Denver is among the latest cities to consider a ban on flavored tobacco products. The Denver City Council is pushing the proposal in hopes that prohibiting flavored tobacco products will reduce the number of young people who experiment with e-cigarettes. But the experience of other cities and states that have implemented similar flavored tobacco bans and the federal data on the causes of youth vaping suggest that the prohibition of safer nicotine alternatives, like e-cigarettes, is unlikely to have a positive public health impact and could undermine it.
In 2018, San Francisco began enforcing its flavored tobacco ban. To investigate the subsequent impact on public health, Yale University’s Abigail Friedman conducted a study evaluating the policy. Friedman’s research showed young people in the San Francisco area had double the odds of smoking compared to young people in similar nearby jurisdictions where there was not a tobacco flavor ban. Friedman stated:
“While neither smoking cigarettes nor vaping nicotine are safe per se, the bulk of current evidence indicates substantially greater harms from smoking, which is responsible for nearly one in five adult deaths annually. Even if it is well-intentioned, a law that increases youth smoking could pose a threat to public health.”
There’s a widespread misperception that the main reason young people experiment with vaping is that e-cigarette products come in sweet or fruity flavors. But according to data from the Centers for Disease Control and Prevention (CDC), the principal reasons young people say they start vaping is “curiosity,” followed by “friend or family member used them,” and then “they are available in flavors, such as mint, candy, fruit, or chocolate” comes in a very distant third.
The minority of youth who vape use non-tobacco flavors, but the same is true for adult smokers who switch to e-cigarettes to quit smoking. According to a 2020 study by researchers at the Yale School of Public Health, the use of e-cigarette flavors is positively associated with smoking cessation outcomes for adults but not associated with increased youth smoking.
Fortunately, youth vaping has been declining since before the COVID-19 pandemic and has plummeted by 60% in the last two years.
Blanket bans on the most popular reduced-risk alternatives to traditional cigarettes would also preempt the Food and Drug Administration’s (FDA) process for evaluating whether these products are a net benefit to public health. In October, the FDA authorized an e-cigarette as appropriate for the protection of public health for the first time. In fact, Denver’s ban, as constructed, would ban Swedish Match’s mint and wintergreen smokeless products, both of which have been authorized as appropriate for the protection of public health by the FDA and are permitted to make marketing claims informing consumers of their safety relative to cigarettes.
“The manufacturer’s data demonstrates its tobacco-flavored products could benefit addicted adult smokers who switch to these products — either completely or with a significant reduction in cigarette consumption,” said Mitch Zeller, head of the FDA’s Center for Tobacco Products.
No longer can it be claimed that the public-health agency doesn’t recognize the basic science that vaping is safer than smoking. Many flavored e-cigarettes are currently under FDA review. If they are found to be a public health risk, they will be removed from the market. But banning e-cigarette flavors regardless of the FDA’s decision would be to ignore the extensive scientific evaluation to which these products are subjected.
The prohibition of menthol cigarettes presents a different problem. As of now, the evidence suggests menthol bans are largely ineffective thanks to cross-border shopping and substitution for regular cigarettes. According to a study published by the National Bureau of Economic Research on menthol prohibition in Canadian provinces, the ban significantly increased non-menthol cigarette smoking among youths, resulting in no overall net change in youth smoking rates. As for adult smokers, the study found provincial menthol bans shifted smokers away from grocery stores and gas stations to First Nations reserves (where the menthol bans do not apply).
In the first year of banning flavored tobacco, Massachusetts lost more than $140 million in tax revenue due to the decrease in sales. However, those sales didn’t stop entirely. Menthol cigarettes sales skyrocketed in the neighboring states of New Hampshire and Rhode Island.
Just as, or more important are concerns over the disparate impact that bans on menthol products may have on black communities. Advocates for the prohibition of menthol cigarettes correctly observe a disproportionate number of black smokers choose menthol products, with around 85% using menthol. From a public health standpoint, it’s hard to ascertain why non-menthol cigarettes, which are equally dangerous, would not be subjected to prohibition while menthol products would be.
The American Civil Liberties Union and other civil rights groups have warned that the prohibition of menthols could disproportionately impact people of color, trigger criminal penalties, and prioritize criminalization over public health and harm reduction by penalizing those who become involved in the illicit trade for menthol cigarettes. In New York City, Eric Garner was killed in a police confrontation sparked by selling loose cigarettes.
With smoking currently at a historic low among youth and adults, there are methods to further reduce the burden of smoking-related disease without risking discriminatory law enforcement action or criminalizing the preferences of one ethnic group while allowing those of others to remain legal.