(a)
Study— The National Institutes of Health, in coordination with other appropriate agencies, shall conduct a study on the short-term and long-term health impacts of e-cigarette use by youth and young adults under 21 years of age, that includes the following:
(1)
An examination of the health impacts of using liquids obtained from the legal market, including liquids that may not have premarket approval from the Food and Drug Administration, compared to liquids obtained illicitly.
(2)
A determination of the precise relationship between underage vaping and underage smoking, which may include using national survey data, in which the reporting of smoking and vaping usage classifications (such as current users, former users, or never users) shall be integrated and not treated as separate or unrelated categories.
(3)
A determination of the precise relationship between vaping and smoking among young adults, who are 21 to 24 years of age, using national survey data, in which the reporting of smoking and vaping usage classifications (such as current users, former users, or never users) shall be integrated and not treated as separate or unrelated categories.
(4)
An examination of e-cigarette usage data from cities, localities, and States that have adopted e-cigarette product bans to evaluate—
(A)
the proportion of e-cigarette users in those areas who return to smoking combustible cigarettes;
(B)
the proportion of e-cigarette users in those areas who access products from illicit markets; and
(C)
the proportion of e-cigarette users in those areas who stop using all nicotine products or reduce their overall nicotine product use.
(5)
A determination of the frequency of use of each specific and multiple tobacco products among high school students in the United States, including—
(A)
the number of high school students who use each specific and multiple tobacco products less than 20 days per month; and
(B)
the number of high school students who use each specific and multiple tobacco products 20 or more days per month.
(6)
An examination of the rates of underage e-cigarette use in cities, localities, and States that have adopted Tobacco 21 laws prior to the date of enactment of the Further Consolidated Appropriations Act, 2020 (Public Law 116–94).
(7)
An examination of illegal smuggling of tobacco products in cities, localities, and States that have—
(A)
banned such products;
(B)
enacted taxes on such products that are higher than the national median; or
(C)
enacted other legal restrictions on such products.
(8)
A determination of how prevalence estimates of tobacco use in the National Youth Tobacco Survey differ from prevalence estimates of tobacco use in other national surveys, including the Population Assessment of Tobacco and Health and the Knowledge Panel.
(9)
A determination of the prevalence of the following high-risk behaviors among high school students, and their relationship, if any, to vaping and smoking:
(A)
Using marijuana or alcohol.
(C)
Underage sexual activity.
(D)
Using an electronic device while driving.
(E)
Knowingly riding in a motor vehicle with a driver who was recently drinking.
(F)
Seriously considering suicide.
(10)
An examination of the role flavors play in youth initiation and use of e-cigarettes and other tobacco products.
(11)
An examination of the risk of youth addiction to nicotine, including the impact of e-cigarettes that use nicotine salts.
(12)
An examination of risks to youth of nicotine use and exposure to harmful and potentially harmful constituents emitted from some e-cigarettes, including flavorings used in e-cigarettes.
(13)
A determination of a credible estimate of the difference in health risks between combustible cigarette smoking and vaping, if a valid estimate can be made, to inform tobacco regulation in the United States, taking into account—
(A)
the findings of the British Royal College of Physicians in their 2016 report, “Nicotine without smoke: Tobacco harm reduction”;
(B)
the article entitled “Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes” published in the American Journal of Public Health in February 2020;
(C)
the findings of the National Academies of Sciences, Engineering, and Medicine in their 2018 report, “Public Health Consequences of E-Cigarettes”;
(D)
relevant reports and advisories of the Surgeon General; and
(E)
other peer reviewed research.