Smoking rate increased in several American states that banned vaping in 2020, according to a study published recently in an international journal.
The study titled “Impact of Banning Electronic Nicotine Delivery Systems on Combustible Cigarette Sales: Evidence from US State-Level Policies” provides novel evidence that banning ENDS or electronic cigarettes was associated with increased sales of combusted or traditional cigarettes, using commercial sales data.
The study 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 US states passed short-term bans on the sale of ENDS in response to an outbreak of illnesses strongly linked to tetrahydrocannabinol vaping products that received national news coverage. While the outbreak of e-cigarette or vaping product use-associated lung injury or EVALI raised public health concerns and focused media attention on ENDS in 2019, it was eventually determined in February 2020 that EVALI cases were strongly linked to vitamin E acetate additive in primarily illicit tetrahydrocannabinol-containing vaping products.
The EVALI issue, however, forced several states to impose emergency bans on the sales of ENDS in the fall of 2019. Massachusetts, for one, implemented an emergency ban on all ENDS on September 24, 2019, while 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 ENDS bans may have affected cigarette sales in Massachusetts, Washington, and Rhode Island. The authors say that as ENDS are seen as potential alternative nicotine products for adult smokers, banning ENDS may have unintended consequences.
Results of the study show that, “cigarette sales in states banning ENDS were significantly higher than would have been observed otherwise.” “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.
“Our results 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,” according to study authors Yingying Xu, Lanxin Jiang, Shivaani Prakash and Tengjiao Chen.
The authors, using 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. They compared cigarette sales in treatment states that passed ENDS bans in fall 2019, halted states that revoked the announced ENDS bans and control states.
They confirmed 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,” the authors say.
Cigarette smoking remains the leading preventable cause of death in the United States, 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 study notes that 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 recent 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 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.
Results of the study provide 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.
Countries such as the Philippines are looking at regulating 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.
The Senate and the House of Representatives in the Philippines approved the Vape Bill to regulate e-cigarettes and heated tobacco products. Once enacted into law, the measure 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.