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.
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