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Monday, June 17, 2024

More Evidence that Bans on Flavored Vaping Products May Increase Teen Smoking


Two new studies posted by the National Bureau of Economic Research find evidence that bans on flavored vaping products may increase youth smoking. This is consistent with prior research showing that policies that make vaping products less available or more expensive can lead to higher youth smoking rates.

The first study is “The Effect of E-Cigarette Flavor Bans on Tobacco Use,” by Chad D. Cotti, Charles J. Courtemanche, Yang Liang, Johanna Catherine Maclean, Erik T. Nesson & Joseph J. Sabia. Here is the abstract:

Advocates for sales restrictions on flavored e-cigarettes argue that flavors appeal to young people and lead them down a path to nicotine addiction. This study is among the first to examine the effect of state and local restrictions on the sale of flavored electronic nicotine delivery system products on youth and young adult tobacco use. Using data from the State and National Youth Risk Behavior Surveys, we find that the adoption of an ENDS flavor restriction reduces frequent and everyday youth ENDS use by 1.2 to 2.5 percentage points. Auxiliary analyses of the Behavioral Risk Factor Surveillance System show similar effects on ENDS use for young adults ages 18-20. However, we also detect evidence of an unintended effect of ENDS flavor restrictions that is especially clear among 18-20-year-olds: inducing substitution to combustible cigarette smoking. Finally, there is no evidence that ENDS flavor restrictions affect ENDS use among adults aged 21 and older or non-tobacco-related health behaviors such as binge drinking and illicit drug use.

The second study is “Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults,” by Henry Saffer, Selen Ozdogan, Michael Grossman, Daniel L. Dench & Dhaval M. Dave. Here is the abstract: 

The vast majority of youth e-cigarette users consume flavored e-cigarettes, raising concerns from public health advocates that flavors may drive youth initiation into and continued use of e-cigarettes. Flavors drew further notice from the public health community following the sudden outbreak of lung injury among vapers in 2019, prompting several states to enact sweeping bans on flavored e-cigarettes. In this study, we examine the effects of these comprehensive bans on e-cigarette use and potential spillovers into other tobacco use by youth, young adults, and adults. We utilize both standard difference-in-differences (DID) and synthetic DID methods, in conjunction with four national data sets. We find evidence that young adults decrease their use of the banned flavored e-cigarettes as well as their overall e-cigarette use, by about two percentage points, while increasing cigarette use. For youth, there is some suggestive evidence of increasing cigarette use, though these results are contaminated by pre-trend differences between treatment and control units. The bans have no effect on e-cigarette and smoking participation among older adults (ages 25+). Our findings suggest that statewide comprehensive flavor bans may have generated an unintended consequence by encouraging substitution towards traditional smoking in some populations.

While the empirical evidence that restrictions on vaping products, including flavor bans, threaten to increase youth smoking continues to accumulate, federal agencies are looking the other way. This is no way to enhance the protection of public health.

The Food & Drug Administration, for its part, has largely excluded the consideration of such effects when evaluating vaping product applications. In reviewing such applications, the FDA focuses on product-specific information to the exclusion of any consideration of how the availability of whole product categories (such as flavored e-cigs) may affect consumer behavior. This is but one small part of the FDA’s overall vaping problem.  

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