If San Francisco ultimately implements its recently adopted ordinance to ban the sale of flavored tobacco products, it will do more harm than good, serving to increase rates of tobacco-related addiction, illness and death across the city. There are two major issues with this ordinance. The first is the ease with which persons who want these products can simply get them in neighboring communities, or from a thriving black market sure to develop within the city.
The second, and more important, is the fact that this ban will virtually eliminate local on-site access to less addictive and remarkably low-risk nicotine vapor products. While barring access to most e-cigarettes, the ordinance will do nothing to reduce access to non-menthol cigarettes, which remain the deadliest and most addictive tobacco products.
Plain nicotine has a taste so harsh that hardly anyone can tolerate it. Cigarettes and similar combustible tobacco products use sugars, licorice extracts and other substances to mask much of this harshness without eliminating the tobacco taste. Because e-cigarettes do not contain tobacco, they are dependent on flavoring to make them palatable to consumers. Even pharmaceutical nicotine lozenges come in a variety of fruit and candy flavors.
This ordinance implies that these products are flavored to attract teens to cigarettes and a lifetime of nicotine addiction. In the case of e-cigarettes, nothing could be further from the truth. Since the advent of significant e-cigarette sales in 2010, it’s true that use by both teens and adults have skyrocketed. But that growth has been associated with record year-to-year reductions in cigarette smoking. Meanwhile, according to the Centers for Disease Control and Prevention, there has been no increase in the number of teens using any tobacco-related product.
This means that e-cigarettes offer two substantial public health benefits that it’s unlikely could be achieved by any other means. The most substantial benefit is diverting teen smokers and teens most likely to start smoking away from cigarettes and away from nicotine addiction. According to another federally sponsored survey, 60 percent of teen e-cigarette use is with zero-nicotine products.
Adult data, most readily available from Great Britain and the European Union, show about half of long-term vapers give up cigarettes entirely, with many later following through to discontinue use of the e-cigarettes themselves.
Many in the tobacco-control community erroneously believe that e-cigarettes recruit teens to smoking who otherwise would not have smoked. This belief is largely based on a set of commonly referenced studies that show no such thing. These studies deal only with experimentation and occasional social use, and show that teens inclined to experiment with tobacco-related products are more inclined to experiment with both e-cigarettes and cigarettes than kids who aren’t inclined to such experimentation.
Some in tobacco control like to highlight so-called “kiddie” flavors like bubble-gum and cotton-candy as evidence that the vaping industry is trying to recruit pre-school children to e-cigarette use. However, there is not a shred of evidence that this is the case, not a shred of evidence that such flavors are more attractive to teens than other flavors and no reference to whether such flavors are even offered by the major manufacturers and vendors of e-cigarette products.
On the adult side, some of the strongest evidence for the efficacy of e-cigarettes in helping smokers to quit came in a study recently by Shu-Hong Zhu that was published in the British Medical Journal. This study strongly suggests that the accelerated reduction in adult smoking in recent years was entirely due to smokers switching to e-cigs.
Flavoring is critical to encouraging smokers to use e-cigarettes to quit. Not only are initial quit rates with vaping products as good or better than with pharmaceutical cessation products like lozenges or the patch, once a vaper has transitioned from tobacco flavor to a fruit or candy flavor, they tend to find the taste of tobacco unappealing. If and when they have the urge to relapse, they relapse to e-cigs, not to cigarettes.
It must be said that the main beneficiary of the proposed ban will be the big tobacco cigarette companies that anti-tobacco advocates love to hate. The losers will be the teens who could have been diverted from cigarettes, and smokers who otherwise would have quit using flavored vaping products.
There are actions that the Board of Supervisors could take that would reduce tobacco-related addiction, illness and death. Banning the sale of flavored tobacco products is not one of them. I therefore urge repeal of this misguided ordinance.