When voters in San Francisco overwhelmingly approved a voting measure to ban the sale of flavored tobacco products in 2018, public health advocates celebrated. After all, tobacco use poses a significant threat to public health and health equity, and the flavors are particularly appealing to young people.
But according to a new study by Yale School of Public Health (YSPH), this law may have had the opposite effect. Analyzes found that after the ban was implemented, the odds of high school students smoking conventional cigarettes doubled in the San Francisco school district compared to trends in districts without a ban, even taking the data into account. individual demographic and other tobacco policies.
The study, published in JAMA Pediatrics on May 24, he would be the first to assess the impact of comprehensive taste bans on the smoking habits of young people.
“These results suggest that we have to be careful, âsaid Abigail Friedman, study author and assistant professor of health policy at YSPH. âWhile neither smoking cigarettes nor vaping nicotine is inherently safe, most current evidence points to much greater harms from smoking, which is responsible for nearly one in five adult deaths each year. Even if well-intentioned, a law that increases smoking among young people could pose a threat to public health. “
Friedman used data on high school students under 18 from the 2011-2019 Youth Risk Behavior Surveillance System school district surveys. Before the ban was implemented, smoking rates over the past 30 days in San Francisco and comparison school districts were similar and declining. Yet once the flavor ban was fully implemented in 2019, smoking rates in San Francisco diverged from trends seen elsewhere, increasing as rates in comparison districts continued to decline.
To explain these results, Friedman noted that electronic nicotine delivery systems have been the most popular tobacco product among young Americans since at least 2014, with flavored options being widely preferred.
“Think about the preferences of young people: some children who vape choose e-cigarettes over combustible tobacco products because flavors, âshe says. âFor these people as well as potential vapers with similar preferences, banning flavors may remove their primary motivation to choose vaping over smoking, pushing some of them toward conventional cigarettes.
These findings have implications for Connecticut, where the state legislature is currently considering two flavor bills: Bill 6450 would ban sales of flavored electronic nicotine dispensing systems, while Bill 326 of the Senate would ban the sale of any flavored tobacco product. As the United States Food and Drug Administration recently announced that it will ban flavors in all combustible tobacco products over the next year, the two bills could result in Connecticut policy similar to the ban. complete enacted in San Francisco.
The San Francisco study has limitations. As the ban was implemented soon after, the trend may differ in the coming years. San Francisco is also just one of many localities and states that have implemented restrictions on the sale of flavored tobacco, with big differences between these laws. So the effects may differ in other places, Friedman wrote.
Yet, as similar restrictions continue to emerge across the country, the findings suggest that policymakers need to be careful not to indirectly push minors into smoking in their quest to reduce vaping, she said.
What does it offer as an alternative? “If Connecticut is determined to make a change before the FDA’s flavor ban for combustible products goes into effect, a good candidate could restrict all sales of tobacco products to adult retailers only – that is, – say 21 and over, âshe said. “This would significantly reduce the accidental exposure of children to tobacco products in convenience stores and gas stations, as well as the access of adolescents to these, without increasing the incentives to choose more lethal combustible products over options. non-combustible like electronic cigarettes. ”