That use now often begins with noncombustible products, which also would be subject to the legislation's age restriction. Data from the 2018 National Youth Tobacco Survey show that e-cigarette use among high school students increased by 1.5 million students between 2017 and 2018.

The AAFP also recently signed letters in support of other possible legislative remedies to U.S. teen smoking. Collectively, the bills represent the first major federal stand against tobacco and nicotine use since the Family Smoking Prevention and Tobacco Control Act of 2009.

The Reversing the Youth Tobacco Epidemic Act, which would restrict flavored products and also raise the sale age, "takes important steps to reduce the number of young people that initiate smoking," the Academy said in an April 19 letter(1 page PDF) to the bill's sponsors, Reps. Frank Pallone, D-N.J., and Donna Shalala, D-Fla.

"We are pleased that the bill will strengthen the FDA's ability to require graphic warning labels, prohibit online tobacco product sales, ban the sale of most flavored products and limit electronic cigarette marketing to adolescents," the letter added. "The AAFP is particularly pleased with the bill's tobacco purchase limits for those aged 21 and younger."

And the Tobacco-Free Youth Act, introduced last month by Senate Majority Leader Mitch McConnell, R-Ky., and Sen. Tim Kaine, D-Va., adds to its own sale-age stipulation a measure to increase anti-smoking funding for the CDC. The Academy was among nine health and medical organizations that signed a May 21 letter(2 page PDF) praising that legislation.

"We recognize this as one among several important federal policy changes needed to address the public health crisis of tobacco use in the United States, including prohibiting the manufacture and sale of all flavored tobacco products; restricting online sale of all tobacco products, particularly to underage purchasers; and increasing funding of the prevention and cessation activities of the CDC Office on Smoking and Health," said the letter. Cosigners included the American Academy of Pediatrics, the American College of Cardiology and the American Lung Association.

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