Four Stores in CT Warned by FDA for Selling e-Cigarettes to Minors as Popularity, Concern Grows

The U.S. Food and Drug Administration has sent out warning letters to 40 retailers in 17 states  – including four in Connecticut - as part of a “concerted effort to ensure youth are not able to access” e-cigarettes – specifically responding to what officials describe as the “surging youth uptake” of JUUL products. According to the federal agency, those receiving the warnings in recent weeks included four Connecticut retailers: Discount Tobacco and Vape in Vernon, Mobil Mart in Waterbury, Shell/Henny Penny in Lisbon, and Smoker’s Outlet in West Hartford. The retailers were warned about selling the increasingly popular – but hazardous – products to minors.

The FDA explained that warning letters are sent to retailers the first time a tobacco compliance check inspection reveals a violation of the federal tobacco laws and regulations that FDA enforces.  During undercover buy inspections by agency representatives, “the retailer is unaware an inspection is taking place” and the minor and inspector “will not identify themselves.”

Published reports nationwide indicate that vaping is increasing rapidly in popularity with young people, especially with the most popular brand, JUUL. Its devices are tiny, and look like a pen or flash drive. When someone vapes, there is no fire, ash or smoky odor — instead, the devices heat up and vaporize a liquid or solid.  School bathrooms, where cigarette smoking was done in “secret” a generation ago, are now often referred to as “juul rooms” according to numerous reports – the nicotine fix of choice of the current generation.  A recent New York Times article prominently featured a description of the magnitude of the problem in a suburban Connecticut high school.

“The FDA has been conducting a large-scale, undercover nationwide blitz to crack down on the sale of e-cigarettes – specifically JUUL products – to minors at both brick-and-mortar and online retailers,” said FDA Commissioner Scott Gottlieb, M.D.

Gottlieb highlighted the danger – and the attraction – of the products to youth.

“We understand, by all accounts, many of them may be using products that closely resemble a USB flash drive, have high levels of nicotine and emissions that are hard to see. These characteristics may facilitate youth use, by making the products more attractive to children and teens.  These products are also more difficult for parents and teachers to recognize or detect. Several of these products fall under the JUUL brand, but other brands, such as myblu and KandyPens, that have similar characteristics are emerging.”

Businesses receiving the warning letters are directed to provide, within 15 days, “an explanation of the steps you will take to correct the violation(s) and prevent future violations (for example, retrain your employees, remove the problematic items, etc.),” the agency website points out.  In addition to federal restrictions, purchase/possession of an electronic nicotine delivery system or vapor product by persons under age 18 is prohibited in Connecticut.

The FDA also sent an official request for information directly to JUUL Labs, requiring the company to submit important documents to better understand the reportedly high rates of youth use and the particular youth appeal of these products.

Said Gottlieb: “We don’t yet fully understand why these products are so popular among youth. But it’s imperative that we figure it out, and fast. These documents may help us get there.”  The agency plans what it calls a “full-scale e-cigarette prevention effort” in the fall.

In addition, the FDA also recently contacted eBay to raise concerns over several listings for JUUL products on its website. eBay took what the agency described as “swift action to remove the listings and voluntarily implement new measures to prevent new listings” from being posted to the website.

E-Cigarettes Remain Controversial as New Federal Law, Yale Academic Study Weigh In

Even as new federal rules restricting the sale of e-cigarettes take effect, advocates in Connecticut continue to urge state lawmakers to impose tougher restrictions on electronic cigarettes and vapor products when they reconvene next year.  They warn that a growing number of young people are using these electronic delivery systems to "smoke" what could be harmful and addictive substances. The U.S. Food and Drug Administration announced rules earlier this year that will forbid e-cigarette shops nationwide from selling the products to people younger than 18 and will require staff to ask for identification that proves customers are old enough to buy.  The rules – which take effect this month - would also extend long-standing restrictions on traditional cigarettes to a host of other products, including e-cigarettes, hookah, pipe tobacco and nicotine gels. Minors would be banned from buying the products.

Teens who initially tried e-cigarettes because of their low cost had significantly stepped up their use of e-cigarettes by the time researchers checked in six months later, according to a study that senior researcher Suchitra Krishnan-Sarin, a professor of psychiatry at Yale University School of Medicine, told WebMD in an article published last week.  The low cost of the devices and the promise they can help teens quit smoking tobacco are the two strong predictors of continued use, she said.

In addition, teens who tried e-cigarettes to quit smoking were more than 14 times more likely to keep using e-cigarettes than those who did not consider this a reason to try the devices, the findings showed.  However, e-cigarettes didn't seem to help the kids quit. Four out of five teens who tried e-cigarettes to quit smoking were still puffing regular cigarettes six months later, the investigators found.

"Even though they said they were using e-cigarettes to quit smoking, it doesn't appear to have necessarily helped them," Krishnan-Sarin said.

Jennifer DeWitt, executive director of the Central Naugatuck Valley Regional Action Council, told members of the General Assembly's Public Health Committee this spring that every principal in the 12-town region her organization covers "has a desk drawer of these items that were confiscated from teens this year," including some retrofitted to smoke marijuana, the Associated Press reported.

"Tobacco is a success story for us in the overall picture of prevention. However, we will take a back-slide if electronic nicotine delivery devices continue to be available in the ways that they are currently," DeWitt said.  She said 7.2 percent of Connecticut high school students are e-cigarette users, marking a higher usage rate than all tobacco products combined.

According to the CDC, nationally, 7 out of 10 middle and high school students who currently use tobacco have used a flavored product. In addition:

• 63% of students who currently use e-cigarettes have used flavored e-cigarettes (1.6 million)
• 61% of students who currently use hookah have used flavored hookah (1 million)
• 64% of students who currently use cigars have used flavored cigars (910,000)

Beginning this month, retailers are prohibited from selling the tobacco products to those under 18, placing them in vending machines or distributing free samples, under the new FDA rules. While nearly all states already ban sales of e-cigarettes to minors, federal officials said they will be able to impose stiffer penalties and deploy more resources to enforce the law. The FDA action comes five years after the agency first announced its intent to regulate e-cigarettes and more than two years after it floated its initial proposal, according to published reports.

“Millions of kids are being introduced to nicotine every year, a new generation hooked on a highly addictive chemical” Health and Human Services Secretary Sylvia Burwell said. “We cannot let the enormous progress we’ve made toward a tobacco-free generation be undermined by products that impact our health and economy in this way.”

The CDC indicated that in 2013, more than a quarter million middle and high school students who had never smoked regular cigarettes had used e-cigarettes, a number that had grown three-fold in just two years. A high proportion of middle and high school students saw e-cigarette advertisements (in 2014) from one or more of the following four sources: retail, Internet, TV/movies, and Magazines/newspapers. Overall, 66% of Middle School Students and 71% of High School Student.

The New Haven Register reported that Dr. Roy Herbst, chief of medical oncology at the Yale Cancer Center and Smilow Cancer Hospital, said state and federal policy-makers should do more to rein in the spread of the devices.

“It didn’t go as far as we would’ve liked but it’s a good step in the positive direction and allows for more research,” Herbst said of the new federal rule. “I think now that we finally have this regulation, it will begin to stem the rapid use of e-cigarette use that is running rampant in the United States and around the world.”

CT Spending on Tobacco Prevention Goes Up in Smoke; E-Cigarettes Raise New Public Concerns

Fifteen years after the landmark state tobacco settlement in which Connecticut played a key role, the state now ranks 34th in the nation – down from 23rd a year ago - in funding programs to prevent youth from smoking and help smokers quit, according to a national report by a coalition of public health organizations.

In the current fiscal year, Connecticut is spending s $3 million on tobacco prevention and cessation programs, which is 6.8 percent of the $43.9 million recommended by the Centers for Disease Control and Prevention (CDC). Other key findings for Connecticut include:

• Connecticut this year will collect $466.1 million in revenue from the 1998 tobacco settlement and tobacco taxes, but will spend just 0.6 percent of it on tobacco prevention programs. This means Connecticut is spending less than a penny of every dollar in tobacco revenue to fight tobacco use.
• Connecticut has cut funding for tobacco prevention programs in half, from $6 million last year to the current $3 million; from 13.7 percent of the CDC recommended spending level down to 6.8 percent.
• The tobacco companies spend $78.1 million a year to market their products in Connecticut. This is 26 times what the state spends on tobacco prevention.

The annual report on states' funding of tobacco prevention programs, titled "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 15 Years Later," was released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

The report comes as evidence increases that tobacco prevention and cessation programs work to reduce smoking, save lives and save money. Florida, which has a well-funded, sustained tobacco prevention program, reduced its high school smoking rate to just 8.6 percent in 2013, far below the national rate.  One study found that during the first 10 years of its tobacco prevention program, Washington state saved more than $5 in tobacco-related hospitalization costs for every $1 spent on the program.

In Connecticut, 15.9 percent of high school students smoke, and 2,900 more kids become regular smokers each year, the organizations in the coalition pointed out. Tobacco annually claims 4,700 lives and costs the state $1.6 billion in health care bills, officials said.

"Connecticut once again is one of the most disappointing states when it comes to protecting kids from tobacco and needs to increase its investment in tobacco prevention," said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. "Tobacco prevention is a smart investment that saves lives and saves money by reducing tobacco-related health care costs. States are being truly penny-wise and pound-foolish when they shortchange tobacco prevention programs."

In 1997, when the settlement was announced, then-Attorney General Richard Blumenthal - a key negotiator in the tobacco settlement talks – described the accord as “a sweeping public health initiative to protect children from the lure of tobacco, save lives, and reimburse states for billions of taxpayer dollars spent on tobacco-related illnesses.”

The national report assesses whether the states have kept their promise to use a significant portion of their settlement funds – estimated to total $246 billion over the first 25 years – to fight tobacco use.  The states also collect billions more each year from tobacco taxes. Tobacco use is the number one cause of preventable death in the U.S., killing more than 400,000 people and costing $96 billion in health care bills each year.  Nationally, about 18 percent of adults and 18.1 percent of high school students smoke.

The report reveals that most states are failing to adequately fund tobacco prevention and cessation programs. Key national findings of the report include:

The states this year will collect $25 billion from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it – $481.2 million – on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.

States are falling woefully short of the CDC's recommended funding levels for tobacco prevention programs.  Altogether, the states have budgeted just 13 percent of the $3.7 billion the CDC recommends. Only two states – Alaska and North Dakota – currently fund tobacco prevention programs at the CDC-recommended level.

Public Expresses Concern Over E-Cigarettes

Within days of the report on tobacco prevention efforts, a national survey reflected public concerns about a new and increasingly popular alternative to traditional cigarettes, called e-cigarettes.  Adults nationwide are concerned about the use of e-cigarettes by children and teens, with 44 percent indicating worries that the devices will encourage kids to use tobacco products, according to a new poll from the University of Michigan.

According to the latest University of Michigan Mott Children's Hospital National Poll on Children's Health, nearly half of parents are concerned their child will try e-cigarettes, which are battery-operated devices that look like cigarettes but don't burn tobacco.  E-cigarettes have replaceable cartridges of liquid containing nicotine, which is inhaled as a vapor along with flavors like chocolate, fruit, candy or even tobacco.

"This poll shows high levels of concern about e-cigarettes and the possibility that kids who try them could start smoking tobacco," says Matthew M. Davis, M.D., M.A.P.P., director of the C.S. Mott Children's Hospital National Poll on Children's Health.

In the poll, which was administered in November 2013 to 2,124 adults age 18 and over, arguments were presented both for and against e-cigarettes.  Then adults were asked for their opinions about the devices and possible regulations and laws.

Advocates of e-cigarettes say they are a healthier alternative to tobacco smoking and argue it may help smokers to quit.  Critics counter that e-cigarettes may have health risks and may encourage people and kids or teens to smoke tobacco. Currently, e-cigarettes are not regulated by the U.S. Food and Drug Administration. Twenty-six states have regulations prohibiting sale to minors; Michigan's legislature currently has bills pending that prohibit those sales.

In the poll, 86% of adults said they have heard of e-cigarettes, while only 13% have ever tried one. Among parents, 48 percent said they are very or somewhat concerned that their children will try e-cigarettes.  Meanwhile, 65% of adults think e-cigarettes should have health warnings like tobacco cigarettes and nicotine products.

Adults also expressed widespread support for new laws regarding e-cigarettes: 88% think manufacturers should be required to test e-cigarettes for safety and 86% favor prohibiting the sale of e-cigarettes to minors. 71% of adults support restricting the marketing of e-cigarettes on social networking sites.

"E-cigarettes are a relatively new product, with little information about safety or long-term health effects. However, the public is clearly aware of the devices and concerned about their impact, according to this month's poll results," says Davis, who is professor of pediatrics and internal medicine at the U-M Medical School and professor of public policy at U-M's Gerald R. Ford School of Public Policy. "In 2010, the poll also asked about e-cigarettes and at that time only one-third of adults had heard of the product. In this poll, that number jumped to 86 percent."

Earlier this year, CT by the Numbers reported that state Attorney General George Jepson and U.S. Senator Richard Blumenthal were among those calling for regulation of e-cigarettes.