The Food and Drug Administration's new plan to regulate electronic cigarettes contains a glaring loophole that some of the nation's most influential medical associations would like to see closed.
Under new rules announced Thursday, e-cigarette sales to minors will be banned and products sold to adults will require new safety reviews and health warnings.
But the FDA action did not include any limits on flavors, which makes e-cigarettes particularly enticing to children, doctors say. Flavorings are already forbidden in traditional cigarettes, with the exception of menthol.
"FDA passed up critical opportunities in this rule by failing to prohibit the sale of tobacco products coming in flavors like cotton candy, gummy bear and grape," Dr. Benard P. Dreyer, president of the American Academy of Pediatrics, said in a statement.
Nancy Brown, chief executive of the American Heart Assn., echoed that sentiment.
"We would have liked to see candy and fruit flavors banned outright for all tobacco products," she said in a statement.
She noted that 70% of middle and high school students who use tobacco use some kind of flavored product, according to a study by researchers from the FDA's Center for Tobacco Products and the Office on Smoking and Health at the Centers for Disease Control and Prevention.
That study, published in October in the CDC's Morbidity and Mortality Weekly Report, estimated that 3.26 million middle and high school students used a flavored tobacco product in the past 30 days. Teens who used e-cigarettes and cigars were most likely to choose some kind of flavored tobacco, the researchers said.
A separate study by researchers at the FDA, the National Institute on Drug Abuse and elsewhere found that flavorings play an essential role in persuading teens to try – and stick with – electronic cigarettes. That report, published the same month in the Journal of the American Medical Assn., found that 81% of youth ages 12 to 17 who had tried e-cigarettes opted for a flavored product their first time out. Among those who kept vaping, 85% chose flavorings on an ongoing basis.
"Flavored tobacco products are enticing a new generation of America's youth into nicotine addiction," Dr. Tom Frieden, director of the CDC, said in October. "Nicotine is not safe for the developing brain, and we must do everything we can to protect kids from a lifetime of tobacco use and nicotine dependence."
Despite the loophole concerning flavorings, medical groups praised the FDA for trying to put e-cigarettes out of the reach of minors.
"Youth use e-cigarettes more than any other tobacco product on the market today," Harold P. Wimmer, president and chief executive of the American Lung Assn., said in a statement. Vaping now serves "as an entry point to more traditional tobacco products" and places "kids at risk to the harms and addiction of nicotine and other tobacco products," he said.
Brown added that e-cigarette use by teens has tripled in just one year; "effective regulation of tobacco products" can help reverse that trend, she said.
"These new regulations will go a long way in helping to protect Americans from cardiovascular disease, the number one killer in the United States, and move us closer to becoming a tobacco-free nation," she said.
But there is still much work left to do, Dreyer warned.
The FDA action "is a welcomed starting point," he said, "but it is only a framework upon which to build meaningful regulation to end the tobacco epidemic in the United States once and for all."