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

 

NY Wrongheadedly Bans Indoor Vaping

Saying that e-cigarettes “carry long-term risks to the health of users and those around them,” New York Governor Andrew Cuomo signed into law on October 23 a bill that bans indoor vaping.  

The governor got his facts wrong.  While e-cigarette usage rates have boomed over the past five years, there is no evidence that they have any significant short-, medium- or long-term health effects. 

Andrew Stuttaford in the National Review (here) labeled Cuomo’s action “an unscientific war,” citing the Royal College of Physicians’ 2016 report (here)(emphasis in original). 

The case for e-cigarettes can be summed up by four key recommendations from the RCP report:

·       E-cigarettes are marketed as consumer products and are proving much more popular than NRT [nicotine replacement therapy] as a substitute and competitor for tobacco cigarettes.

 

·       E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking.

·       … the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.

·       …in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking

Ignoring clear evidence of vapor’s relative safety and widespread use in smoking cessation, politicians and public health officials in New York and elsewhere support the deadly cigarette status quo.

Beyond science issues, vaping bans have little impact on consumer behavior.  E-cigarette vapor dissipates quickly, so while bans may stifle e-cigarette use in public settings, enthusiasts know that they can continue vaping indoors; if they are discreet, no one will know.

The biggest flaw in vaping bans is the false implication – if not the explicit false claim – that vapor is as dangerous as smoke.  In the war on vaping by Governor Cuomo and others, such deception misleads American tobacco users and denies them use of proven harm reduction aids. That is the denial, not the promotion, of public health.

Youth E-Cigarette Bans Increase Youth Cigarette Smoking

Smoking increased significantly among teens aged 12-17 in states that banned e-cigarette sales to minors compared with states that didn’t impose bans, according to a study in the Journal of Health Economics (abstract here) by Yale School of Public Health’s Abigail Friedman.

Dr. Friedman used smoking data from the National Survey on Drug Use and Health (2002 to 2013).  She accounted for other youth smoking factors that vary among states, such as cigarette taxes, smoke-free air laws and medical marijuana laws.

Dr. Friedman concludes: “Across the board, this paper’s analyses find that reducing e-cigarette access increases smoking among 12 to 17 year olds. The effect is large: over the 8 years preceding the first bans on e-cigarette sales to minors, smoking in this age group fell an average of 1.3 percentage points per two year period. The estimated 0.9 percentage point rise in smoking due to bans on e-cigarette sales to minors counters 70 percent of the downward pre-trend in states with such bans.”

She notes, “This paper’s findings will prove surprising for many: policy discussions to date have not considered that banning e-cigarette sales to minors might increase teen smoking.  Assuming that e-cigarettes are indeed less risky to one’s health than traditional cigarettes, as suggested by

existing evidence on the subject, this result calls such bans into question.” (emphasis in original)

Dr. Friedman makes a bold suggestion – one that is sensible and defensible: Ban e-cig “sales to those younger than 16 instead of 18, as initiation of regular smoking first spikes at the former age.” 

E-cigarette companies and advocates support bans on e-cig sales to minors.  While health organizations like the American Cancer Society and Heart Association object to youth e-cig use, they oppose bans for two reasons: 1) e-cig companies support them, and 2) according to the health groups youth bans are not as effective as higher sales taxes and smoke-free or clean-air laws (discussed here).

E-cigarette opponents have been quick to challenge the Yale study.  In a Winston-Salem Journal article, Dr. John Spangler of Wake Forest Baptist Medical Center called the study flawed because it “does not account for unmeasured factors, such as racial and ethnic population mix in states.”  This is a false charge, as the researchers adjusted “for the percent of [each] state’s population identifying as Black, as a different racial minority, and as Hispanic.”  These factors were noted in all three results tables.

Other e-cig prohibitionists support the bizarre logic of University of California- San Francisco professor Stanton Glantz, who has argued in the past that banning e-cigarette sales to kids only makes teens want them more.  Dr. Friedman’s study turns this argument on its head: Banning e-cig sales increases teen smoking.