If you’re like me, you might wonder why there are so many flavors of e-cigarettes—including bizarre ones like wasabi and unicorn—while the only flavor of combustible cigarette besides plain old tobacco is menthol.

The reason is not that cigarette manufacturers lack imagination. Rather, the Family Smoking and Prevention Act prohibits them from selling any other flavors. That restriction currently doesn’t extend to products other than combustible cigarettes, which means cigars, cigarillos, and e-cigarettes can all be flavored. However, thanks to the increased prevalence of e-cigarette use in the United States over the last 10 years, the Food and Drug Administration recently requested public comments on how flavors may attract young people to tobacco products.

This could spell trouble not only for e-cigarette users, but for public health generally. While flavored (menthol) cigarettes account for only a quarter of combustible cigarette use, the vast majority of e-cigarettes produced and sold are flavored. If the FDA decides to extend its flavor ban to other products, one of the most appealing features of e-cigarettes will all but cease to exist. That means many e-cigarette users will likely switch back to unflavored, combustible cigarettes.

This would be harmless—if combustible cigarettes weren’t 95 percent more dangerous than electronic ones.

The fundamental differences between traditional cigarettes and e-cigarettes are the latter’s absence of the tobacco plant—which contains at least two dozen other phytochemicals—and lack of combustion, a process that releases thousands of other harmful chemicals whenever anyone lights up. E-cigarettes have chemicals, of course, but researchers have found that the levels of specific toxicants are between nine- and 450-fold less compared to combustibles.

Unfortunately, some of our most prominent advocacy groups see reduced-risk products like e-cigarettes as the antithesis of public health—and flavors as the root cause. The evidence, however, suggests that certain flavored products, including most e-cigarettes, are not a gateway to combustible cigarette use, but rather a remarkably successful means of helping smokers break their habit. Flavors are an integral part of e-cigarettes’ appeal and cited as a major reason that former smokers are able to stay off of combustibles. Therefore flavor restrictions are likely to have a net negative effect on public health by increasing the riskiest of behaviors: smoking.

This is why it’s so important that smokers have access to lower-risk products. And e-cigarettes are lower in risk—so much so that if just 1 percent of current smokers switched, the United States would save an estimated $2.8 billion over 25 years in Medicaid costs. Whether flavored e-cigarettes can encourage people to move away from combustibles—or never start them in the first place—is dependent on their availability, which is dependent on them not being regulated out of existence.

Of course, it’s advisable that those who quit smoking do so without inhaling anything other than fresh air. Unfortunately, risky products are a fact of life—and in this country, cigarettes and smoking will always be among them. As such, abstinence-only approaches to drug use work best when complemented by harm-reduction programs. Rather than seeking to eradicate destructive behavior altogether, a harm-reduction approach seeks to reduce the degree of harm associated with these behaviors. For those who cannot, or simply don’t wish to, quit smoking, e-cigarettes can provide a safer alternative that helps minimize the risk of death and disease associated with smoking.

For now, it is unclear how the FDA can design flavor-related regulations that address the harms of smoking without compromising the likely benefits of reduced-risk products. The lack of quality research and data on the benefits and hazards of flavored products is concerning, given that the FDA is quickly changing the landscape of cigarettes, combustible and electronic alike. If the assumptions on which the FDA crafts its new regulations are incorrect, rather than quit, some smokers will turn back to dangerous, old, combustible cigarettes.


Image credit: MakcouD

Featured Publications