A partial flavor ban in vaping products sold in America affected the type of vapes college students use, and escalated how many used them, according to a new paper in Environmental Research and Public Health.
In 2019, the US government banned most flavored vaping devices—except for disposables.
“This is a wonderful example of a cohort that Dr. Anne Buu had going at the University of Texas and that was able to be used to examine the real-life effects of what happens when a regulatory policy is put in place,” said UW-CTRI Research Director Dr. Megan Piper, a co-author of the paper with Buu.
Among 650 college students surveyed for this study, adopting disposables appeared to increase dependence due to higher nicotine content, sweet flavors and appealing marketing.
“The goal of the partial flavor ban was to improve public health by taking away JUUL,” Piper said, referring to the popular brand of vaping products that offered replaceable pods with various flavors.
“It was the popular product among youth because the salts efficiently delivered nicotine, it had a different format, it was ‘cool,’ and was marketed to teens and young adults. The notion of the partial flavor ban was, ‘oh my gosh, we have to get rid of this JUUL thing. And we do that not by banning all e-cigarettes but by banning pods.’
“Well, now you’re playing Whack-a-Mole, right? When you only ban a certain type of product, but not the entire product category, it results in problems. Kids are smart, they will switch.”
About one out of four study participants switched from JUUL pod-based reusable products to single-use disposables that allowed flavors. While they’re called “disposables,” the reality is some of these products enable hundreds of puffs before they run out and are thrown into landfills.
When participants changed to disposable vapes, lead author Dr. Shuyao Ran found that they became more likely to use sweet flavors and become more addicted.
Piper said that surprised her because she expected that they would switch products—from pods to disposables—and vape the same amount.
“But what we got was substitution and escalation,” Piper said. “They’re showing higher levels of dependence and they’re showing more flavor utilization. It not only just pushed them to a different product, it actually changed behavior. So that I did find surprising. Again, the products have evolved.”
Participants tended to vape on most days, regardless of product used, approximately 10–14 times per day.
After the partial flavor ban, about 17 percent switched to tanks. Participants who used tank devices tended to be more dependent and more likely to be dual users of combustible and vaping products—and researchers have found that dual use increases risk for lung cancer fourfold beyond smoking alone.
The authors weren’t sure why more participants didn’t switch to products that legally allowed flavors.
“It’s possible that the partial flavor ban got some kids to stop vaping any product,” Piper said, “but disposables offered more nicotine, which might, again, be part of why the dependence was higher.”
Several countries, including France and the United Kingdom, have passed flavor bans on all vapes, citing health and environmental concerns from disposable devices.
While the US FDA has technically only authorized 23 vaping products, some of which are disposable and none are sweet flavored, youth can easily access them at local gas stations and vape shops. The FDA has limited capacity to enforce federal laws across the country.
Without state flavor bans or Tobacco 21 age laws that mirror the federal laws, state police are not allowed to enforce them. Some states have banned all flavored vapes, but even that hasn’t been a perfect solution due to illegal imports and limitations on local law enforcement.
The authors concluded that more uniform laws that universally ban all flavored tobacco products would likely lead to improved public health.
Ran S, Yang JJ, Piper ME, Lin H-C, Nam JK, Buu A. Health Risk Associated with Adopting New-Generation Disposable Electronic Cigarettes (E-Cigarettes) Among Young Adults. International Journal of Environmental Research and Public Health. Online October 18, 2024.