June 26, 2018 08:57 am News Staff – On June 20, the AAFP sent the FDA letters stating the Academy's position on three separate tobacco-related issues: the use of flavors in tobacco products, premium cigars and nicotine levels in cigarettes.

The letters came in response to advance notice of proposed rulemaking (ANPRM) requests for comments by the agency on these topics. Each letter was addressed to Leslie Kux, the FDA's associate commissioner for policy, and signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala.

Citing the Academy's comprehensive position paper on preventing and treating nicotine dependence and tobacco use, all three letters stated: "The AAFP believes the FDA should have the authority to regulate the manufacture, sale, labeling, distribution and marketing of all tobacco products, including cigars of all sizes and flavors, as well as electronic nicotine delivery systems (ENDS)."

Flavors in Tobacco Products

In its letter regarding regulation of flavors in tobacco products,(3 page PDF) the Academy began by citing a robust, evidence-based study from the Campaign for Tobacco-free Kids that found flavored tobacco products of any kind appeal to youth and young adults.

"Eight out of 10 youth ages 12-17 began using tobacco with flavored tobacco products," the letter said, "and young adults ages 18-24 are significantly more likely to use flavored tobacco products than older tobacco users."

The AAFP said regulating flavors in all tobacco products could potentially decrease youth tobacco initiation rates significantly while improving health outcomes among vulnerable populations, preventing long-term addiction to tobacco products, reducing spending on tobacco-related illnesses and lowering the number of long-term tobacco users.

Noting that the Academy "supports the attainment of the highest level of health for all people," the letter urged the FDA to regulate flavored tobacco products and specifically include ENDS in these regulations.

"Finally, the AAFP calls on the FDA to closely examine the ENDS marketed under the JUUL brand," the letter added, referring to a specific type of device that utilizes a proprietary salt-based nicotine e-liquid formula and recharges via a USB port, according to the product's website. "These ENDS are touted as a way to quit smoking; however, … there is only anecdotal evidence supporting successful use of ENDS as cessation devices, and the stronger evidence suggests they are getting more people to start using nicotine than to stop.

"The AAFP strongly urges the FDA to regulate JUUL devices and pods, other ENDS, and tobacco flavors."

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