The FDA and the FTC issued 13 warning letters Tuesday to manufacturers, distributors, and retailers for selling e-liquids used in e-cigarettes, or vaping devices, with labeling or advertising that bears stark resemblances to kid-friendly food products, such as juice boxes, candy, or cookies.
Some of the look-alike products resemble major food and candy brands
or use cartoon-like imagery. Several of the companies receiving warning letters were also cited for illegally selling the products to minors.
The FDA said the move was part of ongoing efforts to protect youth from the dangers of nicotine and tobacco products.
“No child should be using any tobacco product, and no tobacco products should be marketed in a way that endangers kids–especially by using imagery that misleads them into thinking the products are things they’d eat or drink,” said FDA Commissioner Scott Gottlieb, MD, in an announcement. “Looking at these side-to-side comparisons is alarming. It is easy to see how a child could confuse these e-liquid products for something they believe they’ve consumed before—like a juice box. These are preventable accidents that have the potential to result in serious harm or even death. Companies selling these products have a responsibility to ensure they aren’t putting children in harm’s way or enticing youth use, and we’ll continue to take action against those who sell tobacco products to youth and market products in this egregious fashion.”
Some examples of the products outlined in the warning letters, and being sold through multiple online retailers, include “One Mad Hit Juice Box,” which resembles children’s apple juice boxes, such as Tree Top-brand juice boxes; “Vape Heads Sour Smurf Sauce,” which resembles War Heads candy; and “V'Nilla Cookies & Milk,” which resembles Nilla Wafer and Golden Oreo cookies.
Other products include “Whip’d Strawberry,” which resembles Reddi-wip dairy whipped topping, and “Twirly Pop,” which not only resembles a Unicorn Pop lollipop but is shipped with one.
According to a 2016 report from the US Surgeon General
, e-liquids used in e-cigarettes have health concerns beyond encouraging kids to smoke, most notably from poison exposure due to ingestion. From 2010 to 2014, calls to poison control centers about exposures related to e-cigarettes increased dramatically. In 2011, 271 cases were reported, rising to 3783 calls in 2014. The lack of a requirement for child-resistant packaging for may have contributed to these poisonings.
Children are at greater risk because exposure to the nicotine in e-liquid products, even in relatively small amounts, could result in acute toxicity. Severe harm can occur in small children from exposure to or ingestion of e-liquids, including death from cardiac arrest, seizure, coma, or respiratory arrest.
In the warning letters, the FDA was explicit about the risks to small children. For example, in the letter to the manufacturers
of the juice box that resembles apple juice, the FDA noted that as per the labeling on the One Mad Hit Juice Box, the nicotine inside is enough so that "an accidental ingestion of slightly less than a teaspoon would reach the lower end of the fatal dose range for an average two-year-old. Additionally, an accidental ingestion of approximately 3% of a teaspoon would reach the lower end of the non-fatal acute toxicity range for an average two-year-old."
In Tuesday's statement, the FDA said National Poison Data System data show that there were 8269 e-cigarette and liquid nicotine exposures among children younger than 6 years between January 2012 and April 2017.
Last month, the FDA also cited 40 retailers for youth sales of JUUL e-cigarette vaping devices, which are popular with children because of their resemblance to flash drives and the ability to use them surreptitiously during the school day.