In recent years, vaping has become popular as an alternative to traditional cigarettes. Flavoured electronic cigarettes—known as e-cigarettes—have become so popular among young adults that some states have implemented restrictions such as flavour bans and taxes on e-cigarettes to reduce teen vaping.

A new study from researchers at the University of Missouri and the Yale School of Public Health found that state restrictions on flavored e-cigarettes led to a decrease in vaping among young adults in the United States. However, those restrictions also led to an increase in traditional cigarette smoking among young adults compared to states without such restrictions.

The findings show that well-intentioned public health policies can have unintended effects—a topic of interest for Mizzou's Michael Pesko, a professor of economics in the College of Arts and Science.

"We should always be cognizant that any policy will have unintended effects, especially in the public health space. In this case, our study finds flavoured e-cigarette restrictions have the unintended effect of sizably increasing cigarette use," Pesko said. "This is not good from a public health perspective because cigarettes are far more dangerous products. It's the equivalence of steering a ship away from a storm straight into a whirlpool."

A reasonable and achievable policy goal is to reduce tobacco-related disease and death, Pesko said.

"One important component to achieving that is to enact policies that shift away from the most harmful tobacco products to less harmful alternatives," he said. "E-cigarette flavour restrictions have the opposite effect of pushing many people towards more harmful tobacco."

In the study, Pesko also found that in Maryland, a state with a policy that exempted menthol-flavoured e-cigarettes from a ban on other flavours, both vaping and smoking rates decreased, showing that a more nuanced approach to regulation might be the best way to tackle public health issues.

The popularity of e-cigarettes began to rise around 2010. Pesko worked at the Centers for Disease Control and Prevention at the time, and the trend sparked his interest in his current research.

The paper, "Flavored e-cigarette Sales Restrictions and young adult tobacco use," is published in JAMA Health Forum.

More information: Abigail S. Friedman et al, Flavored E-Cigarette Sales Restrictions and Young Adult Tobacco Use, JAMA Health Forum (2024). DOI: 10.1001/jamahealthforum.2024.4594