Experts say it takes more than cracking down on sales. You have to decrease demand.

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Flavors are one of the main reasons teens use e-cigarettes. Getty Images

As health advocates seek stronger action to stop what has been called an “epidemic” of electronic cigarette use among teens, new research has been showing that stricter restrictions on sales to children can make an impact.

But that impact isn’t enough without further action from the governments, advocates say.

A new study found that teenagers were less likely to try e-cigarettes or traditional cigarettes if they lived in cities with stricter limits on retail sales of such products — and were even more less likely to become regular users.

It seems logical that making it harder to obtain tobacco products means fewer people using them. But the rapid rise in teen “vaping” shows that the need for action ends beyond licensing, fining, and monitoring retail shops, experts said.

The number of high school seniors who used an e-cigarette jumped from 28 percent in 2017 to 37 percent last year, according to the National Institute on Drug Abuse.

That’s the latest in a string of findings that vaping is increasing quickly among teens, 2 million of whom are using e-cigarettes, according to the Centers for Disease Control and Prevention (CDC).

That vaping by teens whose brains are still developing can lead to nicotine addiction, lung disease, and exposure to toxic chemicals, according to the Food and Drug Administration (FDA).

“Access restrictions and age restrictions are clearly important and necessary,” Dennis Henigan, vice president for legal and regulatory affairs at the Campaign for Tobacco-Free Kids, told Healthline. “But given the degree and breadth of the epidemic I don’t think they’re enough.”

What practical actions might go far enough?

Start with banning flavors, advocates say.

“It’s really important we get to the heart of the matter — what is it about e-cigarettes that makes kids pick them, particularly those who would never pick up a cigarette?” Erika Sward, assistant vice president of national advocacy at the American Lung Association, told Healthline. “And the first thing is the flavors.”

Advocates say that flavors — from banana pudding to glazed donut to Hawaiian punch — appeal to kids more than to adults. They add that they provide no health benefit and are already banned in traditional cigarettes (other than menthol).

“That’s been demonstrated time and time again that flavored tobacco products all kinda have a particular appeal to young people,” Henigan said. “I think the onus needs to be on the FDA to take these flavored products off the market until a company can actually show that its product isn’t attractive to kids and that it actually helps smokers to quit. And that is what the law requires.”

Dr. Scott Gottlieb, the FDA commissioner, has repeatedly said that e-cigarette use among minors has reached epidemic levels.

His agency has taken enforcement actions against retailers found to have sold e-cigarettes to minors and has launched an investigation into e-cig industry giant Juul.

In November his agency announced new rules to restrict sales of flavored e-cigarette products to stores that don’t allow minors and to increase age verification requirements for online sales.

But if kids want them, they’ll get them — through older friends, by taking them from their parents, by finding ways to order them online, said Sward.

“Ultimately, unless you reduce the demand for these products, kids are going to get them,” she told Healthline.

Her organization sent a letter to the FDA in November saying that sales and access restrictions won’t go far enough.

She’d like to see the minimum age raised to 21, as six states and hundreds of large and small cities have already done. And she’d like to see more campaigns that seek to reduce demand.

“The tobacco industry doesn’t target kids in just one way, so we need to as well,” Sward said.

New research finds strict regulations on sales to minors can reduce the number of kids who start using e-cigarettes.

But health advocates say those restrictions on access and sales aren’t enough by themselves to reduce what they see as an epidemic of vaping among teens.

They want government officials to also take steps such as banning flavors, raising the minimum age, and running campaigns intended to reduce demand.