Tobacco hurt discount has at all times been about steadiness: discovering methods to minimise dangers for individuals who use nicotine whereas avoiding unintended penalties. One of the contested questions on this subject considerations the function of flavours in safer nicotine merchandise like vapes, heated tobacco and nicotine pouches. For some, flavours are an interesting gateway that might pull in youth who would possibly in any other case by no means smoke or vape. For others, they’re a lifeline—making alternate options to cigarettes palatable sufficient that individuals who smoke can truly swap.
A new examine by researchers at Mass Common Brigham, revealed in JAMA Community Open, provides recent proof to this debate. Taking a look at six U.S. states—Massachusetts, New Jersey, New York, Rhode Island, Maryland, and Utah—that enacted vape flavour bans in 2020, the examine examined tendencies in vaping and smoking from 2019 to 2023. As anticipated the outcomes weren’t constructive.
Whereas vaping amongst younger folks and adults declined considerably in states with flavour bans, with vaping amongst 18–24-year-olds dropping by almost seven proportion factors in 2022, grownup use by about one proportion level by 2023, and teenage vaping from 24.1% in 2019 to 14.0% in 2023, in comparison with a decline from 24.6% to 17.2% in different states. This had a negaitive influence on smoking charges.
Banning flavours, fueling smoke
Alongside these reductions got here a much less encouraging development. Not solely did smoking not fall as a lot within the ban states, in some teams, it truly ticked upward. Youth smoking charges had been virtually two proportion factors greater than anticipated in 2021, whereas younger adults confirmed a 3.7 proportion level enhance. This sample confirms what THR consultants have been warning us about all alongside: flavour bans, whereas curbing youth vaping, are inadvertently slowing progress on decreasing smoking—the a lot deadlier behaviour.
The state-level variations supply additional nuance. Massachusetts, which carried out native bans earlier than its statewide regulation and enforced restrictions strictly, noticed the clearest reductions in vaping. States with exemptions—permitting menthol or gross sales in specialty outlets—had weaker outcomes. Even so, not one of the states confirmed strong declines in cigarette use after the bans.
This in fact, will not be the primary time analysis has prompt that limiting flavours might have unintended penalties. A 2020 paper in Nicotine & Tobacco Analysis discovered that U.S. adults who vaped non-tobacco flavours had been extra more likely to give up smoking than these restricted to tobacco-flavoured choices. One other examine in Dependancy (2021) concluded that adults who switched to flavoured e-cigarettes had been extra profitable in sustaining cigarette abstinence over time. These findings echo what many hurt discount advocates have lengthy argued: flavours should not simply beauty—they’re purposeful instruments for substitution.
Menthol, mango, and the maths of hurt discount
Proof from heated tobacco merchandise (HTPs) reinforces this. A latest scientific trial revealed within the American Journal of Preventive Drugs examined menthol-flavoured versus tobacco-flavoured HTPs amongst grownup menthol cigarette customers. The outcomes had been hanging: these given menthol HTPs reduce their cigarette consumption by 80%, whereas these utilizing tobacco-flavoured HTPs lowered by solely 37%. The nicotine supply and puffing behaviour had been just about an identical throughout each teams; what made the distinction was flavour. Menthol, lengthy identified to easy the harshness of smoke, seems to make HTPs extra satisfying replacements for cigarettes.
The function of flavours in substitution will not be trivial. Cigarettes kill eight million folks every year worldwide. Any intervention that meaningfully helps people who smoke go away combustion behind has main public well being significance. Evaluations such because the one revealed within the Worldwide Journal of Environmental Analysis and Public Well being in 2024 have proven that vaping and HTPs slash publicity to poisonous chemical substances by greater than 90% in contrast with cigarettes. Polycyclic fragrant hydrocarbons, unstable natural compounds, tobacco-specific nitrosamines, and carbon monoxide—all key drivers of most cancers, coronary heart illness, and respiratory sickness—drop to near-undetectable ranges. The distinction between persevering with to smoke and switching to a flavoured various may actually be life or demise.
In fact, the considerations about youth uptake can’t be dismissed. Flavours like fruit or sweet do attraction to adolescents, and experimentation is widespread. But large-scale surveys counsel that the majority younger individuals who attempt vapes don’t develop into day by day customers, and only a few progress to smoking. Within the U.Okay., the place flavoured vapes stay extensively out there beneath regulated circumstances, youth smoking continues to fall to file lows. This means that the supply of flavours, paired with age restrictions and enforcement, needn’t derail tobacco management progress.
Proof vs. ideology
As typical, the problem then is steadiness. Flavour bans might look enticing as a fast answer to youth vaping, however they threat eradicating some of the efficient incentives for grownup people who smoke to modify. Worse, they could push folks again to smoking, because the JAMA Community Open examine warns. A extra nuanced strategy may contain proscribing advertising and marketing and packaging that clearly targets youth, implementing age verification extra rigorously, and limiting essentially the most clearly childlike flavour names—with out eliminating adult-appealing choices like menthol, fruit, or dessert profiles.
Finally, the dialog about flavours must be grounded in hurt discount. The query will not be whether or not flavours are risk-free however whether or not they assist extra folks escape the vastly larger dangers of smoking. The proof up to now suggests they do. If policymakers wish to shield younger folks whereas additionally driving down smoking-related illness, the purpose must be regulation that preserves flavours as a software for grownup people who smoke whereas curbing irresponsible promotion and entry by youth.
The Mass Common Brigham examine provides an important reminder: tobacco management insurance policies don’t function in a vacuum. As consultants within the subject have constantly highlighted, each lever pulled to limit one behaviour can shift one other, for higher or worse. If the purpose is to save lots of lives, then the proof factors clearly to this: sustaining entry to flavoured alternate options, alongside sensible regulation, could also be the simplest technique to scale back hurt throughout the inhabitants.
Report by Dr. Farsalinos Explains Why Vape Flavour Bans are Counterproductive
