Do Flavored Tobacco Products Cause Significantly More Youths to Get Addicted?

In June, San Francisco voters will vote on Proposition E, which would ban flavored tobacco products in San Francisco. Here is the Yes on Prop E campaign and here is the No on Prop E campaign.

I’m not going to state my opinion of Prop E in this post. Instead, I’m interested in the question – do flavored tobacco products cause significantly more youths (in this post, I will define ‘youth’ as someone who is less than 18 years old) to get addicted to tobacco than would otherwise happen?

The proponents of Prop E claim that the answer is ‘yes’. Their evidence is that most youths who use tobacco started with flavored products, and that a high percentage of youths who use tobacco used a flavored product within the past month. However, it’s possible that, in the absence of flavored tobacco, they all would have just been using unflavored tobacco instead.

Though flavored tobacco products have been around for a really long time, tobacco flavored with anything other than menthol has only been widely available in the United States recently
(because there already is a ban on flavoring cigarettes with anything other than menthol, and the popular alternatives to cigarettes are fairly recent). So if these new flavored products are causing lots of youth who would otherwise not use tobacco to start using tobacco, I would expect to see a spike in tobacco use among youth.

Based on the information I could find, the percentage of youth in the USA who smoke cigarettes at least daily has dramatically decreased since I graduated from high school (I don’t want to reveal what year I graduated from high school; suffice to say, it was a year when a lot more youth were smoking cigarettes daily than in recent years). There is less information on e-cigarettes because they have not been around very long, but the percentages they report … look roughly like the percentages for daily cigarette use when I was in middle school and high school. Except they count any youth who used an e-cigarette in the past 30 days, whereas only cigarette smokers who used on a daily basis were counted.

With these numbers, it does not look like flavored tobacco products are actually increasing tobacco use in youth – it looks like it’s just substituting the use of unflavored tobacco with flavored tobacco. That is consistent with what I remember from high school. A lot of my classmates in high school were cigarette smokers – in fact, I suspect my high school had a higher percentage of cigarette smokers than what that link reports. There were certainly a lot of smokers in my peer group, though maybe not all of them smoked every day, or maybe some teenagers do not answer these surveys honestly. Some of my peers in the 12th grade also went to hookah bars and got flavored smoke – but only if they were 18, because otherwise they could not get in the hookah bar, and they had been smoking cigarettes before their turned 18.

However, this is just the surface. I’m far from an expert on any of this, and it is possible that there are important factors that I do not know about.

There is a study (Villanti AC, Johnson AL, Ambrose BK, et al. Use of flavored tobacco products among U.S. youth and adults; findings from the first wave of the PATH Study (2013-2014)) which found that “81 percent of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use” but since I have not seen the study itself, I’m not sure how to interpret this. Do these youth mean that the main reason they use e-cigarettes INSTEAD OF CIGARETTES is the appealing flavors, or do they mean that they would not be using tobacco AT ALL if ‘appealing flavors’ were not available? I don’t know.

I know little about e-cigarettes. I suppose they may be way more horrible than cigarettes in some way, but that is not the case that the Yes on E campaign is trying to make. Based on their arguments, e-cigarettes are bad because they are a ‘gateway’, they are not claiming that e-cigarettes are worse than cigarettes in any other way.

The one piece of evidence I have found that leads me to think that flavored tobacco products may actually induce people who would not otherwise use tobacco to use ironically comes, not from the proponents of the ban, but from the opponents. Specifically, it the fact that storekeepers are so adamantly opposed to Prop E, and that the opponents of Prop E emphasize that banning flavored tobacco would hurt small business. I understand that the small-business storekeepers have a tough time making a living in San Francisco, and that tobacco products are an important source of revenue for them. The fact that they are so vehemently opposed to me indicates that THEY think that a significant portion of people will stop buying tobacco if flavored tobacco is no longer available (or does flavored tobacco have a much higher profit margin than unflavored tobacco? Or do they think they will just lose all of their customers to the internet? I do not know). It is also possible that this will primarily influence adults, not youth.

In short, based on the evidence I’ve seen, I’m not convinced that flavored tobacco products lead to significantly higher usage of tobacco among youth than would otherwise exist, but I admit that it is possible that flavored tobacco products are hooking more youth than unflavored tobacco products would hook.

2 thoughts on “Do Flavored Tobacco Products Cause Significantly More Youths to Get Addicted?

  1. I think it’s a case that, once again, law makers are misunderstanding the nature of addiction. In my city they’ve actually raised the purchasing age of tabacco to 21 like that’s going to do anything. My brother smokes and he’s now technically underage since he’s 20, but he didn’t start smoking until he was 18 because he started using tobacco to replace another addiction, food. He was trying to lose a bunch of weight to try an get into the military, but food was his stress relief. When that was taken away he needed to find a replacement and cigarettes suppress his appetite (which really means it satisfies what was previously a food addiction with a tobacco one). I think you’re right that banning flavored tobacco products aren’t going to do a damn thing because 1) it’s just one city and anybody can get a bus ticket and 2) it’s not solving the problem of addiction which is a very misunderstood topic (according to my professors at least).

    (side note: I know I never comment on them, but the eco-friendly, non-toxic posts are super interesting and I’m definitely going incorporate some of your recommended practices when I eventually get my own place, so thanks for sharing those!)

    • In California they also recently raised the age for tobacco to 21, which I agree is pointless, possibly even counterproductive.

      All of the cities/counties bordering San Francisco are also considering a ban on flavored tobacco products, which if they all pass would make it a bit more difficult than buying a bus ticket (i.e. someone in San Francisco would have to cross two county lines by bus, which actually is inconvenient), but this is strictly a ban on the SALE of flavored tobacco, flavoring tobacco for personal consumption would still be legal (I suppose it is just possible that only committed smokers would consider DIY flavoring, and that it will be much less tempting than ready-made flavored tobacco to potential new smokers).

      I think it may be worthwhile to try this ban as an experiment so that researchers can study a real-life example rather than just hypotheticals – and I would rather have this tried out at the city level before, say, the FDA mandates it for the entire United States – but I am doubtful that this will work out as the law makers intend (and, by the same token, I doubt it will be utterly devastating for the small businesses which sell flavored tobacco – most of them existed before e-cigarettes became popular, and they managed to survive back then).

      And I am glad that you appreciate my eco-friendly/non-toxic posts!

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