A 2018 ban on flavored tobacco products in San Francisco may have had some unintended consequences, new research suggests this week. The study found that high school kids were more likely to pick up smoke after the ban than those living elsewhere.
In 2018, San Francisco it has become the first U.S. city to implement a wholesale ban on flavored tobacco products, following a move passed by voters. This ban included products such as menthol cigarettes, as well as all flavored e-cigarettes or vaping devices, and extended to all retailers, including dedicated vape shops. At the time, several public health organizations such as the American Heart Association supported the ban, while tobacco companies financed a $ 12 million advertising campaign against her.
Proponents have argued that these flavor bans will make tobacco products less attractive to children and young adults, thus preventing them from taking up any nicotine habits. However, in recent years, some experts on drug policy and harm reduction have begun to question whether these types of bans could be counterproductive, especially when it comes to vaping devices. The argument is that these bans will lead to some people being vaped only to continue to use or switch to cigarettes entirely. And while e-cigarettes aren’t completely risk-free, their harms appear to be significantly smaller than other tobacco products.
The new study, published Monday at JAMA Pediatrics, it seems to suggest that this exact scenario unfolds as feared among high school students in San Francisco.
Study author Abigail Friedman, a health policy researcher at the Yale School of Public Health, analyzed data from a national survey of students conducted every two years by the Centers for Disease Control and Prevention, called the Youth Risk Behavior Surveillance System (YRBSS). This survey is used regularly to estimate recent drug use rates among children and adolescents. Friedman focused specifically on YRBSS data collected from San Francisco and other major cities in the country, such as New York City or Philadelphia; he also compared data from San Francisco to other cities in the state, including Los Angeles.
Prior to the ban, smoking patterns among high school students were quite similar in different cities, Friedman found, with children smoking less and less at the time. But then, there was a clear difference between San Francisco and other places. That is, reported smoking rates in San Francisco appeared to increase but continued to fall elsewhere. Friedman estimated that 6.2% of high school students smoked in 2019, compared to 2.8% of students in other cities. And while adapting to smoking trends in all of these cities, he estimated that the odds of high school students smoking in San Francisco have more than doubled since the ban.
“States and localities are increasingly restricting sales of flavored tobacco products, often motivated by a desire to reduce youth tobacco use,” Friedman said in an email to Gizmodo. “Evidence that this policy was associated with increased smoking among minors enrolled in high school suggests a need for caution.”
The results carry their limitations. For one, the study does not prove that there is a causal link between smoking cessation and the increase in young people; they show only one association. Friedman also made assumptions about the best way to compare these cities with each other, namely that these estimates are not necessarily set in stone. But the same pattern of increased smoking by teens linked to the ban was also found when she compared San Francisco alone to other cities in the state, reinforcing the case that the ban had a real impact.
Other cities and states, such as Massachusetts, have passed their own local versions of this ban. In early 2020, the Food and Drug Administration passed one partial prohibition on most flavored e-cigarettes, following concerns about increased teenage vaping and a fire of unrelated poisonings linked to illicit cannabis vape. At the moment, the agency is in the midst of working on how to regulate e-cigarettes, which will decide the final fate of flavored vaping products.
Friedman warns that his findings are not necessarily generalizable, meaning that the effects of the taste ban in San Francisco may not play the same elsewhere. More studies should look at the overall impact of these bans and whether any changes in the smoking rate in adolescence will remain in the long run. But she also argues that these findings should make people aware of the possible consequences that could come with these policies.
“In promoting regulations to reduce youth vaping, policy makers should be careful not to create incentives that increase the use of conventional cigarettes,” he said.