Yale Discovers Unexpected Ban Consequences

The research, led by Yale School of Public Health Associate Professor Abigail Friedman, found evidence that banning flavours in eliquids for vaping does decrease young adult vaping…BUT, the unexpected consequence of these bans is an increase the number who smoke traditional cigarettes relative to what would be expected without these policies. 

“Given evidence of greater health costs from cigarette smoking than vaping e-cigarettes, these findings highlight a need for nuanced approaches to tobacco control that account for effects across different nicotine and tobacco products,” the University states.

E-cigarette flavour restrictions have become a popular public health measure in the United States, is being rolled out across Europe, and could feature as part of the UK government’s war on smoking due to the measures it granted itself in the Tobacco and Vapes Bill.

Aimed at reducing youth vaping, “there is growing concern that these restrictions may have unintended consequences, such as encouraging smoking, a more harmful behaviour.”

The authors of the new study used the Behavioral Risk Factor Surveillance System (BRFSS) data from 2016 to 2023, matching 18- to 29-year-olds’ survey responses to the percentage of state residents covered by flavour restrictions to estimate the impact of the ban on young adult vaping and smoking.

The researchers say this approach allowed statistical analyses to isolate the effects of these policies from other tobacco regulations and environmental factors, providing a clearer picture of their impacts.

Key findings

• Reduction in vaping: State-level flavour restrictions yielded a 3.6 percentage point decline in daily vaping among 18- to 29-year-olds relative to trends in non-adopting states.
• Increase in smoking: These same policies caused a 2.2 percentage point increase in daily smoking among the same age group, relative to non-adopting states’ trends.
• Net impact: Among young adults, these policies yield about 3 additional daily smokers for every 5 fewer daily vapers.
• Maryland: Maryland’s policy — a regulation prioritizing enforcement action against sales of flavoured e-cigarettes but exempting menthol and open-system e-cigarettes — did not result in increased smoking, suggesting potential benefits from more tailored policies.
• Limitations: The analysis was limited to 31 states due to vaping data availability and was not a randomized trial. The study’s methods allow for causal interpretation under specific assumptions.

Abigail Friedman, lead author of the study, commented: "This study’s evidence linking restrictions on flavoured e-cigarette sales to increases in young adult smoking raises real concerns for population health. With substantial variation in risk profiles across modern nicotine and tobacco products, this research underscores the need to assess such policies’ cross-product effects, to ensure that they serve public health.

“Reassuringly, our findings for Maryland suggest potential benefits from more tailored policies: Exempting menthol flavours and open-system devices, Maryland’s regulation was associated with decreases in young adult vaping without increased smoking. Understanding what drove this — regulatory details versus separate contextual factors — could reveal promising approaches to reduce young adult vaping without increasing smoking, the primary driver of tobacco-related disease.”

References:

• Flavored E-Cigarette Sales Restrictions and Young Adult Tobacco Use - https://jamanetwork.com/journals/jama-health-forum/fullarticle/2828404

Photo Credit:

• Banner image created using Grok AI

Dave Cross

Journalist at POTV

View Articles

Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous start-ups to develop content for their websites.