budget social media, such as Twitter and Facebook. Many health advocates worry that with big tobacco’s deep pockets, the marketing will become more aggressive, and even more youth-oriented, creating a young generation of e-cigarette smokers hooked on nicotine before researchers fully understand what risks the product may pose.

At the same time, public health officials are grappling over whether the devices are useful for consumers who are trying to kick their tobacco habit.

“Sales of e-cigarettes have grown rapidly in the United States,” the letter from the attorneys general to the FDA states. “After doubling every year since 2008, sales in 2013 are now accelerating even faster and projected to reach $1.7 billion.”

The letter also notes recent data released by the Centers for Disease Control and Prevention that found that e-cigarette use among middle and high school students has doubled since 2011.

That data found that an estimated 1.78 million students had used e-cigarettes as of 2012. That year, an estimated 160,000 students who reported ever using e-cigarettes had never used conventional cigarettes, the agency said.

The devices, often sold in flavors such as berry, peach, and vanilla, seem to entice younger customers, which health advocates worry may lead them toward tobacco cigarettes. Federal regulations have banned flavors from tobacco cigarettes, and the attorneys general urge similar action for the battery-powered devices.

The products have also attracted a following of former smokers who say the e-cigarette helped them quit tobacco.

Studies on this issue — and whether the devices pose health risks — are still pending. Because e-cigarettes are unregulated by federal authorities, it makes it difficult for consumers to know how much nicotine or other chemicals they may be inhaling. The agency has announced its intention to regulate the products as tobacco but it has not provided a time frame. Regulation would subject the products to the same standards and scrutiny as conventional cigarettes.

An increasing number of Massachusetts communities have recently joined Boston, which passed regulations in late 2011 to treat e-cigarettes like tobacco products, banning their use in the workplace and restricting their sale to adults only. A number of states, including New Hampshire, Minnesota, and Maryland, have prohibited sales to minors, while others have curbed use in public places. Massachusetts has not taken either action.

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