The public health community is working on numerous interventions to restrict and ban the uptake and use of novel nicotine products. Among their strategies include imposing stiffer taxes, enactment of laws to prohibit the sale and marketing of novel nicotine products as well as banning the sale of flavoured Electronic Nicotine Delivery Systems (ENDS) also known as e-cigarettes.
The justification for these stiffer measures according to the World Health Organisation (WHO) is to protect young people and youths from vaping as they believe vaping is equally dangerous to human health as smoking combustible cigarettes. This is despite overwhelming scientific evidence from numerous studies that have been conducted by independent researchers.
Of late, public health focus has been on banning the sale of flavoured ENDS. However, research studies have shown that banning flavoured nicotine products especially e-cigarettes puts adult smokers who wish to quit or switch to safer alternatives between a rock and hard place. Data shows that the favours appeal to adult smokers and banning flavours leaves them without an option but to return to smoking. Data has also shown that banning has no real impact on youth vaping and it increases youth smoking.
In the United States of America for example, the Food and Drug Administration (FDA) reports that 2.5 million people vape and 85 percent of vapers prefer flavours. Thus, smarter regulation is needed to ensure that the right balance is struck between harm reduction and avoiding unintended consequences such as underage access and environmental harm.
Speaking at the E-Cigarettes Summit in the United Kingdom, Professor Abigail Friedman, the Associate Professor, Department of Health Policy & Management, Yale School of Public Health said even though over 375 United States localities and seven states have adopted permanent restrictions on sales of flavoured e-cigarettes as a means to reduce youth use and improve public health, this has not improved public health outcomes.
“Research evidence shows that flavour policies that restrict sales of flavoured ENDS are associated with reduced ENDS sales but associated with increased combustible cigarettes sales and the corresponding results for use,” said Professor Friedman.
She added that a myriad of evidence links policies that make Electronic Nicotine Delivery Systems (ENDS) more expensive i.e. taxes, to increased cigarette smoking.
“Purely based on economic theory, we should be concerned that policies that make ENDS less appealing will have a similar direction effect. Consumption effects from reducing a product’s appeal should be in the same direction as policies increasing its price, all else equal.”
Findings from a study that looked at sales data for ENDS and combustible cigarette sales show that ENDS flavour policies reduced the sale of ENDS but increased that of combustible cigarettes. There was an increase of 15 cigarettes purchased for every 1 less 0.7mL ENDS pod sold.
“The implications of flavour policies are that any public health benefit of reducing ENDS use by restricting ENDS flavours could lead to offsetting public health damage by increasing cigarette use,” said Prof Friedman.
Professor Lion Shehab, a Health Psychology Professor, at the University College London, said recent device and flavour restrictions announced by various governments may have various consequences on e-cigarette uptake.
“A number of tobacco control policies are being introduced including the Smokefree Generation and it was announced that there is a consultation to restrict e-cigarettes in order to reduce youth vaping which people are very much concerned about,” said Professor Shehab.
He added that the consequences of tighter regulation of e-cigarettes (EC) may include the cessation of all nicotine products which may either lead to relapse or the switching to other harm reduction products.
“We do know that in markets that have limited access to e-cigarettes, heated tobacco products (HTP) have increased in popularity. I know that there may be various regulations that will likely reduce e-cigarette use and may encourage some smokers and ex-smokers to switch to alternative harm-reduction products, including heated tobacco products.”
Over 30 countries do not permit the sale of e-cigarettes as consumer products, and by extension do not permit the sale of flavoured e-cigarettes. Among the countries which permit their sale, 6 have introduced national-level bans on flavours other than tobacco flavour (Finland, Hungary, Netherlands, Ukraine, Lithuania, China), two have banned flavours other than tobacco and menthol (Denmark and Estonia) and two (Canada and the United States) have sub-national restrictions in place. In the United States, the Food and Drug Administration has denied marketing orders to e-cigarettes with flavours other than tobacco, and has denied orders for some menthol flavours. Several other countries have announced an intention to ban flavourings.
