WASHINGTON — Boston’s public health chief joined health officials from 10 other cities in urging the US Food and Drug Administration Thursday to toughen the agency’s proposed regulations for electronic cigarettes.
“They don’t go far enough,” Barbara Ferrer, executive director of the Boston Public Health Commission, said in an interview before an afternoon meeting of policy makers and health advocates on Capitol Hill. “The FDA should aggressively limit access to minors and not allow marketing to them or flavorings like bubble gum.”
Last week, the agency proposed to regulate e-cigarettes — which contain nicotine in liquid form that is heated and inhaled as vapor — as tobacco products, but stopped short of some of the harsher restrictions that apply to cigarettes.
While the new rule would restrict sales to minors, ban free samples, and place health warning labels on products, it does not limit advertising, ban online sales, or force manufacturers to remove sweet flavorings that appeal to younger people.
“There are gaps in the proposed regulations that must be addressed to protect and promote the public’s health, such as the marketing, flavoring, and manufacturing of e-cigarettes,” the city health officials wrote in a letter sent Thursday to FDA Commissioner Margaret Hamburg.
A study released Thursday by Legacy, a nonprofit antitobacco organization, found that $39 million was spent on e-cigarette advertising from June through November 2013, with most of the messages aimed at youth: Eighty-nine percent of teenagers ages 13 to 17 reported that they are aware of e-cigarettes, and 14 percent said they had tried them.
“We don’t want to wait a year or more until there’s implementation of this rule to prohibit young people from purchasing e-cigarettes,” Ferrer said. “We’d like those prohibitions to be effective immediately, once they’re done with the comment period.” The FDA is accepting comments from the public until July 9 and could take months or years to issue a final regulation after reviewing all the comments submitted.
Boston and 51 other municipalities in the state have enacted bans on the use of e-cigarettes in any locations that are smoke-free, including bars, public parks, and workplaces. State legislators are considering whether to pass a statewide law with the same restrictions.
Los Angeles, Chicago, New York City, and Philadelphia all implemented laws in April that forbid e-cigarettes in places where smoking is prohibited. While Boston prohibits the sale of e-cigarettes to anyone under age 18, New York went further, banning the sale of cigarettes and e-cigarettes to anyone under the age of 21.
“We have a big problem on our hands,” Dr. Mary Travis Bassett, New York City’s health commissioner, said at the meeting. “E-cigarette flavors and marketing are clearly aimed at youth, and it’s working.”
In Boston, e-cigarette sales are skyrocketing; 310 merchants were granted permits to sell them in all of 2013, compared with 482 who have been granted permits so far this year, according to Ferrer.
She and other city health officials argued that e-cigarettes have not been shown to be safe and contain hazardous chemicals, carcinogens, and varying degrees of nicotine in the liquid cartridges. The FDA proposes to require manufacturers to submit safety studies, list all the ingredients on the label, and stop making unverified health claims such as that the products can help smokers quit.
Dr. Michael Siegel, a tobacco control specialist at the Boston University School of Public Health, said that while he agreed that the FDA should restrict marketing to youth, he thought the agency went too far in not allowing e-cigarette manufacturers to make the claim that their products are safer than cigarettes.
“We can’t draw conclusions on the absolute safety of e-cigarettes,” Siegel said, “but there’s no doubt that they deliver fewer carcinogens and have fewer risks than the real thing.” He pointed to recent studies indicating that smokers who switched from tobacco cigarettes to e-cigarettes experienced improvement in their lung function and ability to exercise.
“I also believe there’s enough evidence to show that e-cigarettes are effective at helping many smokers quit,” Siegel added, “but we don’t have a good conception of who these people are and what proportion of the smoking population we’re talking about.”