Are flavored e-cigarette bans effective?

By Bhavana KunkalikarReviewed by Benedette Cuffari, M.Sc.May 23 2023

In a recent study posted to the medRxiv* preprint server, researchers explore the effects of flavored e-cigarette bans on the use of e-cigarettes.

Study: The impact of flavored e-cigarette bans on e-cigarette use in three US states. Image Credit: Oleg GawriloFF / Shutterstock.com

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Growing concerns about e-cigarettes

The United States Food and Drug Administration (FDA) and policymakers are highly interested in the impact of e-cigarette flavors and their restrictions on the usage, initiation, and cessation of smoked tobacco products and e-cigarettes. Flavored e-cigarettes have the potential to reduce health risks by attracting smokers to instead use e-cigarettes or by encouraging youth to use e-cigarettes instead of traditional smoking, assuming that e-cigarettes are a safer alternative.

The surge in e-cigarette usage, especially among young people, combined with the sudden outbreak of lung injuries linked to vaping in 2019, led the FDA and various state and local authorities to prohibit or contemplate prohibiting all or some e-cigarettes, including those with added flavors apart from tobacco.

About the study

The current study utilized Amazon Mechanical Turk (MTurk), an online crowdsourcing platform commonly used in tobacco research, to collect data in a cost-effective and efficient manner. The study inclusion criteria required participants to be 18 years or older, a present resident of the state for the past six months, a regular user of e-cigarettes for a minimum of six months prior to the survey, and previously received an approval rating of 90% and over from previous MTurk tasks.

The researchers collected information from participants about their e-cigarette usage in the 30 days following the state flavor ban and the month prior to the ban. Respondents were asked to report their daily use of e-cigarettes before the ban, as well as the frequency of e-cigarette use, categorized as daily, weekly, less than weekly, or not at all, after the ban. Furthermore, data on e-cigarette usage was collected, including flavor preferences and acquisition methods, from participants both before and after the implementation of a ban.

Demographic data, including age, race/ethnicity, gender, educational qualification, and household income, along with other variables that could have influenced respondents' reactions to the ban, were also collected. These variables included the duration of regular e-cigarette use, desire to quit prior to the ban, and reasons for using e-cigarettes. The survey included questions about respondents' awareness and support of the ban and their perception of local retailers' compliance with the ban.

Study findings

A total of 1,624 respondents participated in the study, most of whom were young adult males between 25 and 34 years of age. Most respondents were White and had attained a bachelor's degree or higher.

A significant number of participants had been using e-cigarettes for a period ranging from two to five years. Additionally, almost 80% expressed a strong desire to quit.

According to the survey, 54.4% of respondents reported using e-cigarettes due to the availability of various flavors, while 36.6% used them in an effort to quit smoking traditional cigarettes. However, most of the participants smoked cigarettes on a regular basis, either daily or weekly.

Additionally, most of the respondents were already aware of the ban prior to the survey. While many felt neutral about the ban, more participants supported the ban than opposed it.

The flavor bans resulted in 8.3% of users quitting e-cigarettes. The usage of menthol and other banned flavors decreased, while the usage of non-flavored e-cigarettes rose from 5.4% to 25.4%. The use of non-banned, tobacco-flavored e-cigarettes reduced from 20.1% to 15.6%.

Paired t-tests showed that all changes in flavor use from pre- to post-ban were statistically significant. Those who utilized e-cigarettes on a weekly basis were more likely to quit e-cigarette usage and reduce their usage of menthol and non-tobacco and menthol (TM) flavors as compared to those who used e-cigarettes daily.

Before the ban, the percentage of e-cigarette users who primarily used tobacco flavor was highest among daily smokers. This percentage decreased with the intensity of smoking, while former smokers and never-smokers exhibited the lowest likelihood of primarily using tobacco-flavored e-cigarettes.

Smokers had a higher preference for menthol flavor as compared to former and never smokers. Non-TM flavors showed a reverse pattern in terms of percentage, with the lowest percentage among daily smokers and the highest percentage among never-smokers. The percentage increased progressively among those who smoked weekly or less and former smokers.

Conclusions

The study findings suggested that non-flavored e-cigarettes can be a viable substitute for both tobacco and non-tobacco-flavored e-cigarettes. Additionally, state bans on e-cigarette flavors are unlikely to cause a significant proportion of adult e-cigarette users to increase or switch to smoking. Enforcing a complete flavor ban and ensuring retailer compliance is essential for regulating the use of e-cigarettes.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.