Comment from New Orleans Health Department

RE: FDA-2026-D-1817 Dear FDA Leaders: The undersigned urge you to reconsider guidance that would allow certain Flavored Electronic Nicotine Delivery Systems (ENDS) for premarket applications, and to maintain the prohibition on all flavored ENDS, for the following reasons: Over the last decade, communities across the United States have experienced a surge in youth tobacco use, largely traceable to the explosion of flavored e-cigarette products that have entered the market. These items, flavored like fruit candy and sold in bright colors, have proven to be highly appealing to middle and high school children. Even flavors considered to have “lower youth appeal,” such as cinnamon, coffee, tea, mint, or spices, still pose a significant risk and are not an appropriate safeguard against exposure, because less popular flavors can still attract youth populations (1). For example, the CDC found that more than 1 in 5 students who reported current use of at least 1 tobacco product reported use of a menthol-flavored tobacco product(2). Flavored tobacco products also play a key role in how youth, perceive, initiate, progress and continue using tobacco products(3). Interviews with young adults have shown that many believe flavored e-cigarettes are less harmful, suggesting that flavors can distort risk perception of vapes, encouraging its use (4). By partially restricting flavored e-cigarettes, the FDA would leave the door open for youth initiation. Furthermore, it leaves a loophole for manufacturers to rebrand or market products in a misleading way, making it difficult to regulate and restrict these products. This undermines efforts to reduce youth tobacco use. As a result, the only effective way to prevent initiation from occurring is to eliminate flavored e-cigarettes altogether.(5) Not only are flavored nicotine products appealing to youth, but they are also marketed and accessible to youth, further exacerbating the public health issue.  Approximately 77% of public schools are within a 10-minute walk of at least one outlet selling tobacco(6). For schools with high concentrations of low-income students, there is an average of nearly 11 stores selling tobacco within this same distance, significantly increasing exposure (3). This saturation of products is reflected in usage patterns. According to the CDC, 90.3% of high school students and 87.1% of middle school students who used e-cigarettes in the past 30 days reported using a flavored e-cigarette during that time (7). In Louisiana, where our burden of tobacco use is higher than the national average, close to 1 in 3 high schoolers report using a vapor product, and close to three- quarters of those students said they preferred a flavored item (8). Opening the door to additional legal flavored tobacco products will increase youth exposure to tobacco and worsen this public health issue. By preventing the possibility of introducing any flavored Electronic Nicotine Delivery Systems (ENDS), the FDA can protect the health and well-being of the United States’ youth and reduce their likelihood of experimenting with tobacco. Thank you for the opportunity to comment. Dr. Jennifer Avegno, M.D. Deputy Mayor of Health and Human Services City of New Orleans Shelina Davis, MPH, MSW Chief Executive Officer Louisiana Public Health Institute 1. Nguyen, N., McKelvey, K., & Halpern-Felsher, B. (2019). Popular flavors used in alternative tobacco products among young adults. Journal of Adolescent Health, 65(2), 306–308. 2. Cornelius, M. E., Gentzke, A. S., Loretan, C. G., Hawkins, N. A., & Jamal, A. (2024). Use of menthol-flavored tobacco products among US middle and high school students: National Youth Tobacco Survey, 2022. Preventing Chronic Disease, 21. 3. Huang L, Baker HM, Meernik C, et alImpact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review. Tobacco Control 2017;26:709-719 4. Hoffman, A. C., Salgado, R. V., Dresler, C., Faller, R. W., & Bartlett, C. (2016). Flavour preferences in youth versus adults: A Review. Tobacco Control, 25(Suppl 2), ii32–ii39. 5. Sanchez, L. M., Cho, J., Harlow, A. F., Miech, R. A., Sussman, S., Dai, H. D., Adjei, A., Han, D., Li, M., Meza, L., Leventhal, A. M., & Bae, D. (2025). Correlations between flavored e‐cigarette use and tobacco and substance use among US Youth, 2021 to 2023. The Milbank Quarterly, 103(S1), 392–410. 6. After-school smoke? The problem with tobacco retailers near schools. Truth Initiative. (2017, February 9). 7. Centers for Disease Control and Prevention. (2023, November 2). Tobacco product use among U.S. middle and high school students - national youth tobacco survey, 2023. Centers for Disease Control and Prevention. 8. Well-Ahead Louisiana. (n.d.). Louisiana Youth Tobacco Survey. Well-Ahead Louisiana.