The California Medical Association (CMA) has long recognized that tobacco use is a costly habit that often leads to illness, poor health and death.

In 1963, CMA was the first among state medical societies to create policy to inform people about the harmful effects of cigarette smoking. And despite decades of education about the deadly health toll of tobacco, new candy and fruit-flavored e-cigarette products (that appeal to young people and are falsely thought to be healthier) have led to an uptick in the numbers of new smokers and in continued use among established smokers. 

CMA issued a white paper in 2016 that presented evidence and research on the impact of flavored and mentholated tobacco products on public health, particularly among priority populations. Priority populations are groups that have higher rates of tobacco use than the general population, experience greater secondhand smoke exposure at work and at home, are disproportionately targeted by the tobacco industry, and have higher rates of tobacco-related disease compared to the general population. 

Key findings included: 

• There are now over 460 brands of e-cigarettes and more than 7,700 unique e-cigarette flavors available for purchase online, including a wide range of child-friendly candy and fruit-flavors that are not permitted in cigarettes, such as Wrigley’s, Atomic Fireball, Tutti Frutti and Cap N’ Crunch. 
• Teen e-cigarette use tripled between 2013 and 2014 and now exceeds youth use of traditional cigarettes. 
• Approximately 2 million high school students and 450,000 middle school students currently use e-cigarettes, according to a Centers for Disease Control and Prevention survey. 
• In California, 63 percent of smokers start by the age of 18, and 97 percent start by 26.