Report finds 'disturbing failure' to stop underage smoking, vaping in U.S.

The legal age to buy tobacco should be raised to 21 and flavored e-cigarettes should be removed from the market, the American Lung Association says.
Image: A person smokes an e-cigarette in Brooklyn on July 8, 2018.
The American Lung Association has called for e-cigarettes to be banned from the market.Gabby Jones / Bloomberg via Getty Images

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By Shamard Charles, M.D.

Stricter enforcement is needed to stop the teen vaping epidemic, the American Lung Association said Wednesday in a scathing report that cites the failure of states and the federal government to keep underage kids away from e-cigarettes.

The annual “State of Tobacco Control” report singled out the Food Drug Administration for not taking “decisive action” to stop e-cigarette and tobacco use by teens and adolescents and to remove menthol cigarettes and flavored cigars from the U.S. market.

“This year’s report finds a disturbing failure of the federal government and states to take action to prevent and reduce tobacco use in 2018, placing the health and lives of Americans at risk, including our youth,” the American Lung Association's national president and CEO, Harold P. Wimmer, said in a statement.

The report grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use, including funding for state tobacco prevention programs and access to smoking cessation services.

The report found that:

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  • Forty-three states and the District of Columbia had failing grades regarding prevention programs.
  • Only half of the states and D.C. implemented smoke-free workplace policies.
  • Thirty-seven states and D.C. received a “C” grade or worse in providing coverage and access services that help people quit smoking.
  • Forty states were found to have inadequate policies aimed at enforcing the age of tobacco sales to those over 21 rather than the state age for sale, receiving an “F” grade in this category.

“The FDA’s failure to act has emboldened the tobacco industry, which has become increasingly aggressive in seeking to delay or oppose proven policies,” Wimmer said.

States need to raise their minimum age to purchase tobacco products to 21 and remove flavored e-cigarettes from the market, Erika Sward, national assistant vice president for advocacy for the American Lung Association, told NBC News.

In November, the Centers for Disease Control and Prevention found a 78 percent increase in vaping by high school students, translating to 3.6 million high school and middle school students now using e-cigarettes. A separate study recently conducted by the National Institute for Drug Abuse found that one-third of all high school seniors report using a vaping product.

The Lung Association's report comes on the heels of a Jan. 18 FDA meeting at which Commissioner Dr. Scott Gottlieb threatened to take e-cigarettes off the market if companies don't stop targeting underage youth.

The FDA has the authority to stop e-cigarette sales and force companies to go through a formal approval process. But the agency hasn't acted fast enough to protect kids from vaping and using tobacco, Sward said.

“As a result of the failure by the federal and state governments to act, the tobacco industry is on a resurgence,” and therefore maneuvering “to addict our kids,” Sward said.

In December, Altria, one of the leading tobacco companies, acquired a large stake in Juul, one of the biggest vaping companies.

“The FDA remains fully committed to significantly reducing tobacco-related disease and death and has made tremendous progress on this front through our comprehensive plan on tobacco and nicotine regulation — with ambitious public health goals for 2019,” the FDA said in a statement given exclusively to NBC News in response to the Lung Association's report.

“In the last year alone, the agency has advanced work to render cigarettes minimally or nonaddictive, announced historic plans to ban menthol in cigarettes and cigars, and is exploring additional product standards,” the FDA said.

The FDA also noted its recent efforts to escalate a “series of unprecedented actions” to stop teen use of tobacco products, especially e-cigarettes. It has also advanced policies to increase access to, and use of, medicinal nicotine products like patches to help users quit and has launched several adult and youth-focused tobacco public education prevention and cessation campaigns.

Nicotine is one of the most addictive substances, and studies have shown that it may be harder to quit smoking than using cocaine or opiates, like heroin. Studies also show that using nicotine can affect the developing brain of teens and adolescents.

No states received an overall “A” grade, but Sward did highlight the difference between states with better overall grades from those with worse grades.

“The states that have the highest grades are taking affirmative action to work to increase their tobacco taxes, to raise the minimum age of sale of tobacco products to 21, to put into place youth prevention programs that are evidence based and also to help smokers get the help they need to quit,” Sward said.