Illustration for article titled San Francisco's Flavored Vape Ban Associated with Increased Adolescent Smoking, Study FindingsPhoto: Yuri Cortez (Getty Images)

A 2018 San Francisco ban on flavored tobacco products could have had some unintended consequences, new research this week suggests. The study found that high school teenagers were more likely to quit smoking after the ban than those who lived elsewhere.

In 2018 San Francisco has been The first US city to introduce a wholesale ban on flavored tobacco products following a measure passed by voters. This ban included products such as menthol cigarettes as well as any flavored e-cigarette or vaping device and was extended to all retailers, including dedicated vape stores. At the time, many public health organizations like the American Heart Association supported the ban while tobacco companies financed a $ 12 million ad campaign against it.

Proponents have argued that these taste bans make tobacco products less attractive to children and young adults, thus preventing them from ever adopting nicotine habits. In recent years, however, some drug policy and harm reduction experts have wondered whether such bans could exist counterproductiveespecially when it comes to vaping devices. The argument is that these bans will spur some people who would have vaped to continue using cigarettes instead, or to switch to cigarettes altogether. And while e-cigarettes are not entirely risk-free, their damage appears to be significantly less than that of other tobacco products.

The new study, released The Monday in JAMA Pediatrics seems to indicate that this very scenario has turned out to be feared among the students in San Francisco.

The study’s author, Abigail Friedman, a health policy researcher at the Yale School of Public Health, analyzed data from a national student survey conducted every two years by the Centers for Disease Control and Prevention and called Youth Risk Behavior Surveillance System (YRBSS) is called. This survey is routinely used to estimate recent drug use rates among children and adolescents. Friedman specifically focused on YRBSS data collected in San Francisco and other major cities in the country such as New York City or Philadelphia. She also compared data from San Francisco to other cities in the state, including Los Angeles.

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Yale researcher Abigail Friedman found a marked difference in the smoking rate among teenagers between San Francisco and other cities after a 2018 ban on flavored tobacco products.Yale researcher Abigail Friedman found a marked difference in the smoking rate among teenagers between San Francisco and other cities after a 2018 ban on flavored tobacco products. Graphic: Abigail Friedman / JAMA Pediatrics

Before the ban, smoking trends among high school students in different cities were pretty similar, Friedman noted, with children reportedly smoking less and less over time. But after that there was a distinct difference between San Francisco and other places. In fact, reported smoking rates in San Francisco appeared to be increasing, but continued to decline elsewhere. Friedman estimated that 6.2% of students there smoked in 2019, compared to 2.8% of students in other cities. And as she adjusted to smoking trends in all of those cities, she estimated that the likelihood of students smoking in San Francisco more than doubled after the ban.

“States and communities are increasingly restricting the sale of flavored tobacco products, often as a result of a desire to reduce teenagers’ tobacco consumption,” Friedman said in an email to Gizmodo. “Evidence that this policy has been linked to an increase in smoking among minors enrolled in high school suggests that caution should be exercised.”

The results have their limits. On the one hand, the study does not prove that there is a causal link between the ban and increased smoking among adolescents. They just show an association. Friedman also had to make assumptions about how best to compare these cities, which means these estimates aren’t necessarily set in stone. But the same pattern of increasing teen smoking related to the ban was also seen just comparing San Francisco to other cities in the state, which substantiated the case that the ban had a real impact.

Other cities and states, such as Massachusetts, have since passed their own local versions of this ban. In early 2020, the Food and Drug Administration passed one partial ban on most flavored e-cigarettes after concerns about increased vapors in teenagers and an outbreak of unrelated poisoning related to illegal cannabis vapes. Currently, the agency is working on the regulation of e-cigarette regulation that will determine the ultimate fate of flavored vaping products.

Friedman cautions that their results are not necessarily generalizable, which means that the effects of the San Francisco ban on taste may not be the same elsewhere. More studies need to look at the overall impact of these bans and see if teenage smoking rates will change over the long term. However, she also argues that these findings should make people aware of the potential consequences that could be associated with these policies.

“In promoting regulations to reduce vaping among adolescents, policymakers must be careful not to create incentives that increase conventional cigarette consumption,” she said.