Less Vaping, More Smoking

The Predictable Effect of Flavored E-cigarette Restrictions

Enumerating the failures of the U.S. public health establishment over the last few years would be a considerable undertaking. Although lapses in the COVID-19 pandemic response are perhaps the most salient, regulatory blunders around e-cigarettes may — in the long-run — prove even more damaging.

Over the last few years, hundreds of localities and a handful of states have implemented restrictions — including, in some cases, outright bans — on the sale of flavored vaping products. Policymakers, such as New York State’s Commissioner of Health, have claimed the measures “will protect our children” and prevent “Big Tobacco [from] target[ing] young New Yorkers for a lifetime of nicotine addiction.”

An op-ed in the New York Times, co-written by the president of the Campaign for Tobacco-Free Kids, warned that vaping was “turning millions of young people into addicted customers” and insisted that “banning flavored e-cigarettes is the most important thing we can do to reduce use among young people.”

Deterring youth from using tobacco products is a laudable goal. But evidence is mounting that targeting flavored e-cigarettes is a disastrously misguided strategy. While the policy does achieve its first-order goal of reducing e-cigarette sales, its backers too often ignore its downstream effects. As any student of ECON 101 could have predicted, restricting access to flavored e-cigarettes causes consumers to search for alternative sources of nicotine, and many end up smoking more combustible cigarettes.

A recent study led by researchers at the Yale School of Public Health finds that for every one less 0.7 mL e-liquid pod sold due to flavor restrictions, an additional 15 cigarettes are purchased, including from brands disproportionately used by underage youth. To put that in perspective, the average user vapes about 2-3 mL of e-liquid per day. That implies that reducing e-cigarette use by the average daily consumption volume for one person comes at the cost of increasing smoking by three packs of cigarettes. Hardly an attractive tradeoff, especially in light of the fact that e-cigarettes — though far from risk-free — carry fewer toxins and are less lethal than combustible tobacco products.

This latest research adds to a growing literature documenting the unintended consequences of cracking down on e-cigarettes. A paper published earlier this year found that taxing vaping products led to large increases in cigarette smoking among youth that “may considerably undercut or even outweigh any public health gains.” Another study estimated that taxing e-cigarettes at the same rate as combustible cigarettes would deter more than 2.75 million smokers from quitting in the U.S. over a 10-year period.

Cigarette smoking remains a public health scourge in the U.S., causing 480,000 deaths (more than the number of COVID-19 victims in 2020) and more than $240 billion in preventable health care spending annually.

Over the last decade, e-cigarettes have contributed to declining rates of smoking among both adults and adolescents. Yet draconian restrictions on e-cigarettes threaten to reverse these gains by giving more lethal combustible products a competitive advantage over less dangerous alternatives.