While U.S. policymakers have restricted flavored vapes to make e-cigarettes less appealing to young people, that plan may be backfiring.
A new study found that for every 0.7 milliliters of "e-liquid"for e-cigarettes that isn't sold because of flavor restrictions, an additional 15 traditional cigarettes were sold.
The study, supported by U.S. National Institutes of Health, uncovered evidence that these extra cigarettes were being sold in brands that are popular with people 20 and younger.
Flavor restriction policies may actually magnify the harms of nicotine rather than help, the authors said.
"While neither smoking nor vaping is entirely safe, current evidence indicates substantively greater health harm from smoking than vaping nicotine products,"said first author Abigail Friedman, an associate professor at the Yale School of Public Health.
"These policies' public health costs may outweigh their benefits," she said in a university news release.
Policymakers focused on vapes because of their fruity and dessert-like flavors, which could make them appealing to young people.
An outbreak of vaping-associated lung injuries in 2019 led to at least 68 deaths and thousands of hospitalizations.
This led to restriction of vapes, though the primary cause of the outbreak was an additive most common in cannabis vaping products, according to the Yale School of Public Health.
To study the impact of restrictions on flavored e-cigarette products, researchers evaluated sales of both electronic and conventional cigarettes in 16 U.S. states.
This included creating a database of state and local restrictions within those states and reviewing specific restriction policies. Sales data came from gas stations, groceries and convenience stores.
The authors also considered restrictions on flavored cigar and menthol cigarette sales, tax rates, cannabis availability and unemployment rates.
Comparing restrictions against sales data over four-week intervals from January 2018 through March 2023, they saw that flavor restrictions went from affecting 1.3% of people nationwide to 38%.
In areas where flavor restrictions were in effect for at least a year, cigarette sales rose 10% in brands favored by adults and 20% in those attractive to underage smokers.
About 71% of increased sales were for non-menthol cigarettes, researchers found.
The authors urged policymakers to consider other approaches to protecting public health.
"Some leading scholars have advocated for regulating tobacco products proportionate to their risk,"they wrote. "This approach would avoid giving more lethal combustible products [such as cigarettes] a competitive advantage over less lethal alternatives "¦ [and] could mean more flavors being available in [vapes] than cigarettes."
A limitation of the study is that sales data did not include e-cigarette sales made online, in vape shops or at illicit markets.
The findings were recently published prior to peer review at Social Science Research Network. Research is typically considered preliminary until peer-reviewed.
More information
The U.S. Centers for Disease Control and Prevention has more on youth and tobacco use.
SOURCE: Yale University, news release, Oct. 18, 2023
