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On June 5, voters in San Francisco will vote whether the city should ban flavors, including menthol, in tobacco and vaping products. Proposition E comes a year after the San Francisco city council unanimously voted to ban flavored tobacco products in June 2017.
Since then, opponents and proponents of Prop. E have spent millions of dollars campaigning against and for the ban. Erroneously, proponents of the measure are relying on fear mongering tactics, twisting campaign finance data to purport that “big tobacco” has raised $11.5 million to counter the campaign, whereas supporters have received only $4.2 million.
Unfortunately, this is incorrect. In April, the California Department of Health launched a $75 million campaign exaggerating the risks of vaping and has produced television ads featuring children vaping since January 2018. Groups lobbying for Prop. E including Campaign for Tobacco-Free Kids, American Heart Association, the American Lung Association and the American Cancer Society have also spent millions on the issue.
While these extensive campaigns claim that banning flavors will “protect the children,” there is much evidence that is contrary to their claims.
Tobacco use among youth has gone down, according to data from the National Youth Tobacco Survey and reiterated by the Centers for Disease Control (CDC). CDC found, between 2015 and 2016, “a significant decrease in use of any tobacco product, any combustible tobacco product, tobacco products, electronic cigarettes, and hookahs,” among high school students.
Regarding specifically electronic cigarettes, researchers examining Hawaiian youth found only two percent of respondents reported using e-cigarettes daily or weekly. Approximately 71 percent of respondents reported never using electronic cigarettes or vaping devices. A larger study examining youth concluded that only “34 percent of 12th graders, 32 percent of 10th graders, and 21 percent of 8th graders,” had ever tried an e-cigarette. The authors of the study also noted that of youth users, “65-66% in each grade reported vaping ‘just [flavoring]’ at last use.” Another study found that “a tenth to a fifth of 11-to-16 year olds have tried e-cigarettes, but only 3% or less used them regularly and those were mostly already tobacco smokers.” The argument that youth will use electronic cigarettes then move onto tobacco products simply doesn’t hold.
Banning flavoring in electronic cigarettes and vaping devices will do a disservice to smokers who rely on electronic cigarettes as tobacco harm reduction (THR) tools. Research consistently finds persons have been able to “quit and [reduce] smoking with the help of e-cigarettes.” A December 2017 study by the Medical University of South Carolina “found that smokers who are willing to use e-cigarettes tend to smoke less and have increased quit attempts.”
Many public health groups have acknowledged the health benefits of electronic cigarettes, and promote their usage.
In a landmark study, in 2015 Public Health England (PHE) noted electronic cigarette use to be “around 95% safer than smoking.” In 2016, the Royal College of Physicians determined e-cigarette use “unlikely to exceed 5% of the harm from smoking tobacco,” and urged public health groups “to promote the use of e-cigarettes.” In November 2016, Cancer Research UK acknowledged the harm reduction provided by e-cigarettes, stating “it is important that regulation does not stifle [their] development.”
In 2018, the National Academies of Sciences, Engineering and Medicine found e-cigarette use to result in “reduced short-term adverse health outcomes in several organs.” In 2018, PHE reviewed their 2015 paper, finding health risks associated with e-cigarettes to be minimal, and “switching completely from smoking to vaping conveys substantial health benefits.” Meanwhile, in 2018, the American Cancer Society finally acknowledged that the “exclusive use of e-cigarettes is preferable to continuing to smoke combustible cigarettes.”
Flavors also have an important role while helping adult smokers quit combustible cigarettes. Research conducted in 2017 examined the impact of flavor bans. The authors of the study noted that a flavor ban “would result in increased choice of combustible cigarettes,” with electronic cigarette use declining by approximately 10 percent.
Meanwhile, the use of electronic cigarettes can aid in decreasing associated health costs related to smoking. A 2017 policy study by R Street examined the financial impact to Medicaid costs, should a limited number of Medicaid recipients switch from combustible cigarettes to electronic cigarettes and vaping devices. The author used a sample size of “1% of smokers [within] demographic groups permanently” switching. Through this analysis, the study estimates that Medicaid savings “will be approximately $2.8 billion per 1 percent of enrollees,” over the next 25 years. Should a flavor ban go into effect, these estimated cost savings will be significantly less.
Rather than being tricked by anti-tobacco and anti-vaping organizations claiming to promote public health, while erroneously spreading fear upon unfounded youth tobacco usage, San Francisco should educate smokers about the benefits of THR. It will be a great disservice to the many smokers who have finally found relief through these products and rely on flavors to aid in their cessation efforts.