Flavored Vape Bans Led to Increase in Teen Smoking: Study

Bans on flavored e-cigarettes —also known as vapes—may lead to an unintended increase in tobacco cigarette use, particularly among young adults, according to a recent analysis.

Public health experts have long debated whether the availability of flavors such as fruit, candy, and mint significantly attract young people to vape products. Over the last decade, the immense popularity of vaping brands like Juul has led to piecemeal restrictions on flavored varieties. (The FDA banned Juul outright in 2022, but recently reversed course.)

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But a new working paper published in the National Bureau of Economic Research finds "evidence of an unintended effect" in the youngest consumers who, rather than quit nicotine products in the face of flavored vape bans, appear to simply move to combustible cigarettes, widely considered to be a more dangerous product.

"The restrictions are associated with a decline in flavored electronic nicotine delivery system (ENDS) sales, but also an increase in cigarette sales," according to the paper, titled "The Effect of E-Cigarette Flavor Bans on Tobacco Use."

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The research, conducted by scholars from institutions including Michigan State University and San Diego State University, indicated that the adoption of flavor restrictions resulted in a significant reduction in youth vaping by 1.2 to 2.5 percentage points.

However, it also led to a "notable increase" in combustible cigarette smoking specifically among 18- to 20-year-olds.

"The reduction in vaping appears to occur via substitution towards combustible cigarette smoking. Such substitution is arguably more surprising and noteworthy", the authors wrote.

According to the research, restrictions were associated with a 2.4 to 2.6 percentage point increase in the likelihood of smoking cigarettes.

The researchers analyzed data from the State and National Youth Risk Behavior Surveys and the Behavioral Risk Factor Surveillance System. The study was funded with a grant from Global Action to End Smoking, an independent, U.S. nonprofit organization.

This is not the first time researchers have drawn such a conclusion. Research published in 2021 by Yale University's School of Public Health suggested that restrictions on vape products, intended to curb youth nicotine use, may have had the opposite effect and pushed teenagers toward traditional cigarettes.

"Given the plausibly higher health risks of combustible cigarettes relative to e- cigarettes, such substitution implies that the net effect of ENDS flavor restrictions on public health may be limited or potentially even negative," the Yale researchers found.

The study also found that while flavor restrictions effectively reduced vaping among younger users, they had little to no impact on older adults, who showed no significant change in vape use.

Secondary analyses revealed that various flavor bans did not lead to significant increases in other risky behaviors such as binge drinking or illicit drug use. However, the primary concern remains the shift from vaping to smoking, which poses a greater health risk due to the higher levels of toxicants in cigarette smoke compared to e-cigarette vapor​​.

A 2023 study by the Centers for Disease Control and Prevention (CDC) found that more than 1 in 10 Americans aged 18 to 24 are regular e-cigarette users. In the same year, the National Youth Tobacco Survey reported that 89 percent of youth who vaped used flavored varieties.

As of last year, nine states, the District of Columbia, and over 370 localities had adopted policies restricting the sale of flavored e-cigarettes.