Ban on flavours in e-cigs led to more young people smoking

The proportion of young people smoking cigarettes rose sharply when San Francisco banned flavoured e-cigarettes. This is according to a study that compared the smoking behaviour of young people in different US cities.

That banning flavourings in both tobacco and e-liquid for e-cigarettes has become increasingly common as politicians seek to reduce nicotine use among young people. Several US states, as well as several European countries, have introduced varying degrees of bans since 2018. Also in Sweden, a governments a ban on all flavours, except tobacco flavours.

But how does a flavour ban on e-cigs affect young people's nicotine habits?
This is what researchers at the Yale School of Public Health want to find out.

Flavour ban leads young people to smoke

San Francisco was one of the first cities in the US to ban flavours in e-liquid and tobacco. By the time the ban was introduced in 2018, the percentage of schoolchildren who smoked was declining to 4 per cent. Similar figures were reported from neighbouring cities. Two years later, the share of young smokers in neighbouring cities had decreased further, to 3%, while the share of young smokers in San Francisco increased significantly. To almost 6 per cent.

"This is a worrying development. It suggests that restricting access to electronic cigarettes leads young people to smoke instead," the researcher writes. Abigail Friedman who conducted the study.

Substitutes for cigarettes

The study, published in the Journal of the American Medical Association (JAMA).The study included 10 000 high school students in San Francisco who were compared with 100 000 students in schools in neighbouring cities. The researchers point out that the results do not necessarily indicate the same trend in other US cities and states. 

"But at the same time, other studies on raising age limits show that they favour cigarette sales at the expense of e-cigarette sales. This suggests that the products are substitutes for each other." Abigail Friedman writes in her analysis.

Eferlyser cautious regulation

She says the results are an indication that politicians need to think carefully when regulating e-cigarettes. At least if the aim is to reduce smoking among the population.

"Although the rules are the same for smoking tobacco as for e-cigarettes, they affect young people who vejpar, more than young people who smoke. Politicians should be careful when regulating these products. It is easy for the rules to create incentives to increase the use of traditional cigarettes," says Mr Perez. Abigail Friedman to Gizmodo magazine.

She is now calling for more studies to look at the impact of flavour bans on e-cigarettes.

"Should have been obvious"

The study has attracted the attention of several US media outlets and prompted many health commentators to react. In particular, those who support a harm reduction approach to reduce the harms of cigarette smoking.

"It may not have been obvious to some politicians that e-cigarettes are a substitute for cigarettes. But the study should have implications for future policy work. Restricting e-cigarettes, whether in terms of flavours, nicotine strength or otherwise, is likely to lead to more people choosing cigarettes instead," the author writes. Christopher Snowden

Flavour ban underway in Sweden

Currently, several states and cities are planning a ban. In Europe, countries such as Denmark and Finland have already introduced flavour bans for electronic cigarettes. The Netherlands is expected to introduce flavour bans in 2022. And as Vejpkollen has previously reported, the the Swedish government presented a draft law banning all but tobacco flavours in e-liquids. The European Commission is also expected to examine the possibility of banning flavours in e-liquids under the EU Tobacco Directive.

Sources for this article:
A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavoured Tobacco Products in San Francisco, California

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