Thursday, June 17, 2021

Man, Oh Man, That San Fran Flavor Ban!


Tobacco flavor bans are all the rage among tobacco prohibitionists.  As I noted last week, the first attack on flavored tobacco took place over a decade ago (here).  Tobacco opponents pursue flavor bans, rather than outright prohibition, as a form of Tacit Incremental Prohibition - Tobacco Elimination. 

Prohibition, when it is imposed, has consequences, as seen when San Francisco banned the sale of tobacco products containing any non-tobacco flavors in January 2019.  The San Fran ban was comprehensive, covering menthol cigarettes and almost all e-cigarette and vapor products.

Abigail Friedman, Ph.D., of the Yale School of Public Health, just published an analysis in JAMA Pediatrics (here) of smoking among underage high schoolers in San Francisco compared with seven other cities and counties, including Los Angeles, San Diego, New York City, Philadelphia, plus Florida’s Broward, Orange and Palm Beach Counties.  She used data from the CDC’s Youth Risk Behavior Surveillance System (YRBSS) every other year from 2011 to 2019. 

As the chart at left shows, Dr. Friedman found that smoking among underage high schoolers declined everywhere from 2011 to 2017, from nearly 10% to about 4%.  However, while the smoking rate continued to drop in other jurisdictions in 2019, to 2.8%, it spiked upward in San Francisco, to 6.2%.

Dr. Friedman notes that the San Francisco increase “raises concerns that reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking. Indeed, analyses of how minimum legal sales ages for electronic nicotine delivery systems are associated with youth smoking also suggest such substitution” (Friedman’s reference here).

I confirmed Dr. Friedman’s primary results using the same YRBSS data, but I also found intriguing information about underage smokers, which I illustrate in the following chart.

Note the big difference between San Francisco and other areas in the number of days smoked in the past month.  It appears that there are many more infrequent smokers in San Francisco: 60% smoked only 1-2 days, and over 80% smoked less than 10 days.  If teens were substituting cigarettes for flavored vape products in San Fran, most were doing so experimentally, with no major difference in frequent smoking.

As tobacco flavor bans become more common, research like Dr. Friedman’s will increase in importance, and will likely be ignored by tobacco prohibitionists.


Thursday, June 10, 2021

The War on Tobacco Flavors Is Another Element of the TIP-TOE Game Plan: Tacit Incremental Prohibition - Tobacco Elimination


In a recent interview with Strong and Free Podcast producer Christopher Balkaran, I explained why in the 1990’s I jumped from a conventional academic career into tobacco harm reduction research and policy analysis.  When I challenged conventional wisdom about smokeless tobacco, finding many of the attacks on it as unsupported and dishonest, I exposed a number of inconvenient truths about the tobacco control community. 

Alas, the first recognition of an important concept is frequently ignored, and eventually forgotten.  Dr. Philip Cole, my only tobacco research colleague and coauthor for nearly 10 years, wisely observed, “Our tobacco work will be ignored and vilified.  I prefer the latter, because it means that someone is noticing.

Today, there is a fresh push to ban tobacco flavoring, particularly menthol cigarettes and all vapor products.  The effort is largely driven by the Campaign For Tobacco-Free Kids and their allies, ostensibly to protect children from a lifetime of nicotine addiction.  

The drive to ban flavors is not new.  In 2010, I commented on one of the first studies demonizing mint and wintergreen flavors in dip products.  The next year, I coined TIP-TOE, or Tacit Incremental Prohibition - Tobacco Elimination, as a moniker for the prohibitionists’ effort “to employ an escalating series of legislative and regulatory controls in order, over time, to remove all tobacco products from the marketplace.”  I noted that zealots “believe that a world without nicotine is both desirable and achievable, yet they are not courageous enough to demand outright prohibition. Instead, they’ve implemented the subtle TIP-TOE strategy of chipping away at consumer rights and industry initiatives… They would ban tobacco products that are almost risk-free, while assuring continued market dominance by vastly more hazardous cigarettes.  Using TIP-TOE tactics, tobacco prohibitionists are sprinting toward a public health disaster.” 

Flavor bans have predictable results, some of which are unintended by their prohibitionist promoters.  In the next blog I’ll discuss one consequence of the 2019 San Francisco flavor ban.