STATE-LEVEL restrictions on flavored e-cigarettes, implemented across several U.S. states, appear to have led to a decrease in e-cigarette use among young adults and older adults. However, the findings of a recent study indicate an unintended consequence: an increase in cigarette use among youths and young adults in states that adopted these flavor bans.
The study, based on data from the Youth Risk Behavior Survey (YRBS) and the Behavioral Risk Factor Surveillance System (BRFSS), assessed e-cigarette and cigarette use across a wide demographic spanning high school students to adults aged 25 years and older. By comparing post-policy trends from 2020 to 2023 in states with flavor bans against control states without such policies, researchers observed a clear decline in e-cigarette use among older age groups, including a significant reduction among adults aged 25 and older. For example, in states with flavor bans, the prevalence of e-cigarette use among young adults decreased from 17% in 2019 to 14% in 2023.
However, while e-cigarette use dropped in these states, there was a concerning increase in cigarette use, particularly among youth and young adults. The analysis indicated that for youths aged 14 to 18, the prevalence of cigarette use rose by 1.8 percentage points in 2021, with further increases in subsequent years. Among young adults, this rise was even more pronounced, with a 3.7%-point increase in 2021, followed by steady increases in 2022 and 2023.
These findings underscore the complexity of tobacco control measures. While e-cigarette flavor restrictions are successful in reducing vaping rates, they may inadvertently push some individuals, particularly young users, toward traditional cigarette use. This shift suggests that future public health strategies should consider potential substitution effects and focus on comprehensive prevention programs to curb tobacco use in all forms, particularly among youth.
The study’s authors highlight the importance of continued research into the long-term effects of flavor bans and the need for policies that balance the reduction of e-cigarette use without exacerbating cigarette consumption.
Reference:
Cheng D et al. State E-Cigarette Flavor Restrictions and Tobacco Product Use in Youths and Adults. JAMA Netw Open. 2025;8;(7):e2524184.
