Executive Summary

Since their introduction to U.S. consumers in 2007, Electronic Nicotine Delivery Systems (ENDS or e-cigarettes) have gained popularity across age groups. However, as vaping prevalence grew among teens and young adults, public health experts warned against the risk of addiction and potential damage that nicotine use poses to developing brains. This, in turn, has prompted a flurry of policies at local, state and national levels that target the wide variety of flavored nicotine products believed to appeal directly to underage consumers.

The specific policies are too recent and too uneven to evaluate directly. However, a review of the research on e-cigarettes as smoking cessation tools, the appeal of flavors and the impacts of other tobacco legislation suggest that flavor bans will likely have both public health benefits and consequences. Two potential consequences stand out: unintended harms to consumers through the disruption of smoking cessation efforts and the growth of counterfeit and contraband products; and harm to communities via lost funding for broader health resources.

A limited number of studies have looked at people’s actual and presumptive responses to flavor bans. This small body of research suggests that the policy could reduce vaping in general, but that it may drive some current vapers to resume or increase their use of combustible cigarettes and others to seek out their preferred e-cigarette flavors through illicit markets and hard-to-regulate online retailers. As such, both potential sets of behavior changes could tip the net public health impact of flavor bans toward harmful.

Because ENDS users inhale a nicotine-infused vapor rather than toxin-laden tobacco smoke, vaping is considered a safer alternative to smoking combustible cigarettes. In fact, both the U.S. Centers for Disease and Prevention and Public Health England have stated (albeit to varying degrees) that smokers would benefit from switching to e-cigarettes, and the devices are gaining traction as cessation tools. Furthermore, research shows that flavors may aid individuals who are using e-cigarettes to quit or reduce smoking. Flavor bans, as a result, risk diminishing ENDS products’ role in harm reduction.

A small but consistent proportion of vapers who opt to continue using flavored e-cigarettes after a ban may face a different type of health risk. The tobacco market is considered especially vulnerable to counterfeit and contraband products, both of which are more likely to be more dangerous than their legal counterparts. Counterfeit e-cigarettes have been found to be mislabeled, have high levels of potential toxins, and poor manufacturing standards. Scholars who have studied prohibition of tobacco and other drugs posit that increased restriction often leads to a rise in the prevalence of illicit products and markets.

Beyond the potential unintended consequences that prohibitions have for current or future vapers, flavor bans could affect communities more widely. State and federal governments do apply a proportion of tobacco tax revenue to prevention and cessation resources. However, much of that money is used for programs that serve the general public, such as the national Children’s Health Insurance Program or Colorado’s enhanced health care funding for low-income older adults. Because e-cigarettes are believed to be associated with few health consequences, these funds come at relatively low cost. Thus, reducing such revenue while driving new public health challenges could be harmful to communities as a whole.

It is not yet clear exactly how bans on flavored e-cigarettes will play out. However, by extrapolating from the limited studies available as well as research on e-cigarettes and tobacco policy more generally, it appears that the outcomes will be mixed and complex. As such, it is important for policy makers and community members considering such prohibitions to weigh the potential for public health consequences as well as possible benefits.

Press release: States Continue to Try and Ban Flavored E-Cigarettes Despite Potential Unintended Public Health Consequences

Image credit: Aleksey Kurguzov