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Devin Miller

Today's guidance is a major missed opportunity to protect children from the dangers of e-cigarettes.

​Washington, DC—The American Academy of Pediatrics (AAP) opposes the guidance issued today by the Trump administration, which will allow menthol flavored e-cigarettes to remain on the market as well as all flavors for refillable tank-style products.

"Today the Trump administration failed to take the strong action necessary to address the youth e-cigarette epidemic. The guidance could have been a meaningful victory for children's health and instead is a major missed opportunity that will still leave young people at risk for addiction," said AAP President Sally Goza, MD, FAAP. "Science shows us that flavors lure children in and this guidance will allow thousands of flavors— like mango, grape, and green apple— to stay on the market in vape shops across the country for use in refillable vaping devices. As a pediatrician, I know that children like flavored products. We give children flavored medicines because they taste better. But adding a flavor to a dangerous product like tobacco is a recipe for disaster."

"Menthol e-cigarette pods made by JUUL and others will also remain on the market, giving young people an appealing flavor to easily access. The bottom line is that children are at nearly the same level of risk now as they were before this guidance came out, and that is a shame," Dr. Goza said.

An estimated 5.3 million middle and high school students currently use e-cigarettes. Use is becoming more frequent, an indicator of growing addiction. More than one-third (34.2%) of high school e-cigarette users now report using 20 or more days per month, while 18% of middle school users report such frequent use.

The Academy has long advocated for the U.S. Food and Drug Administration (FDA) to use its existing authority to appropriately regulate all e-cigarettes—including removing menthol and other flavored products from the market—and has successfully sued the agency for allowing these products to remain on the market without public health review by FDA. In November, Dr. Goza attended a meeting at the White House to outline pediatricians' concerns over e-cigarettes to President Trump and other administration officials.

"We are in the midst of a public health emergency. E-cigarettes risk addicting an entire generation of young people to nicotine," Dr. Goza continued. "Pediatricians are reporting their teenage patients are putting e-cigarettes under their pillows so they can vape overnight and parents who frantically call our offices because their children can't stop using the products. E-cigarettes are incredibly addictive to young people and leaving any flavors on the market is dangerous for children's health."

In 2019, 64% of high schoolers who used e-cigarettes reported using mint or menthol flavored products. This has spiked in recent years, up from 51% in 2018 and 42% in 2017.

Indeed, data on traditional cigarettes—for which menthol is the only flavor available— show that over half of youth smokers ages 12-17 use menthol cigarettes, compared to less than one-third of smokers over age 35. The tobacco industry also has a history of targeting African American communities with menthol products, leading to racial disparities and making African American youth more vulnerable to nicotine addiction.

"Menthol – which is an ingredient in both mint and menthol flavored products – provides a cooling sensation that masks the harsh taste of nicotine, making it easier for children to get hooked. The idea that menthol is an adult flavor is just plain wrong," said Dr. Goza.

The Academy rejects the guidance issued today. Congress must step in to prohibit all flavored tobacco products.

"We need bold, decisive action to protect young people from e-cigarettes and today's guidance falls far short of that," said Dr. Goza. "Pediatricians call on Congress to step in where the administration has failed. We will continue to do everything we can to protect our patients from tobacco and nicotine addiction."

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds.

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