ACP Calls for Ban on E-Cigarette Flavors, TV Ads

Marcia Frellick

April 20, 2015

The American College of Physicians (ACP) is updating its 2010 call for regulations on e-cigarettes and other electronic nicotine delivery systems (ENDS), with proposed rules that include banning flavors and television advertising.

The position paper, written by Ryan A. Crowley, BSJ, on behalf of ACP's Health Public Policy Committee, was published in the April 21 issue of the Annals of Internal Medicine.

Global sales of the products are expected to pass $50 billion by 2030, but evidence about their health effects and usefulness as a smoking cessation tool is scant and sometimes conflicting. Some experts contend they may expose bystanders to toxins. Others worry they will entice young people.

The products are currently unregulated. However, the US Food and Drug Administration has proposed that the products fall under the Family Smoking Prevention and Tobacco Control Act, which regulates cigarettes and other tobacco products.

The ACP's first recommendation supports that proposal. The second is to ban characterizing flavors from all tobacco products, including ENDS. ENDS products are available in chocolate, cotton candy, and peach, for instance.

"Tobacco use usually begins in adolescence, and tobacco companies have targeted this vulnerable and impressionable age group by offering flavored products that appeal to young palates," the author writes.

The ACP also encourages higher taxes on ENDS products, citing evidence that young tobacco users are especially likely to cut use if the price gets too high. According to the World Health Organization, " 'on average, a 10% price increase on a pack of cigarettes would be expected to reduce demand for cigarettes by about 4% in high-income countries,' with even greater reductions in low- and middle-income countries," the author notes.

In light of rapidly climbing advertising dollars spent to promote these products, the ACP recommends legislative or regulatory efforts to restrict promotion, advertising, and marketing, much like the restrictions for regular tobacco products. It also calls for a ban on television advertising. The message that should get out, especially in educational settings, the article says, is the potential risks of the products.

Other recommendations include extending clean air laws to these products and promoting more research into their effects.

"This paper is not intended to offer clinical guidance or serve as an exhaustive literature review of existing ENDS-related evidence but to help direct the College, policy-makers, and regulators on how to address these products," the author writes.

Financial support for this article was provided exclusively by the ACP. Crowley and the Health Public Policy Committee of the American College of Physicians members have disclosed no relevant financial relationships.

Ann Intern Med. 2015;162:583-584.


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