How Bans on Flavored Vapes Could Increase Teen Smoking

Many local jurisdictions have adopted laws banning the sale of flavored vaping products (i.e. vaping products with flavors other than tobacco). Additional cities, such as Cleveland, are considering whether to follow suit. The federal Food & Drug Administration has also refused to approve marketing applications for non-tobacco-flavored vaping products (aka ENDS or “electronic nicotine delivery systems”).

All of these policies are largely justified on the grounds that non-tobacco flavors may appeal disproportionately to to non-smokers, and to youth in particular. The further concern is that once people start vaping, they may be more likely to end up smoking. Yet there has been little effort to study whether restricting access to flavored vaping products produces the desired policy outcomes, and little consideration by policy-makers about whether policies that make vaping less attractive increase smoking. This matters because, whatever the risks of vaping, the use of vaping products is far less dangerous than smoking.

Prior research has found that taxes and age-based restrictions on vaping products have the unintended consequence of increasing smoking rates. This suggests that vaping and smoking are economic substitutes, and that any policy that makes vaping marginally less attractive than smoking has the possibility of increasing smoking rates over what they would otherwise have been. As a consequence, it would be reasonable to suspect that vaping flavor bans might reduce the rate at which smokers switch to vaping and, even worse, could lead to increased smoking.

A new working paper by health researchers Abigail S Friedman, Alex C. Liber, Alyssa Crippen, and Michael F. Pesko looks at the effects of flavor bans on cigarette consumption, and the results are concerning. Here is there abstract:

Over 375 US localities and 7 states have adopted permanent restrictions on sales of flavored electronic nicotine delivery systems (“ENDS”). These policies’ effects on combustible cigarette use (“smoking”), a more lethal habit, remain unclear. Matching new flavor policy data to retail sales data, we find a tradeoff of 15 additional cigarettes for every 1 less 0.7 mL ENDS pod sold due to ENDS flavor restrictions. Further, cigarette sales increase even among brands disproportionately used by underage youth. Thus, any public health benefits of reducing ENDS use via flavor restrictions may be offset by public health costs from increased cigarette sales.

And from the body of the paper:

This research has five key findings. First, ENDS sales fall and cigarette sales rise as a greater percentage of state residents is subject to policies restricting flavored ENDS sales. Effects are in the same direction for policies prohibiting all ENDS sales (i.e., flavored and unflavored), consistent with substitution. Second, ENDS flavor policies’ relationships to ENDS and cigarette sales are larger in the long-run; that is, for policies in effect a year or longer. Indeed, when allowing differential effects over time, the relationship between ENDS flavor policies and cigarette sales are positive and significant in the long-run but not the short-run. Third, 71% of the increase in cigarette sales associated with ENDS flavor restrictions comes from tobacco-flavored cigarettes. Alongside the inclusion of controls for restrictions on menthol cigarette sales, this finding indicates that the observed substitution response to ENDS flavor policies cannot be attributed to menthol cigarettes’ availability nor fully counteracted by menthol cigarette sales prohibitions. Fourth, ENDS flavor restrictions’ relationship to cigarette sales holds across cigarette product age profiles, including for brands disproportionately used by underage youth. Finally, separating ENDS flavor prohibitions from less restrictive policies limiting flavored ENDS sales to particular types of retailers reveals that both policies yield reductions in ENDS sales and increases in cigarette sales once in effect for at least a year.

These findings are consistent with flavored ENDS policies encouraging substitution from ENDS towards combustible cigarettes, aligning with results from 16 of 18 other studies assessing cigarette use following adoptions of minimum legal sales age laws for ENDS, ENDS tax rate increases, and advertising restrictions (Pesko 2023). In other words, policies making ENDS more expensive, less accessible, or less appealing appear to incentivize substitution towards cigarettes.

If restrictions on vaping product flavors are going to be promoted as public health measures, policy makers might want to look at the actual evidence to see whether these policies actually enhance public health.

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