Restricting Online Sales and Reclassifying E-Cigarettes as Prescription-Only: A Public Health Policy Perspective

The widespread use of electronic cigarettes, particularly among adolescents and young adults in the United States, has emerged as a critical public health challenge. Despite existing federal regulations, online access remains a significant channel for underage use, largely due to inconsistent enforcement of age verification. Although only about 2% of underage e-cigarette users report purchasing them online, more than three-quarters of online vendors allow checkout without verifying age, and test purchases frequently bypass identity checks, with nearly 70% resulting in delivery without age confirmation. E-cigarettes have been associated with numerous adverse health outcomes, including cardiovascular, respiratory, and neurological conditions. This editorial advocates for two urgent policy measures: a federal prohibition on the online sale of electronic nicotine delivery systems and the reclassification of these products as prescription-only. These steps would enhance regulatory oversight, limit youth access, and support evidence-based smoking cessation efforts under professional supervision. Implementing such reforms would strengthen public health protections, reduce healthcare costs, and promote long-term population well-being.