It's been more than two months since President Donald Trump announced that he would ban kid-friendly flavored e-cigarettes, and public health groups are losing patience.
But the administration has taken no action yet, fueling speculation that Trump is backing away from a ban because doing so may cost him votes next November.
"We are deeply troubled by reports that politics may be interfering with policy that would prevent children from the dangers of e-cigarettes," Nancy Brown, CEO of the American Heart Association, said in a statement.
"We remain hopeful the Trump administration will listen to the concerns expressed by the first lady and millions of parents and move forward with plans to remove all flavored e-cigarettes, including mint and menthol, from the market," the statement went on.
Other anti-tobacco advocates agreed, warning that inaction would have long-standing consequences.
"If the Trump administration backs off for political reasons, it will create a public health crisis that we will live with for decades," Matthew Myers, president of the Campaign for Tobacco-Free Kids, said.
"The rise in the use of e-cigarettes among kids is a crisis of proportions that we haven’t seen in decades," he told NBC News, adding it's the fruity and minty flavors that attract kids to vaping in the first place.
"Eliminating those flavors will eliminate the on-ramp" for kids, Myers said.
"If removing flavors is a dead issue until all the votes are counted next November, it will be a real tragedy for our nation's youth and public health. The worsening youth e-cigarette epidemic will not miraculously get better on its own," said Robin Koval, president of the Truth Initiative, a nonprofit anti-tobacco organization.
The White House has not said publicly that it's reversing course on the proposed ban.
"President Trump and this administration are committed to responsibly protecting the health of children. At this time, we are in an ongoing rule-making process, and I will not speculate on the final outcome," Judd Deere, a White House spokesman, said Monday.
The number of kids vaping nicotine has doubled in the past two years, according to research published in September. More than 25 percent of high school seniors and more than 20 percent of high school sophomores said they'd vaped within the past month. One in 11 kids in the eighth grade admitted to vaping as well.
Meanwhile, cases of severe lung illnesses linked to vaping continue to grow. The Centers for Disease Control and Prevention reported 2,172 cases last Thursday. And Monday, health officials in Louisiana reported the first such death in that state, bringing the national total to 44.
Juul under fire
In a related development, California Attorney General Xavier Becerra and Los Angeles District Attorney Jackie Lacey announced Monday they are filing a lawsuit against Juul Labs Inc. for allegedly targeting teenagers with advertisements for its e-cigarettes and downplaying the dangers of vaping.
"We’ve worked too hard, committed our hard-earned money for too long combating harmful tobacco use to stand idly by as we now lose Californians to vaping and nicotine addiction," Becerra said in a statement. "Juul adopted the tobacco industry’s infamous playbook, employing advertisements that had no regard for public health and searching out vulnerable targets."
Lacey said Juul and other nicotine product makers "must be held accountable."
"This lawsuit takes that fight to a new front, against a new threat," Lacey said.
One in 10 high schools students in and around Los Angeles reported using e-cigarettes. "That is not by chance," Los Angeles County Supervisor Janice Hahn said.
In response to an email, Juul spokesman Austin Finan said the company has not yet reviewed the complaint but insisted they are working with lawmakers and others "to combat underage use and convert adult smokers from combustible cigarettes."
Juul has pulled many of its most popular flavored pods from store shelves, including mint, fruit, mango and creme. The company still sells menthol and tobacco-flavored pods.