Tobacco

Did San Francisco's Ban on Flavored Tobacco Products Increase Teen Smoking?

Further evidence that well-intentioned regulation of vaping products can have negative consequences for public health.

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In 2018, San Francisco voters approved a ban on the sale of all flavored tobacco products, including e-cigarettes and other vaping products. The idea was that flavorings make tobacco products attractive to youth, and that banning such flavors would discourage use by teens. Yet laws do not always have their intended effects.

San Francisco's flavor ban appears to have increased teen smoking, according to new research from the Yale School of Public Health, just published in JAMA Pediatrics. From the study:

San Francisco's ban on flavored tobacco product sales was associated with increased smoking among minor high school students relative to other school districts. While the policy applied to all tobacco products, its outcome was likely greater for youths who vaped than those who smoked due to higher rates of flavored tobacco use among those who vaped. This raises concerns that reducing access to flavored electronic nicotine delivery systems may motivate youths who would otherwise vape to substitute smoking. Indeed, analyses of how minimum legal sales ages for electronic nicotine delivery systems are associated with youth smoking also suggest such substitution.

Is this surprising? It shouldn't be. The availability of a range of flavors is one thing that makes electronic cigarettes a more attractive source of nicotine than combustible cigarettes. Eliminate that advantage, and those seeking nicotine have less reason to prefer vaping over smoking. And because vaping is far less dangerous than smoking, this is bad for public health.

This new study is consistent with prior research which found the S.F. ban was associated with an overall decline in tobacco consumption but an increase in smoking among younger smokers. It is also consistent with research showing that restrictions on youth access to electronic cigarettes increase teen smoking and that increased e-cigarette taxes increase smoking rates.

As explained in a December 2019 Science article, when it comes to vaping, "prohibitionist measures threaten public health." This is no less true when such prohibitionist measures target youth.

As a parent, I do not want my children smoking or vaping, but there is no question which of the two is a greater threat–and it is not even close. Both combustible cigarettes and e-cigarettes contain nicotine, but only the former contains all the deadly byproducts of combustion. Efforts to reduce teen use of nicotine-products may be worthwhile, but if they have the unintended effect of increasing teen smoking, they are doing more harm than good. Good intentions are not enough to ensure that public health measures actually protect public health.

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  1. The crazies that rule San Francisco understate nothing of perverse incentives.

    1. One of the most important economic concepts in mirco economics is the supply and demand curves. The consumer shift to a competing product is easily predicted by anyone with an understanding of the supply and demand curve. As the price of any product rises, consumers shift to a less expensive similar product.

      Another way of stating Nico perverse incentive comment is that progressives / Liberals believe the laws of supply and demand do not apply to their policies, whether it is rent control, minimum wage, taxation, etc

  2. I’m just fed up with vaping being a “tobacco product”.

    Nicotine and tobacco are not synonyms, and nobody should pretend they are.

    (Yes, it’s addictive. No, I don’t care – because nicotine by itself isn’t what kills smokers or wrecks their health; it’s the other stuff in burning tobacco.

    Which vaping doesn’t have, and the promised Horrible Health Effects Of The Vapes have still not shown up.

    This nonsense is literally killing people by pushing them to smoke rather than vape.)

    1. (Disclosure: I don’t vape, and I smoke a couple cigars a year, so I have no personal skin in this game.)

    2. They’ve already tipped their hand on the next step after banning flavored tobacco. They want to reduce how much nicotine can be in a single cigarette, meaning people will have to smoke twice as many to get their nic fix

      1. Which since the nicotine isn’t the dangerous part (99.9% of the negative health affects of smoking come from combustion byproducts) will actually make smoking more dangerous.

    3. “I’m just fed up with vaping being a “tobacco product”.”
      But, but…but,
      those people in San Francisco believe in science!

  3. Is there, well, anything that actually shows nicotine is bad for you? Everything I’ve seen either says neutral or its actually a cognitive enhancer.

    Also I just feel a lot of the propaganda around this … like I had a cigar for the first time a few months back and it felt … fine? Like it felt nice. I haven’t had anything since, but like I can think of a model where if you tell everyone its gonna be this awful thing and it isn’t, well, people find out, smoke more, which isn’t good!

    1. It can increase your blood pressure, but that’s about all I know

    2. The LD 50 dose for nicotine is almost as high as caffeine.

      Nicotine Poisoning

      The LD50 of nicotine is 50 mg/kg for rats and 3 mg/kg for mice. 0.5–1.0 mg/kg can be a lethal dosage for adult humans, and 0.1 mg/kg for children.[18][19] However the widely used human LD50 estimate of 0.5–1.0 mg/kg was questioned in a 2013 review, in light of several documented cases of humans surviving much higher doses; the 2013 review suggests that the lower limit causing fatal outcomes is 500–1000 mg of ingested nicotine, corresponding to 6.5–13 mg/kg orally.[20] An accidental ingestion of only 6 mg may be lethal to children.[21]

      It is unlikely that a person would overdose on nicotine through smoking alone. The US Food and Drug Administration (FDA) stated in 2013: “There are no significant safety concerns associated with using more than one [over the counter] OTC [nicotine replacement therapy] NRT at the same time, or using an OTC NRT at the same time as another nicotine-containing product—including a cigarette.”[22][23][24] Ingestion of nicotine pharmaceuticals, tobacco products, or nicotine containing plants may also lead to poisoning.[4][5][6] Smoking excessive amounts of tobacco has also led to poisoning; a case was reported where two brothers smoked 17 and 18 pipes of tobacco in succession and were both fatally poisoned.[2] Spilling an extremely high concentration of nicotine onto the skin can result in intoxication or even death since nicotine readily passes into the bloodstream following skin contact.[25][26]

      The recent rise in the use of electronic cigarettes, many forms of which are designed to be refilled with nicotine-containing “e-liquid” supplied in small plastic bottles, has renewed interest in nicotine overdoses, especially in the possibility of young children ingesting the liquids.[27] A 2015 Public Health England report noted an “unconfirmed newspaper report of a fatal poisoning of a two-year old child” and two published case reports of children of similar age who had recovered after ingesting e-liquid and vomiting.[27] They also noted case reports of suicides by nicotine, where adults drank liquid containing up to 1,500 mg of nicotine.[27] They recovered (helped by vomiting), but an ingestion apparently of about 10,000 mg was fatal, as was an injection.[27] They commented that “Serious nicotine poisoning seems normally prevented by the fact that relatively low doses of nicotine cause nausea and vomiting, which stops users from further intake.”[27] Four adults died in the US and Europe, after intentionally ingesting liquid.[28] Two children, one in the US in 2014 and another in Israel in 2013, died after ingesting liquid nicotine.[29]

  4. Better to smoke cigarettes and die, than to vape and be consigned to an eternity of douchiness.

  5. “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”

  6. It seems a rather common situation that we get rid of what we perceive as a big problem, and then something worse moves in to replace it.

    Our foreign policy seems to work that way a lot.

    World War I got rid of the Kaiser, but it didn’t exactly make the world safe for democracy. The Iraqi war got rid of Saddam Hussein, but didn’t exactly replace him with peace and love.

    1. But vaping is hardly worse than smoking tobacco.
      AND is a very very far cry from a good cigar

  7. This was the intent. One of the giant vape companies is owned by a tobacco company, which had the vape company make a big to do about withdrawing sales from 10s of thousands of outlets, and run radio ads about how responsible they were, and how, hint hint, that would make good regulation.

    The idea was to hurt all vaping and pull down regulatory burden onto itself.

    So surprise! It worked, and tobacco sales went up.

  8. You liar and bigot — government can do no wrong!

    Recant! Recant! WHAAAAAAAAAAAA!!!!!!!!!!

  9. I really hate studies which purport to he statistically based, but in fact don’t demonstrate anything statistically significant.

    The margins here are too small to be anything but noise.

  10. Anti-smoking campaigns were on their way to eliminating nicotine addiction as a viable business model in America. In pro-vaping commentary, that fact is always tacitly passed by.

    Vaping—regardless of the reasons for its invention and acceptance—was quickly recognized by tobacco companies as a way to revive and continue a declining nicotine-addiction business model. Some vaping opponents predicted that tobacco companies would gain control of the vaping industry, and use it to continue their long-standing practice of addicting children to nicotine to sell cigarettes.

    The narrative in the OP appears to be an example of that dynamic in action. Commenters above who rush to defend vaping do so not because they are sensitive to the harms they pretend to deplore—harms which vaping demonstrably continued in this case—but because they approach every subject involving public health with an ideological anti-government bias. Vindication of that bias is their motive.

    Objection to the practice of government public health policies is a commonplace example of a malign tendency among the anti-government right wing. When a policy alternative relies on a government practice which could prove successful and popular, anti-government ideologues typically prefer to allow or even encourage public harm as an alternative. Not infrequently, they tout a predictably degraded result from that approach as virtuous, and call it, “liberty.” Encouraging addiction is not the path to liberty.

    1. People die because you are a bigot … who uses the force of government guns on people he disagrees with.

      The worst kind …

    2. Lathrop,
      you can just sit in you rocking chair with a cup of de-ionized hot water while the rest of us enjoy a good cigar. To each his own.

    3. “Encouraging” addiction? Huh?

  11. Can we please stop reflexively prefacing horrible, failed policies like this with “well-intentioned”? Seeking to control others through state violence is not “well-intentioned” and I’m tired of pretending otherwise.

    1. NNP, whereas seeking to control others and enslave them to your commercial interest, by addicting them as children, is okay, even exemplary?

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