Frances Daniels, a Baltimore mother of three, read the Trump administration's 20-page report called "Make Our Children Healthy Again," and noticed some notable words were missing from it: "Smoking" and "nicotine."
The word "tobacco" is mentioned once in the document, in a reference to the Bureau of Alcohol, Tobacco and Firearms.
"I was horrified," Daniels says. "It never once mentioned substance usage. Specifically: nicotine."
That was of grave concern to Daniels, because nicotine and the chemicals vaped with it, hooked and nearly killed one of her children three years ago. Her child spent six brutal weeks in the hospital with EVALI, a lung injury caused by e-cigarette use. "They had about six tubes in their lungs at one point, draining fluid out — three on each side with machines on either side of the bed."
Health Secretary Robert F. Kennedy Jr. says the strategy is "mobilizing every part of government to confront the childhood chronic disease epidemic." The administration's list of recommendations in its report calls for public-service campaigns about the risks of alcohol, controlled substances, and vaping. It also recommends continued crack downs on illegally imported vapes, and it announced a $86 million seizure of e-cigarettes last week.
NPR has reached out to the Department of Health and Human Services for comment.
A priority in Trump 1.0
The report's prescriptions sound too weak to Meredith Berkman, co-founder of Parents Against Vaping E-cigarettes. She says it contrasts with President Trump's stance in 2019, when she met with him.
"He was in the Rose Garden and in the Oval Office, talking about youth vaping," she says of his emphasis on prevention, during his first term. "The fact there is not a greater emphasis put on tobacco and nicotine, which is harming youth — it's very, very surprising."
Tobacco use remains the top cause of preventable death in the US.
That's why Brian King — an epidemiologist and former head of the Food and Drug Administration's Center for Tobacco Products — says omissions of smoking, tobacco and other nicotine products make no sense. "Something to combat chronic disease without tobacco control is like attempting a triathlon without a bicycle — you are destined for failure before leaving the starting line," King says.
Cuts to successful tobacco control efforts
King, now executive vice president at the Center for Tobacco-Free Kids, says the administration's stated support for public awareness and greater enforcement run counter to its recent actions. "In the same breath, the administration has eliminated the very unit that conducts that work at FDA," he says. He also notes the Trump administration eliminated the Office of Smoking and Health at the Centers for Disease Control and Prevention, which funded state tobacco control programs — some of which King says are in the process of shutting down.
Such programs are credited with dramatic reductions in smoking — and more recently vaping — among teens.
Earlier this year, the Trump administration also withdrew plans to ban menthol-flavored cigarettes, despite the fact that flavored tobacco and nicotine are known to be a major draw for young people, says Priya Fielding-Singh, director of policy at the Global Food Institute at George Washington University. "An educational campaign isn't a compelling substitute for enacting tobacco regulation to keep these products out of the hands of kids and teens," Fielding-Singh said in a statement.
Nevertheless, smoking and vaping are falling out of favor with adolescents, and Penn State public health professor Jonathan Foulds says therefore young people today are at far less risk — especially compared to the many other public-health threats they face. "Nicotine itself is not very high on the list of public health priorities for kids," Foulds says.
Nicotine is, of course, addictive and affects heart health. But Foulds says not all forms of nicotine are the same. Oral nicotine pouches like Zyn, for example, and even vaping, may be preferable to cigarette use, he says. "It's much less harmful than smoking," even if it's not harmless, he says. "We shouldn't exaggerate the risk of it; we should be glad that they're not smoking."
Foulds says so far there's scant evidence that many people who start vaping in adolescence take up smoking later in life.
But in Frances Daniels' experience, it all goes hand in hand. "Nicotine is harmful, as well as the process of vaping — they're both harmful," she says.
Her child recovered and quit nicotine, she says. But she continues warning others about the risks.
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