25: FDA’s E-Cigarette Review

Jeffrey Ekoma, ASTHO’s Director of Government Affairs, discusses the FDA’s move to delay a decision on marketing applications for some flavored e-cigarette products; Melissa McGrath, Chief of Staff for the Council of Chief State School Officers,...

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Jeffrey Ekoma, ASTHO’s Director of Government Affairs, discusses the FDA’s move to delay a decision on marketing applications for some flavored e-cigarette products; Melissa McGrath, Chief of Staff for the Council of Chief State School Officers, explains how state education and public health officials are working to create school-focused mental health programs; and we share details of ASTHO’s next Insight and Inspiration event in October.

ASTHO News Release: Prohibiting menthol in cigarettes and cigars will improve the public’s health

ASTHO Policy Statement: Tobacco use prevention and control position statement

ASTHO Event: Insight and Inspiration series

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This is Public Health Review Morning Edition for Tuesday, September 14th, 2021. I'm Robert Johnson.

Here's today's news from the Association of State and Territorial Health Officials.


It'll be at least a few more weeks before we know whether the FDA will ban e-cigarettes made by some of the larger manufacturers, including JUUL.

Last week, the agency announced it had rejected hundreds of thousands of applications, but postponed decisions about others. The delay means some of the most popular products will continue to be available to kids.

Jeffrey Ekoma is ASTHO's director of government affairs. He's thinking about the FDA's decision and the way forward in today's morning conversation.

The FDA has rejected applications for nearly a million flavored e-cigarette products, but the applications from some of the larger manufacturers like JUUL remain undecided.

What’s ASTHO’s take on the FDA's approach so far?


Yeah, I think like many other, you know, public health leading and facing organizations and advocates, I think we were really waiting for the FDA to sort of close this matter, considering how long it's taken to sort of reach where we are now.

I think the decision for the FDA really was, you know, can manufacturers of e-cigarettes, you know, are they able to put forth enough evidence leaning towards the benefits of their products to adult smokers and that those products sort of outweigh the risk to youth?

And I think what's coming is that, that isn't the case with so many applications being denied.

But ultimately, I think we're really waiting for what's going to happen with manufacturers that have the largest market share, because those are the products that we know that are really being marketed and targeted towards youth.

And I think the decision that sort of came forth last week is concerning just because we know that youth are using these products. And until there is a clear decision on those, I think that will ease a lot of the tension that exists between sort of what's happening in the rate of youth that use e-cigarettes.


Because every day that goes by is another day when a kid could get hooked on these products, right?


Correct. And I think, you know, we even saw sort of pre-COVID, there were a lot of kids who were being impacted by lung injuries, right?

So, I think we want to make sure that we're continuing to not get to that point again where children are really largely impacted by this because of the marketing practices of companies.

And although they're marketed towards adults, they are also indirectly—and sometimes directly, as well—being marketed to youth.


The FDA did issue a statement last week and it said it expects to take more actions in the coming weeks.

Do you have any sense for what we might expect out of the FDA in the coming weeks?


Yeah, I think that a lot of that remains unclear.

I think in their press release and sort of the statements from key leadership at the FDA is, although they intend to continue to do this, I don't think they've set forth an actual date where we can look forward to. And I think that does raise concerns for advocates.

With respect to this, they've been very expedient with trying to get these products off the market and they're sort of doing it on a rolling basis. But there's really no target date for advocates to look forward to say, "Hey, at this moment, we know that products made by larger companies, those will be taken off the market."

And we know that it's really, there really—there's only been one application that has been approved to date and it happened with the Philip Morris product.

So, ultimately, I think for advocates, the lesser a rolling basis is done and the more firm a date is, I think, would make a lot more people that have really been fighting the fight toward ensuring that our products aren't being marketed to youths, I think that would bring forth a lot of content people in that space.


What does all of this mean for those fighting to reduce e-cigarette use among youth?


The fight continues.

I think the data backs up the claims that are being made. You know, we continue to see the use of e-cigarettes being the highest use for children and youth that are using tobacco products, right?

So, we want to continue to fight the good fight because it, although there has been progress, we want to make sure that we fully reach the progress with respect to this particular activity. With the PMTA applications that already been submitted, we just need decisions on them. And I think that we'll continue to do that

But for every advocate out there, it's continuing to fight the good fight because there has been progress, but we want to make sure that there's more and more progress as well.



Also this morning, ASTHO members are working closely with state and territorial education leaders to protect school kids from COVID-19.

Melissa McGrath is chief of staff for the Council of Chief State School Officers. She says her members are teaming with public health experts to address kids' mental health needs, finding ways to spend federal dollars on critical resources.


In states like Oklahoma, you're seeing that state invest about $35 million of its COVID relief aid to go toward a statewide school counselor corps so that they can pay about half of the cost of the salaries and benefits for mental health professionals in that state to go out to 181 of its school districts over the next three years.

You've seen other states like Ohio develop a framework of how their schools can address the whole child when those students head back into school, and that means addressing their mental health and social-emotional wellbeing needs.

So, states are addressing it in different ways.



Finally today, everyone's feeling the stress of the pandemic. ASTHO considers the topic in another Insight and Inspiration event planned for Wednesday, October 20th.

Sebastian Junger will share a vivid portrait of the impact of post-traumatic stress, comparing the experience of military veterans to the trauma endured by our frontline health professionals battling COVID-19.

Junger is a best-selling author and award-winning journalist.


Find the link for the event, along with links to everything else we covered today, in the show notes.


Also, remember to follow us on apple podcasts or Spotify, or listen on Alexa or Google assistant.

And, if you have a minute, please take time to leave us a rating and a review.


Join us tomorrow morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition.




Jeffrey Ekoma

Senior Director, Government Affairs, ASTHO

Melissa McGrath

Chief of Staff, Council of Chief State School Officers