E-Cigarette Warning Labels to Prevent Adolescent Use: A Letter Response

Abstract

We thank the authors Braillon and Nolte for suggesting a role for warning labels on disposable electronic nicotine delivery systems (ENDSs) and nicotine refill cartridges [1]. In April 2014, in a move that asserts jurisdiction over ENDS, the Food and Drug Administration-Center for Tobacco Products (FDA-CTP) proposed the following warning label for disposable ENDS, cartridges, and liquid nicotine: “WARNING: This product contains nicotine derived from tobacco. Nicotine is an addictive chemical” (Figure 1) [2]. After an extended period of public comment, the proposed warning label is currently under review. The label references the addictive potential of nicotine, a warning which may be of benefit to certain adolescent populations who have been found to be unaware of the addictive potential of ENDS [3]. Warning labels for cigarettes appear to communicate greater risk (Figure 2) [4] than the proposed warning label for ENDS. This is appropriate, in our opinion, given current evidence for ENDS being harmful, but less harmful than cigarettes [5]. The proposed warning label by FDA-CTP has been found to reduce ENDS selection among adults [6], but there are not yet data exploring its impact on ENDS selection among adolescents. In sum, we believe that it is appropriate for the FDA to require a warning label on disposable ENDS, cartridges, and liquid nicotine to warn of the risk of ENDS in a way that reflects the current evidence, and we therefore endorse the expeditious implementation of the proposed label. Jenna M. Hughes, M.D. Department of Healthcare Policy and Research Weill Cornell Medical College New York, New York