More Americans Are Smoking In Areas That Banned Vaping: U.S. Study

More Americans are smoking in US states that banned Electronic Nicotine Delivery Systems (ENDS) or e-cigarettes, according to a study published in March in an international journal.

Photo Insert: A full ban on Electronic Nicotine Delivery Systems (ENDS) was associated with increased cigarette sales of 7.5 percent in Massachusetts.

“Cigarette sales in states banning ENDS were significantly higher than would have been observed otherwise,” the authors of the study concluded, based on data in Massachusetts, Washington, and Rhode Island which are among the states that banned vaping in 2020.

Authors of the study titled “Impact of Banning Electronic Nicotine Delivery Systems on Combustible Cigarette Sales: Evidence from US State-Level Policies” presented evidence that banning ENDS or electronic cigarettes was associated with increased sales of combusted or traditional cigarettes, using commercial sales data.

Researchers Yingying Xu, Lanxin Jiang, Shivaani Prakash, and Tengjiao Chen said the results of the study highlight and quantify potential unintended consequences of ENDS sale restrictions, which should be considered in the future as part of public health impact analyses of such policies.

It was published in the international journal Value in Health on March 5, 2022, after the authors looked at the cigarettes sales data in 2020 following the start of restrictions on vaping in several states in the US in the fall of 2019.

Several states imposed short-term bans on the sale of ENDS following the outbreak of the so-called e-cigarette or vaping product use-associated lung injury or EVALI which was strongly linked to tetrahydrocannabinol vaping products.

The issue raised public health concerns and focused media attention on ENDS in 2019, but it was later determined that EVALI cases were strongly linked to vitamin E acetate additive in primarily illicit tetrahydrocannabinol-containing vaping products. Among the states that imposed emergency bans on the sales of ENDS in the fall of 2019 was Massachusetts on September 24, 2019. Rhode Island and Washington instituted similar short-term bans on non-tobacco flavored ENDS in early October 2019.

The study assessed how such state-level bans may have affected cigarette sales. ENDS are seen as potential alternative nicotine products for adult smokers, and banning ENDS may have unintended consequences, according to the authors.

It used state-level cigarette sales data from a third-party commercial database, explored the impact of state-level ENDS bans on cigarette sales using both difference-in-differences and synthetic control methods. It also compared cigarette sales in treatment states that passed ENDS bans in fall 2019, halted states that revoked the announced ENDS bans, and control states.

“A full ban on ENDS was associated with increased cigarette sales of 7.5 percent in Massachusetts. Banning non-tobacco flavored ENDS was associated with a 4.6-percent increase in cigarette sales,” the study says.

The authors acknowledged that future research is needed to determine the long-term impact of bans on ENDS. “Additional research is also needed to investigate the impact on spatial spillover effects, illicit markets, and other scenarios that may arise in response to ENDS restrictions. Furthermore, the long-term impact of ENDS sales bans on ENDS and cigarette sales, as well as the distal public health outcomes, will need to be studied as additional data become available,” they said.

In the US, cigarette smoking remains the leading preventable cause of death, while e-cigarettes are considered alternative products that deliver nicotine through heated aerosols. ENDS are also seen to have the potential to reduce smokers’ exposure to known toxic and cancer-causing chemicals from combustible tobacco.

The authors of the US study say the short-term bans on ENDS provided an opportunity to evaluate the effect of restricting ENDS sales and, in particular, the potential for unintended effects on cigarette sales. Prior to the short-term bans, the prevalence of e-cigarette use has increased among US adults over the past several years, with 4.5 percent of US adults reporting ENDS use in the past 30 days as of 2019.

A Cochrane review of published literature, including randomized controlled trials, found moderate-certainty evidence that rates of quitting cigarettes were higher with ENDS than nicotine replacement therapy or nicotine-free e-cigarettes. Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health.

The US study also gives other countries the opportunity to evaluate their current policies on smoke-free alternatives such as e-cigarettes and heated tobacco products that are considered less harmful than traditional cigarettes.

Among these countries is the Philippines which plans to regulate the manufacture, sale, and use of these smoke-free products to provide millions of smokers with less harmful alternatives. Public Health England, a government health agency in the United Kingdom, acknowledged that e-cigarettes are 95-percent less harmful than tobacco.

Congress approved the Vape Bill to regulate e-cigarettes and heated tobacco products. Once enacted into law, the bill is expected to reduce the smoking rate in the country and provide 17 million Filipino smokers a way out of smoking through less harmful, smoke-free alternatives.

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