- State flavour bans cut vape use among 18 to 24-year-olds by around two to three percentage points
- But cigarette use rose by a similar amount in the same group, creating a net health loss
- Young people aged 14 to 17 showed little overall change in vaping but some signs of increased smoking
- Adults aged 25 and over were unaffected, with no measurable change in smoking or vaping
Comprehensive U.S state bans on flavoured vapes may be doing more harm than good, according to a new study in Health Economics.
Drawing on four national datasets, the researchers found that vape use among young adults fell after bans – but cigarette smoking rose by almost the same amount, wiping out any potential health benefit.
“Although the bans aim to curb youth initiation into nicotine use, the findings suggest a troubling substitution effect that could undermine broader tobacco control efforts,” said corresponding author Henry Saffer, Ph.D., of the National Bureau of Economic Research and the Graduate Centre of the City University of New York.
Key results
The study examined three groups – teens aged 14 to 17, young adults aged 18 to 24, and adults aged 25 and over – across six U.S. states that brought in sweeping flavour bans between late 2019 and mid-2020.
For young adults, vape participation fell by about two to three percentage points after the bans. But cigarette use rose by 3.5 percentage points – what the authors describe as “approximately an even swap from e-cigarettes to cigarettes.”
Because cigarettes carry much higher risks than vapes, the study concludes there is “a net negative effect on health for this age group.”
Among teens aged 14 to 17, the results are less clear. Across datasets, the researchers “do not find any statistically significant effects of the bans on e-cigarette participation.”
Some models do show “a significant positive effect of flavour bans on cigarette use by youth,” but the authors caution against over-interpreting this due to pre-existing trends. The takeaway is that bans did not clearly reduce youth vaping, and may have nudged some towards smoking.
For adults 25 and older, there was no measurable impact on either vaping or smoking.
Why bans miss the mark
The study helps to explain why flavour bans often fail. Using the PATH survey, the authors report that “a substantial fraction of youth and young adult e-cigarette users continue to report using banned flavours even after the bans were implemented.”
In reality, many simply worked around the rules – buying online, crossing state borders, using non-compliant retailers, or modifying devices to add flavours themselves. Some states also allowed exemptions for specialist stores, further weakening the policy. As the authors put it, “the statewide restrictions are still being circumvented, even if more comprehensive in scope compared to the federal ban.”
The cost of substitution
During the study period, around 16 per cent of young adults vaped and 12 per cent smoked. After bans, those rates shifted to roughly 13.5 per cent vaping and 15.5 per cent smoking – a near one-for-one substitution.
“However, cigarettes are known to be more dangerous to health than e-cigarettes. Thus, there is a net negative effect on health for this age group,” the authors said. They added that “such unintended consequences underscore the need to account for not only outcomes directly targeted by such restrictions but also potential spillovers into non-targeted outcomes for a more complete calculus of the potential costs and benefits of such policies.”
Methods at a glance
To isolate policy effects, the authors combined evidence from the state-representative Youth Risk Behavior Survey, the school-based Monitoring the Future survey, the longitudinal PATH panel, and the adult-focused Behavioural Risk Factor Surveillance System.
The researchers tested the results using two different statistical methods and found the same pattern: young adults vaped less but smoked more, youth vaping barely changed, and older adults were unaffected.
What it means for harm reduction
The findings reinforce a key harm-reduction principle: policies that restrict access to less harmful products, without addressing demand, can push people towards more dangerous ones. In this case, sweeping flavour bans on vapes did not reliably cut youth vaping and appear to have steered some young adults back to cigarettes.
As the authors note, compliance gaps and easy workarounds weaken the impact of bans – while substitution effects can turn a well-intentioned policy into a public-health setback.
