Prohibitions on flavored e-cigarettes, also referred to as vapes, could potentially result in a rise in tobacco cigarette consumption, especially among young adults, as indicated by a recent examination.

There has been ongoing discussion among public health specialists regarding the extent to which flavors like fruit, candy, and mint contribute to the appeal of vaping among youth. In the past decade, the widespread popularity of vaping brands like Juul has prompted incremental limitations on flavored options. (The FDA completely prohibited Juul in 2022, though this decision was later reversed.)

However, a recent working paper released by the National Bureau of Economic Research reveals “indications of an unintentional consequence” among the most youthful consumers. Instead of discontinuing nicotine product use following flavored vape bans, these individuals seem to transition to combustible cigarettes, which are generally recognized as a more hazardous product.

As per the paper titled “The Effect of E-Cigarette Flavor Bans on Tobacco Use,” the limitations are linked to a decrease in sales of flavored electronic nicotine delivery systems (ENDS), along with a simultaneous rise in cigarette sales.

Research conducted by scholars from institutions such as Michigan State University and San Diego State University showed that the implementation of flavor restrictions led to a notable decrease in youth vaping, ranging from 1.2 to 2.5 percentage points.

Nevertheless, it also resulted in a “remarkable increase” in the consumption of combustible cigarettes, particularly among individuals aged 18 to 20 years old.

“The decrease in vaping seems to happen through a shift towards combustible cigarette usage. This substitution is arguably more unexpected and significant,” the authors noted.

According to the study, limitations were linked to a 2.4 to 2.6 percentage point rise in the probability of cigarette smoking.

The researchers examined data from the State and National Youth Risk Behavior Surveys as well as the Behavioral Risk Factor Surveillance System. Funding for the study was provided by a grant from Global Action to End Smoking, an independent nonprofit organization based in the United States.

This isn’t the first instance where researchers have reached such a conclusion. A study published in 2021 by Yale University’s School of Public Health suggested that limitations on vape products, aimed at curbing youth nicotine consumption, might have inadvertently encouraged teenagers to turn to conventional cigarettes.

“Considering the plausibly greater health risks associated with combustible cigarettes compared to e-cigarettes, such substitution suggests that the overall impact of ENDS flavor restrictions on public health could be limited or potentially even adverse,” concluded the Yale researchers.

Additionally, the study discovered that while flavor restrictions effectively decreased vaping among younger individuals, they had minimal impact on older adults, who exhibited no significant alteration in vape usage.

Further analyses revealed that various flavor bans did not result in notable increases in other risky behaviors such as binge drinking or illicit substance use. Nevertheless, the primary concern remains the transition from vaping to smoking, which poses a heightened health risk due to the elevated levels of harmful substances in cigarette smoke compared to e-cigarette vapor.

A 2023 study conducted by the Centers for Disease Control and Prevention (CDC) revealed that over 1 in 10 Americans aged 18 to 24 are regular e-cigarette users. In the same year, the National Youth Tobacco Survey disclosed that 89 percent of youth who vaped preferred flavored varieties.

As of the previous year, nine states, along with the District of Columbia, and over 370 localities had implemented policies restricting the sale of flavored e-cigarettes.