Another Study Shows Unintended Consequences of Flavor Bans

A new study published in JAMA Network Open adds to the growing body of evidence that statewide bans on flavored e-cigarettes may be producing unintended—and harmful—consequences for tobacco control. Rather than simply curbing vaping among youth, these policies appear to correlate with increased combustible cigarette use, particularly among young adults.

The researchers analyzed data from two major Centers for Disease Control and Prevention surveys: the Youth Risk Behavior Survey (YRBS) and the Behavioral Risk Factor Surveillance System (BRFSS). The YRBS is conducted biennially among U.S. high school students and tracks various health risk behaviors, including tobacco and vapor product use. The BRFSS is an annual survey of adults aged 18 and older that assesses a wide range of behavioral health factors.

Using these datasets, the authors examined six states that had implemented statewide flavored e-cigarette restrictions: Massachusetts, New Jersey, New York, Rhode Island, Maryland, and Utah. California and Washington, D.C., were excluded from the primary analysis due to insufficient post-policy data.

In states with flavor bans, youth e-cigarette use dropped significantly, from 24.1 percent in 2019 to 14 percent in 2023. In comparison, youth vaping in non-policy states declined from 24.6 percent to 17.2 percent. Among young adults aged 18 to 24, vaping increased in states without flavor restrictions, rising from 17 percent in 2019 to 20.4 percent in 2023. In contrast, vaping slightly decreased in policy states during the same period, from 15.6 percent to 14.6 percent. Among adults aged 25 and older, vaping increased in both groups—rising from 4 percent to 6.6 percent in non-policy states, and from 4.1 percent to 5.2 percent in policy states.

The more concerning findings involved combustible cigarette use. In flavor ban states, youth cigarette smoking increased by 1.8 percentage points in 2021, though this trend did not persist into 2023. Among young adults aged 18 to 24, smoking increased by 3.7 percentage points in 2021, 2.7 percentage points in 2022, and 3.2 percentage points in 2023. These increases occurred even as overall smoking rates continued to decline nationwide, suggesting a possible substitution effect—particularly among individuals who had previously used e-cigarettes.

These results echo earlier studies. A 2024 analysis published in JAMA Health Forum found that flavored e-cigarette bans were associated with a 3.6-point reduction in daily vaping and a 2.2-point increase in daily smoking, compared to trends in states without restrictions. Similarly, a 2020 report by Tobacco Harm Reduction 101 examining local bans in California found that while vaping remained stable or even increased, combustible cigarette use was also on the rise.

The rationale behind flavor bans often assumes that youth are primarily motivated to vape because of flavors.

However, national data suggest otherwise. According to the 2021 National Youth Tobacco Survey, only 13.2 percent of middle and high school students cited flavors as a reason for using e-cigarettes. In contrast, 43.4 percent reported using them to manage feelings of anxiety, depression, or stress.

Recent numbers from 2024 show that youth vaping is now at an all-time low, with only 5.9 percent of youth reporting current use. By comparison, 7.8 percent of adults aged 18 and older were current e-cigarette users in 2023. Data for 2024 adult use is pending.

Lawmakers considering restrictions on flavored vapor products should carefully review the full scope of available data. While the intention of these policies is to reduce youth access and appeal, they may be inadvertently pushing some users—especially young adults—back to smoking. Any policy aimed at improving public health should account for both its intended and unintended effects.

Nothing in this analysis is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101.