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Research & Commentary: Flavor Bans Do Not Reduce Youth E-Cigarette Use

August 29, 2019

State Government Relations Manager Lindsey Stroud examines the California Youth Tobacco Survey results from 2017-18, finding youth vaping has increased in several California localities that have restricted access to flavored tobacco products.

As lawmakers across the country consider legislation to curb youth use of electronic cigarettes and vaping devices, one policy gaining traction is banning the sale of flavored e-cigarettes. Although addressing youth e-cigarette use is laudable, policymakers should refrain from such bans because they threaten tobacco harm reduction options for adults. Moreover, according to data from the California Youth Tobacco Survey (CYTS), flavor bans have not reduced youth use of electronic cigarettes and vaping devices.

Santa Clara County, California, banned flavored tobacco products to age-restricted stores in 2014. To purchase a flavored tobacco product in the county, the retail establishment must bar persons under 21 from entering. Despite this, data from the 2017-18 California Student Tobacco Survey for Santa Clara County found “the vast majority of high school students (82.3%) in Santa Clara County who were current tobacco users reported using a flavored tobacco product.” Popular flavored products included “current hookah users (82.9%), e-cigarette users (82.6%), and [little cigars] users (82.3%).” Regarding combustible cigarettes, 62.9 percent of respondents “reported using menthol/mint cigarettes in the last 30 days.”

More pointedly, youth e-cigarette use in Santa Clara County has increased while the flavor ban has been in effect. For example, in the 2015-16 CYTS, 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.

Contra Costa County, another municipality in California that has restricted the sale of flavored e-cigarettes, has also experienced a recent increase in youth vaping rates. Although the 2015-16 CYTS survey included other localities including Marin, San Francisco, San Mateo and Solana, the 2017-2018 CYTS survey reported only on Contra Costa. In 2015-16, 8.3 percent of high school students in the various localities reported current use of electronic cigarettes and vaping devices. In the 2017-18 CYST survey of solely Contra Costa County high school students, this number increased to 17.2 percent reporting current e-cigarette use.

It should be noted that the CYTS defines “current use” as any use within the past 30 days. This definition makes it difficult to understand whether these students are casual vapers, i.e., they used a vaping product a few times in the past 30 days, or whether they were using these products every day, for the past 30 days.  

Lawmakers should not interpret these results as a need to further restrict access to flavored e-cigarettes. Without a doubt, this would harm millions of former American adult smokers who have finally quit combustible cigarettes by switching to electronic cigarettes and vaping devices.

In the largest survey of American adult vapers, flavors were vital in helping smokers quit combustible cigarettes and remain abstinent from smoking. This 2018 survey, conducted by researchers at the Onassis Cardiac Surgery Center, Greece, and Centre for Substance Use Research, Scotland, UK, surveyed nearly 70,000 American adults and found that 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively. Only 20 percent of respondents reported using tobacco flavors at the point of e-cigarette initiation.

Further, it is highly likely that banning flavored e-cigarette products could prompt former smokers to return to tobacco cigarettes. A 2017 study by the National Bureau of Economic Research concluded banning flavors “would result in the increased choice of combustible cigarettes.” Indeed, the authors expect e-cigarette use to decrease by approximately 10 percent if flavors are banned.

Despite recent media fearmongering, e-cigarettes are at least 95 percent less harmful than tobacco cigarettes. In fact, in June 2019, the American Cancer Society (ACS) noted that “e-cigarette use is likely to be significantly less harmful than smoking regular cigarettes.” ACS contributes this to the fact that e-cigarettes “do not contain or burn tobacco.” Moreover, e-cigarettes are twice as effective as nicotine replacement in helping smokers quit.

Despite good intentions, policies such as increasing the tobacco purchasing age to 21 and taxing electronic cigarettes and vaping devices have not decreased youth use of e-cigarettes. In fact, the exact opposite has happened: youth use of e-cigarettes has increased while these regulations have been on the books.

Rather than restricting adult access to e-cigarettes and vaping devices, policymakers should redirect current tobacco moneys (mostly from the Master Settlement Agreement) to education and prevention programs. Furthermore, municipalities ought to implement consequences for youth who are found in possession of e-cigarettes instead of across-the-board bans and other restrictive measures.

The following articles provide more information on e-cigarettes and tobacco harm reduction.

Tobacco Harm Reduction 101: A Guidebook for Policymakers
https://www.heartland.org/publications-resources/publications/latest-heartland-policy-booklet-addresses-vaping-myths
This booklet from The Heartland Institute aims to inform key stakeholders on the much-needed information on the benefits of electronic cigarettes and vaping devices. Tobacco Harm Reduction 101details the history of e-cigarettes, including regulatory actions on these products. The booklet also explains the role of nicotine, addresses tax policy and debunks many of the myths associated with e-cigarettes, including assertions about “popcorn lung,” formaldehyde, and the so-called youth vaping epidemic.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
https://www.heartland.org/publications-resources/publications/vaping-e-cigarettes-and-public-policy-toward-alternatives-to-smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Research & Commentary: Largest Vaping Survey Finds Flavors Play Important Role in Tobacco Harm Reduction
https://www.heartland.org/publications-resources/publications/research--commentary-largest-vaping-survey-finds-flavors-play-important-role-in-tobacco-harm-reduction
In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines a survey of nearly 70,000 adult vapers in the United States. The survey was completed in response to the U.S. Food and Drug Administration’s recent Advanced Notice of Proposed Rulemaking seeking comment on the role of flavors in tobacco products. The authors found nearly 95 percent of survey respondents were at one time smokers and the majority reported using flavors at the point of e-cigarette initiation. Stroud compares this to other surveys. She concludes, “eliminating flavors will force [vapers] to vape only tobacco-flavored e-cigarettes, which would likely cause them to return to combustible cigarettes.” Stroud also found research has found e-cigarettes are a key tobacco harm reduction product and could help alleviate state budgets by mitigating health care costs.

Research & Commentary: Randomized Trial Finds E-Cigarettes Are More Effective Smoking Cessation Tool Than Nicotine Replacement Therapy
https://www.heartland.org/publications-resources/publications/research--commentary-randomized-trial-finds-e-cigarettes-are-more-effective-smoking-cessation-tool-than-nicotine-replacement-therapy
Lindsey Stroud, a State Government Relations Manager at The Heartland Institute examines a study in The New England Journal of Medicine that finds e-cigarettes and vaping devices to be twice as effective as nicotine replacement therapy (NRT) in helping smokers quit cigarettes. Nearly 700 participants were studied over a 52-week period, with researchers finding that 18 percent of e-cigarette users reported abstinence, compared to 9 percent of those using NRT. Stroud writes that “these latest findings provide more valuable information on the public health role that e-cigarettes and vaping devices provide for the 38 million cigarette smokers in the United States,” an implores policymakers to regulate these devices in a way that promotes their usage.

Podcast Series: Voices of Vapers
https://www.heartland.org/multimedia/podcasts?fromDate=&toDate=&q=voices+of+vapers
In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.

 

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Lindsey Stroud, a state government relations manager at Heartland, at lstroud@heartland.org or 757/354-8170.