The Impact of a Comprehensive Tobacco Product Flavor Ban in San Francisco Among Young Adults

By Kenneth D. Warda et al. For Addictive Behaviors Reports
Summary of Study

Bottom Line: Despite governments' moves to ban them, e-cigarette flavors play an important role in helping smokers quit. This study examines the impact of flavor bans in San Francisco and finds that e-cigarette use fell and cigarette smoking rates increased following the ban, suggesting flavor bans may do more harm than good.

E-cigarettes have the potential of being a less harmful alternative to current smokers if they switch from smoking to e-cigarettes completely. Evidence suggests that flavors in e-cigarettes might help such switching. Despite this evidence, the FDA, Congress, and many states and cities have moved to ban and restrict flavors. The FDA has implemented a new enforcement policy to stop the sale of all cartridge-based e-cigarettes with flavors other than tobacco or nicotine.

Flavor bans may push some e-cigarette users to turn to cigarette smoking and could prompt some youth to initiate into smoking instead of e-cigarette use. Moreover, state and local flavor bans may simply prompt users to get their flavored tobacco products in nearby jurisdictions that still sell them, from illegal local sellers, or through Internet sales, thereby reducing any beneficial public health impacts.

In January 2019, San Francisco implemented a comprehensive ban on the sale of all flavored e-cigarettes (other than tobacco flavor). This study assesses the impact of the flavor ban policy among young adults in San Francisco by surveying 247 e-cigarette users. Among the findings:

  • The prevalence of using flavored e-cigarettes decreased significantly.
  • Use of still-permitted tobacco-flavored e-cigarettes increased.
  • Cigarette smoking increased.
  • The proportions of e-cigarettes, cigarettes, and cigars obtained over the Internet or through the mail increased after the ban, and the proportions obtained from retailers outside of San Francisco also increased.
  • Among those who exclusively used flavored e-cigarettes before the ban, about 60% continued to use them exclusively after the ban.
  • Most participants who left comments were negative toward the ban. The negative comments repeatedly included adjectives such as ridiculous, stupid, and invasive. One commented “The ban does nothing except make people want it more.”

Access the full study HERE.