County board legislators in Westchester, New York are considering a local law that would prohibit “the sale or distribution of flavored e-cigarettes and flavored e-liquids.”

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Unfortunately, flavor bans do not reduce youth e-cigarette use or address the recent outbreak of illnesses supposedly linked to vaping. In fact, several state health departments and the Centers for Disease Control and Prevention (CDC) have linked these cases to the use of tetrahydrocannabinol (THC) products. Flavor bans merely restrict adult access to tobacco harm reduction products, thus forcing adults to seek such products on black markets and/or revert back to smoking tobacco cigarettes.

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The Heartland Institute examined the effects of flavor bans, finding these measures to have no impact on youth e-cigarette use. For example, Santa Clara County, California, banned flavored tobacco products to age-restricted stores in 2014. Despite this, youth e-cigarette use increased. In the 2015-16 California Youth Tobacco Survey (CYTS), 7.5 percent of Santa Clara high school students reported current use of e-cigarettes. In the 2017-18 CYTS, this increased to 10.7 percent.

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Further, in an October 15 report, CDC found 78 percent of 849 patients reported vaping THC-containing vaping devices. This is similar to reports from many state health departments. The Utah Department of Health concluded 94 percent of patients with vaping-related lung illnesses reported use of “any THC cartridges.” The California Department of Health found 81 percent of patients had used a “product containing THC.” On October 18, the Connecticut Department of Public Health found 26 of 34 patients (76 percent) with vaping-related lung illnesses reported using THC-containing products. Only 2 patients, or 0.05 percent, reported “exclusive use of nicotine.” Six patients were unable to identify what they had vaped. Because the vast majority of these THC-infused products are illicit and purchased on black markets, it is highly unlikely a ban on flavored e-cigarette products will have any effect on vaping-related hospitalizations.

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Moreover, flavors are immensely popular, especially among adults. A 2016 Consumer Advocates for Smoke-Free Alternatives Association survey of more than 37,000 adult vapers found 72 percent of respondents “credited tasty flavors with helping them give up tobacco.” Further, a 2018 survey of nearly 70,000 American adults noted 83.2 percent and 72.3 percent of survey respondents reported vaping fruit and dessert flavors, respectively. In the same survey, only 20 percent of respondents reported using tobacco flavors at point of e-cigarette initiation. In essence, flavor bans will likely push former smokers back to much more harmful, combustible cigarettes. A 2017 study by the National Bureau of Economic Research examined the effects of flavor bans and found banning flavors in e-cigarettes “would result in increased choice of combustible cigarettes.” Even worse, the study’s authors expect e-cigarette use to decline by approximately 10 percent if flavors are banned.

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Despite language in the Westchester bill, manufacturers already disclose information on ingredients in vaping devices. Since 2016, e-cigarettes and vaping products have been regulated by the U.S. Food and Drug Administration (FDA) through the agency’s deeming regulations. Per the deeming regulations, no new e-cigarette product can come to market after August 8, 2016, without prior approval by FDA. Moreover, manufacturers must disclose all ingredients to FDA as of May 8, 2019.

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Despite endless fear mongering, electronic cigarettes are substantially safer than combustible cigarettes. In 2015, Public Health England found e-cigarettes to be “95% safer” than traditional tobacco cigarettes. In 2016, the Royal College of Physicians concluded the harm produced by e-cigarettes is “unlikely to exceed 5% of [the harm] associated with smoked tobacco products.” Most recently, the American Cancer Society declared e-cigarettes to be “significantly less harmful for adults than smoking regular cigarettes … because e-cigarettes do not contain or burn tobacco.”

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Further, Westchester County does not have an issue with youth purchasing e-cigarettes and vaping devices. However, the county does have a problem with underage sales of other tobacco products, including cigars and cigarettes. For example, FDA conducted 374 tobacco product compliance checks with from January 1, 2018 to September 30, 2019. Of these checks, only 41 retailers were found in violation of selling tobacco products to minors. Of the underage sales, 15 involved sales of cigars, 25 involved sales of cigarettes, and one sale involved a single cigarette. Interestingly, convenience stores were the biggest violators, and six retailers with “puff,” “smoke,” or “vapor” in their store names had zero violations.

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Moreover, though youth e-cigarette use is cause for concern, overall tobacco use is down among high school students. For example, according to the 1997 Youth Risk Behavior Survey, 42.7 percent of high school students reported using tobacco products, with 36.4 percent reporting use of combustible cigarettes. According to the 2018 National Youth Tobacco Survey, only 27.1 percent of high school students reported using any tobacco product, with 20.8 percent reporting using e-cigarettes and vaping devices. It is alarming that lawmakers would choose to prohibit adult use of tobacco harm reduction products when youth tobacco use is relatively low compared to 1997.

 

Rather than restricting adult access to e-cigarettes, policymakers should allocate existing funds (from tobacco taxes and MSA payments) to programs intended to reduce youth e-cigarette use. Flavor bans have little effect on youth e-cigarette use and are unlikely to reduce recent vaping-related hospitalizations.

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Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.