How does the San Francisco Flavor Ban Encourage Young People to Take Up Smoking More?

An unprecedented majority of voters outlawed the sale of flavored nicotine vaping devices (as well as flavored tobacco products like vapes and menthol cigarettes) in San Francisco in the summer of 2018.

When the ban was enacted in January 2019, nearly all of the city's retailers complied immediately.

Companies that sell vaping devices spend enormous amounts of money on one side of the argument. At the same time, billionaire Michael Bloomberg, a longstanding supporter of anti-smoking causes who has recently altered his abstinence-only stance toward vaping, contributed millions of his funds to the opposition.

The American Cancer Society and other well-known nonprofit organizations, like the Bloomberg-funded Campaign for Tobacco-Free Kids (CTFK), applauded the outcome.

The American Heart Association believed that the San Francisco vote was beginning to eliminate "the sale of candy-flavored cigarettes before addiction claims a wave of young people," according to Dr. Melissa Welch, a representative for the organization who lobbied voters to pass the ban.

However, a recent study by the Yale School of Public Health (YSPH) suggests that this rule may have had the opposite impact.

After correcting for individual characteristics and other tobacco regulations, analyses revealed that high school students' likelihood of smoking traditional cigarettes in the San Francisco education department after the ban went into effect compared to trends in jurisdictions without the ban.[1]

Similarly, according to a recent study published in JAMA Pediatrics, students in San Francisco's high schools were more inclined to begin smoking than adolescents in other U.S. school systems after the city banned flavored tobacco products and vapes.[2]

Before the taste ban, San Francisco's smoking rates were comparable to those of many other American cities, and over time, fewer teenagers were using traditional cigarettes. In comparison to patterns in similar school districts, once the city implemented its ban, the likelihood that high school students would smoke more than doubled.

Dr. Friedman examined biannual high school freshman data from surveys of school districts carried out by the CDC's Youth Risk Behavior Surveillance System between 2011 and 2019. These surveys track the usage of cigarettes, alcohol, and other drugs, as well as sexual activities "associated with STIs and unwanted pregnancy," among other subcategories.

Friedman conducted statistical regressions contrasting respondents' most recent smoking in San Francisco to that in other school systems.[3]

There was no taste prohibition in place during the time in any other school districts that Friedman took into account in her assessment, including New York City, Broward County, Los Angeles, Orange County, Palm Beach County, Philadelphia, and San Diego.

Friedman said, "The public has to understand precisely how deadly smoking is. "Combustible tobacco usage causes roughly 480,000 fatalities annually in the U.S. That number of fatalities exceeds the CDC's estimate of U.S. COVID-19 fatalities in 2020, but they occur annually. So, the standard for safety is not exceptionally high.

She further stated, "Not using any tobacco products is the safest choice. Smoking will probably be worse for your health than inhaling a nicotine e-liquid from a reputable manufacturer, but if you're going to use tobacco, selecting the most lethal delivery method makes sense."

According to the Royal College of Physicians (RCP) in the U.K., e-cigarette harms are "unlikely to surpass 5% of those linked with smoked tobacco and alcohol, and may be significantly lower than this proportion."

The timing of Friedman's research, which she presented at the U.S. E-Cigarette Summit, seems to coincide with a gradual shift in American attitudes toward vaping.

Along with Friedman, two senior Food and Drug Administration (FDA) officials directly addressed the likelihood that (at least some) vaping goods will be approved by their organization.

While it remains improbable that the FDA would decide on every application for premarket conventional cigarettes by September, the organization has indicated that it will start with the larger firms.

It has significant ramifications that the FDA is willing to state it will soon regulate the vaping sector. The organization will essentially be endorsing that nicotine vaping is significantly less risky than smoking for the first time.

Additionally, it will serve as a long overdue corrective to the bad legislative choices made in response to the skyrocketing youth vaping rates in the late 2010s. There is mounting evidence that prohibitionist policies implemented hastily have increased damages rather than reduced them. They seem to have encouraged increased smoking.

The FDA's readiness to announce that it would soon regulate the vaping industry has significant ramifications. The organization will confirm that vaping nicotine poses much less risk than smoking. Furthermore, it will serve as a long overdue corrective to the bad legislative choices made in response to the skyrocketing youth vaping rates in the late 2010s.

More and more proof is showing that prohibitionist tactics used in a hasty manner exacerbated damages rather than reduced them. They seem to have encouraged smokers to smoke more.

There is no room for the people who had access before when laws are drastically changed — from more lax regulations to considerably harsher ones.

Such initiatives ignored the nicotine industry that was already established and the reality that vaping and tastes have helped millions of adult smokers successfully switch from cigarettes to safer substitutes.

On the one hand, the bans on flavors are designed to stop exposure ostensibly. This notion holds that disclosure alone will result in widespread use, dependency, and issues. There is a notion that these kinds of laws are necessary to safeguard individuals from their actions.

The issue, though, is that when we drastically change policies — from laxer to considerably harsher ones — those who previously had access are left out.

We are seeing the effects being revealed in real-time. Friedman's study is merely the most recent instance.

 Research in the Harm Reduction Journal in May revealed additional data connecting false information about vaping and the wave of lung-related illnesses that began in the summer of 2019 with an increase in smoking cigarettes.[4]

Another study, also published in Nicotine & Tobacco Research the same month, revealed that youths who vape would likely be smoking cigarettes rather than vapes had never been invented.[5]

There are restrictions on the San Francisco study. Given how recently the regulation was put into effect, the tendency might change in the years to come. San Francisco is one of several cities and states that limit the sale of flavored tobacco, and these rules vary significantly from place to place. As a result, outcomes could be different elsewhere.

However, findings imply that policymakers should exercise caution not to unintentionally encourage youngsters to smoke cigarettes as comparable restrictions continue growing around the nation.

There is a lingering painful truth here that most stakeholders wouldn't dare to say. No sane adult would advise a teen who doesn't use nicotine to try vaping. But it's a big triumph for teenagers who would otherwise be smoking.

References: 

[1] https://news.yale.edu/2021/05/25/ban-flavored-vaping-may-have-led-teens-cigarettes-study-suggests

[2] https://jamanetwork.com/journals/jamapediatrics/fullarticle/485644

[3] https://www.researchgate.net/figure/Prevalence-of-tobacco-or-vaping-products-before-and-after-the-flavor-ban_tbl2_340372457

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968985/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925085/