Several American states that imposed short-term bans on Electronic Nicotine Delivery Systems (ENDS) or e-cigarettes saw an increase of up to 7.5 percent in cigarette sales, the leading cause of preventable death in the US, according to a study published in an international journal in March 2022.
“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,” according to the results of the study titled Impact of Banning Electronic Nicotine Delivery Systems on Combustible Cigarette Sales: Evidence from US State-Level Policies.
The authors of the study provided evidence that more Americans are smoking in US states that banned e-cigarettes. These states include Massachusetts, Washington, and Rhode Island.
“Cigarette sales in states banning ENDS were significantly higher than would have been observed otherwise,” the authors of the study concluded.
Commercial sales data provide evidence that banning e-cigarettes was associated with increased sales of combusted or traditional cigarettes, according to researchers Yingying Xu, Lanxin Jiang, Shivaani Prakash, and Tengjiao Chen.
The results of the study 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.
The study was published in 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.
Short-term bans on the sale of ENDS were imposed in several states following the outbreak of the so-called e-cigarette or vaping product use-associated lung injury or EVALI which was strongly linked to tetrahydrocannabinol vaping products.
While the issue raised public health concerns and focused media attention on ENDS in 2019, it was later determined that EVALI cases were strongly linked to vitamin E acetate additive in primarily illicit tetrahydrocannabinol-containing vaping products.
Massachusetts imposed emergency bans on the sales of ENDS in the fall of 2019, while Rhode Island and Washington instituted similar short-term bans in early October 2019.
The authors of the study assessed how such state-level bans may have affected cigarette sales, noting that ENDS are seen as potential alternative nicotine products for adult smokers, and banning them may have unintended consequences.
Cigarette smoking remains the leading preventable cause of death in the US, 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 used 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. It also compared cigarette sales in treatment states that passed ENDS bans in fall 2019, halted states that revoked the announced ENDS bans, and control states.
However, the authors acknowledged 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,” they said.
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.
Prior to the short-term bans, 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 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 US study also gives 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.
The Philippines, for one, plans to regulate 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 approved the Vape Bill to regulate e-cigarettes and heated tobacco products. Once enacted into law, the bill is expected to reduce smoking rate in the country and provide 17 million Filipino smokers a way out of smoking through less harmful, smoke-free alternatives.
