A new study published in JAMA Health Forum shows that sales restrictions on flavoured e-cigarettes may lead to an undesirable side effect: increased use of traditional cigarettes among young adults.
Several countries have introduced restrictions on flavoured electronic cigarettes, or e-cigarettes, in an effort to reduce youth nicotine use. But a new study from the JAMA Health Forum shows that these regulations may have an unexpected and opposite effect. Instead of reducing tobacco use, some young adults appear to be turning to regular cigarettes when flavoured e-cigarettes are no longer available.
Smoking increased when flavours were banned
The research, based on data from several US states, shows that sales restrictions on flavoured e-cigarettes were associated with a decrease in e-cigarette use among young adults, aged 18-29 (3.6%). At the same time, the researchers noted a clear increase in cigarette smoking in the same group (2.2 per cent). The researchers suggest that this may be because young adults, who would otherwise have chosen e-cigarettes, are instead opting for traditional cigarettes when flavoured e-cigarettes are not available.
"Our findings suggest that regulations on flavoured e-cigarettes should be combined with broader strategies to reduce all tobacco use, so that we do not inadvertently reinforce incentives for cigarette smoking," say the researchers behind the study.
Debate on regulation
The results of the study have sparked debate on how best to regulate nicotine products to protect public health. Supporters of the bans argue that flavoured e-cigarettes attract young people to nicotine addiction and that regulation is therefore necessary. Critics, however, point out that a ban risks driving young people to more harmful alternatives, such as regular cigarettes.
Different views in different countries
In Sweden, the Public Health Agency of Sweden has previously warned that flavoured e-cigarettes could make nicotine use more attractive to young people, but at the same time experts have pointed out that e-cigarettes are generally considered a less harmful alternative to traditional smoking. In 2022, the Swedish Parliament voted against a proposal to ban flavours in e-liquid and e-cigarettes.
In Denmark, the government has introduced a ban on flavoured e-liquids, with the exception of tobacco and menthol, which entered into force in April 2022. The aim of the ban is to protect young people from potentially harmful products.
In the UK, the Public Health Agency, Office for Health Improvement and Disparities, have previously emphasised that e-cigarettes are less harmful than traditional cigarettes and can be an aid to smoking cessation. However, they have emphasised the importance of preventing young people and non-smokers from taking up e-cigarettes.
Clear substitutes for young people
According to the researchers behind the study, the results confirm a growing body of research showing that e-cigarettes and cigarettes act as economic substitutes for young people.
"This means that policies that make e-cigarettes more expensive (through taxes) or less attractive (through flavour restrictions) are likely to increase the use of more dangerous, combustible cigarettes in this age group. The findings emphasise the need to consider young adults as a high priority group when designing tobacco and nicotine policies." the researchers write.
At the same time, they underline the importance of carefully considering the consequences of banning flavoured e-cigarettes.
"If the aim is to reduce all nicotine use, more comprehensive strategies that include both prevention and access to less harmful alternatives may be required." the researchers write.
