The Food and Drug Administration (FDA) recently reported that from 2017 to 2018, there was a 78 percent increase in current e-cigarette use among high school students and a 48 percent increase among middle school students. More than two-thirds of these youth use flavored e-cigarettes.

This alarming rise in use has prompted several policy changes that will directly impact youth appeal and youth access to flavored tobacco products. FDA Commissioner Scott Gottlieb, M.D., has taken action by proposing to prevent youth access to flavored tobacco products.

Those products that are appealing to youth, those that have candy, fruit or sweet flavors are to be sold in age-restricted, in-person locations. Those that are sold online are set to have further monitored procedures for age verification.

Under the proposals, electronic products will still continue to have mint and menthol flavorings, but the menthol-flavored cigarettes will be banned. The reason for continuing the mint or menthol flavors for e-cigarettes are because they appeal to adults as a cessation smoking tool.

Studies show that for those flavors, youth use was only 20 percent where adult use was over 40 percent. The ban means that outlets such as gas stations and convenience stores will not be able to sell e-cigarettes with sweet flavorings but will continue to be able to sell e-cigarette products with mint or menthol flavors.

While a recent population survey found that there was no difference in prevalence of nicotine use across races, Hispanics and African-Americans were less likely to be daily smokers, use smokeless tobacco, or use e-cigarettes compared to whites. African-Americans and Hispanics reported higher use of menthol compared to whites.

There seems to be a genetic influence related to preference of menthol in nicotine products. Menthol acts specifically on receptors in the lungs and airways, and the process differs among individuals and populations. This may contribute to differences in menthol preferences among smokers.

There is little argument that restricting the sales of sweet products that appeal to youth is a wise action. And the restrictions of menthol sales in venues frequented by youth are welcomed. Chicago was the first to act on this and banned menthol cigarette products that were sold within 500 feet of schools. Compliance was mixed.

The benefits of banning sales of menthol-flavored cigarette products are meeting considerable resistance from industry and even some consumers.

Ontario, Canada, made the move to slow down the rate of smoking by banning menthol-flavored products in 2017. One month into the ban, a study found that twice as many menthol smokers had attempted to quit than had been predicted.

The implications for the United States are significant. “We would actually expect the impact of this study to be even greater in the U.S. given the higher use and regularity of (menthol cigarette) use,” lead study author Michael Chaiton of the Ontario Tobacco Research Unit and the Dalla Lana School of Public Health at the University of Toronto said in an email. However, unlike the United States, there was little controversy over the ban.

The limitations on sales to youth and the proposed bans hope to slow down the nicotine use among vulnerable populations. But the threat to the industry will certainly eliminate the immediate implementation of these limits.