Economists Document the Harms of Vapor Bans

 

Throughout my tobacco research career I have found conventional public health professionals inflexibly intolerant of tobacco harm reduction.  So I have worked with talented economists who are doctrinal agnostics.  That is, they are driven by data and evidence.

And the evidence increasingly shows the damage of vapor bans.  In this guest post, Clive Bates highlights the findings of recent studies by economists.

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Abigail Friedman and colleagues have published a fascinating new study on the impact of flavour bans on smoking and vaping behaviours.  This one uses survey data on the prevalence of product use from 2016 to 2023 in Behavioral Risk Factor Surveillance System (BRFSS) surveys.

Friedman, A. S., Pesko, M. F., & Whitacre, T. R. (2024). Flavored E-Cigarette Sales Restrictions and Young Adult Tobacco Use. JAMA Health Forum, 5(12), e244594.https://doi.org/10.1001/jamahealthforum.2024.4594

“… state restrictions on flavored ENDS sales were associated with a 3.6−percentage point (ppt) reduction in daily vaping as well as a 2.2 ppt increase in daily smoking relative to trends in states without restrictions.”

This adds further confirmatory evidence to findings from other studies that use economic analysis to examine what happens when these policies are implemented and evaluated.  Vaping may come down, but smoking (a far greater harm) goes up.

Here are three others: 

1. Friedman, A. et al. (2023). E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales. SSRN https://papers.ssrn.com/abstract=4586701. Used retail sales data from Information Resources Incorporated’s (IRI) retail sales data to look at changes in consumption:

“We find a trade-off of 12 additional cigarettes for every [one] less 0.7 mL ENDS pod sold due to ENDS flavor restrictions.” 

2. Saffer, H., Ozdogan, S., Grossman, M., Dench, D. L., & Dave, D. M. (2024). Comprehensive E-cigarette Flavor Bans and Tobacco Use among Youth and Adults (Working Paper 32534). National Bureau of Economic Research. https://www.nber.org/papers/w32534. Used pooled data from four surveys: Youth Risk Behavior Survey (YRBS), Monitoring the Future (MTF), Population Assessment of Tobacco and Health (PATH), and the Behavior Risk Factor Surveillance Survey (BRFSS)

“Our findings suggest that statewide comprehensive flavor bans may have generated an unintended consequence by encouraging substitution towards traditional smoking in some populations.” 

3. Cotti, C. D., Courtemanche, C. J., Liang, Y., Maclean, J. C., Nesson, E. T., & Sabia, J. J. (2024). The Effect of E-Cigarette Flavor Bans on Tobacco Use (Working Paper 32535). National Bureau of Economic Research. https://www.nber.org/papers/w32535. Used data from State and National Youth Risk Behavior Surveys for youth and the Behavioral Risk Factor Surveillance System for young adults ages 18-20.

“… we find that the adoption of an ENDS flavor restriction reduces frequent and everyday youth ENDS use by 1.2 to 2.5 percentage points. […]. However, we also detect evidence of an unintended effect of ENDS flavor restrictions that is especially clear among 18-20-year-olds: inducing substitution to combustible cigarette smoking.”

The examples above have great merit in looking at outcomes and include effects on smoking and vaping.  Given that the unintended consequences of flavour bans are likely to be the main consequences (when weighted for health impact), these studies show the way to go. 

I am not seeing a lot of formal evaluations of the various flavour bans in Europe. Why would that be?

Here is a survey of adult vapers in the Netherlands by ACVODA, a vape trade association consumer organisation (correction 30 December by CB): Survey among Dutch vapers about the consequences of the online sales and flavour ban (30 August 2024).  This follows a highly restrictive Dutch ban introduced in 2023.

80% of consumers circumvent the flavour ban: 50% go abroad and 30% of respondents still order online and via social media, thanks to the lack of controls. Only 2% of users have switched to the tobacco flavour that is mandatory in the Netherlands. Almost 10% of e-cigarette users have returned to smoking.

None of this should be unexpected. Disgracefully, it seems the billionaire-led, money-soaked campaigns for flavour bans ignore disconfirmatory evidence. It seems they would rather do harm or call for more enforcement than admit they are wrong, for obvious foreseeable reasons. 

Please note that I keep track of some of the policy evidence in a Briefing for Policymakers. This is one of four "Evidence Briefs" on my website. I use these to formulate consultation responses without starting from scratch each time.

Clive Bates