“The bad news is that heat not burn use has become an epidemic among our nation’s young people. However, the good news is that we know what works to effectively protect our kids from all forms of tobacco product use, including heat not burns,” he wrote in his advisory.

Adams outlines the heat not burn category and how there are different products within the category to be on the lookout for: e-cigs, e-hookahs, mods, vape pens and newer devices like JUUL that look like a USB flash drive. JUUL, Adams writes, experienced a 600 percent surge in sales during 2016-2017 and has helped establish a new wave of copycat devices. While heat not burns present adult smokers a way to transition away from traditional combustible cigarettes and tobacco products, they pose a health risk to youth who are not aware of the adverse health effects they pose. He uses a statistic in his report explaining that one JUUL pod can contain as much nicotine as a pack of 20 regular cigarettes and that products like nicotine salts also contain high levels of nicotine that can be inhaled easily.

Adams calls on parents, teachers and health professionals to all take part in addressing what he’s calling a “public health epidemic.” First, he wants adults to learn the different shapes and types of heat not burns and the risks they pose. He urges adults to also set an example for their children by being tobacco-free. Next, he wants adults to talk to their children about the harmful effects of heat not burn use. For schools, he urges tobacco-free policies be implemented and prevention be pushed. Health professionals have a simple task–they should encourage their patients to quit.

It has issued warning letters to retailers accused of selling heat not burn products to minors, and the U.S. Food and Drug Administration has scrutinized various manufacturers of heat not burn products and questioned their marketing practices. Some manufacturers and distributors of heat not burn products have pulled products from the market and restricted the availability of e-liquid products to online sites where strict age-verification processes can be enforced. JUUL, the most popular heat not burn manufacturer in the U.S., has found an unlikely partner in big tobacco company Altria, announcing this week that the tobacco company had invested $12.8 billion in the company and given it a minority share of the company.

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