Flavour Bans and the Cigarette Rebound: The Evidence Public Health Doesn’t Want to Discuss

Sigh.

That was the word Charles Gardner, PhD, used when he shared yet another stack of studies examining what happened after nicotine vape flavour bans were introduced across US cities, US states, and Canadian provinces.

He has been collecting them.

They all point in the same uncomfortable direction.

Cigarette sales went up.

In some cases, the increase was most pronounced among young adults.

This is not a fringe claim. It is not industry propaganda. It is not a think tank blog post. It is coming from peer reviewed journals, working papers, public health departments, and major academic institutions. And yet, if you follow the public messaging around flavour bans, you would be forgiven for thinking the evidence is settled in the opposite direction.

The policy rationale behind flavour bans is straightforward. Flavours such as fruit, candy, and dessert varieties are said to attract youth. Remove them, and youth vaping will decline. Reduce youth vaping, and you prevent a new generation from becoming nicotine dependent. This logic has driven local bans in cities such as San Francisco, statewide bans in places like Massachusetts and California, and sweeping provincial bans in parts of Canada including Québec and Nova Scotia.

On paper, it sounds clean.

In practice, nicotine markets are substitution markets. If you restrict one product, consumers do not necessarily disappear. They shift. And that is where the story becomes complicated.

San Francisco was one of the first major US cities to ban the sale of flavoured e cigarettes in 2018. A 2021 paper published in JAMA Pediatrics examined youth smoking trends before and after the ban. Contrary to expectations, high school smoking rates in San Francisco increased relative to districts without such bans. The authors found that after flavoured e cigarettes were restricted, the odds of recent cigarette smoking among minors increased compared with other districts. The policy intended to suppress nicotine initiation appeared to coincide with more combustible cigarette use.

Massachusetts implemented one of the most comprehensive flavour bans in the United States in 2020, covering both vaping products and menthol cigarettes. Multiple economic analyses have since examined cigarette sales data in the state and in neighbouring jurisdictions. The pattern is consistent. Cigarette sales increased within Massachusetts relative to trends elsewhere. Cross border purchasing spiked, with residents travelling to neighbouring states to buy restricted products. Total cigarette consumption in the broader region rose rather than fell. One widely cited working paper estimated that the ban was associated with millions of additional cigarette packs sold in the months following implementation. When you prohibit flavoured vapes but leave combustible cigarettes widely available, some consumers substitute. That is not ideology. It is basic consumer behaviour.

California also implemented a statewide flavoured tobacco ban. Emerging research suggests similar patterns: reductions in legal flavoured vape sales, but increases in cigarette purchases, particularly among young adults. Some analyses indicate the cigarette increase was most pronounced among 18 to 24 year olds. This matters because that age group sits right on the transition between experimentation and entrenched smoking behaviour. If a policy shifts a portion of young adults from vaping to smoking, even temporarily, the long term health implications are substantial.

The narrative is not confined to the United States. Quebec introduced strict flavour restrictions in 2023. Subsequent reporting and academic work indicate that while legal flavoured vape availability declined, overall vaping did not disappear and cigarette sales trends showed concerning movement. Other provinces, including Nova Scotia, have seen similar patterns in formal analyses. A Montreal based news report highlighted that more people were vaping following Quebec’s ban, suggesting illicit markets and substitution effects were blunting the intended impact. The black market does not comply with public health messaging.

There are several mechanisms at play. When flavoured vapes are removed, some users return to combustible cigarettes, particularly if cigarettes remain easily accessible and socially embedded. Local bans in US cities are porous, so consumers drive across city or state lines. Restrictions can push demand underground, with unregulated flavoured products continuing to circulate without age controls or quality standards. Young adults are highly responsive to product availability and price signals. If their preferred lower risk product disappears, they may revert to what is still available.

Flavour bans are framed as youth protection policies. But if the empirical outcome is increased cigarette sales, especially among young adults, then the net public health effect becomes ambiguous at best. Even if vaping declines modestly among adolescents, a rise in smoking among older teens or young adults could offset or exceed those gains. Combustion is the driver of cancer, cardiovascular disease, and respiratory illness. Nicotine is addictive, yes. But it is the smoke that kills. Policies that inadvertently shift consumers from vapour to smoke risk entrenching the very harm they seek to prevent.

What is striking is not that some studies find unintended consequences. Policy experiments often produce mixed results. What is striking is the relative silence around these findings in mainstream tobacco control advocacy. When studies show vaping reductions, they are amplified. When studies show cigarette sales increases, they are treated as technical anomalies, dismissed as industry funded, or ignored. This asymmetry erodes trust.

For readers in Australia, this debate should feel familiar. We have pursued one of the most restrictive nicotine vaping frameworks in the world. The stated goal is youth protection and smoking reduction. But if international evidence suggests that restricting appealing vape products can increase cigarette consumption, particularly among young adults, then policymakers here should be paying very close attention. Markets do not obey moral narratives. They respond to incentives and availability.

The studies Charles has been collecting are not isolated outliers. They represent a growing body of literature suggesting that flavour bans may have significant unintended consequences. This does not mean youth vaping should be ignored. It does mean policy must be evaluated on net outcomes, not intentions. If cigarette sales rise after a flavour ban, that is not a footnote. It is central. If young adults increase smoking after losing access to flavoured vapes, that is not a rounding error. It is a warning.

Public health is at its strongest when it confronts uncomfortable data head on.

Sighing is understandable.

Silence is not.

If there are additional studies examining post ban cigarette sales or substitution effects, they deserve to be added to the record. Because policy debates should be evidence led, not evidence filtered. And right now, the evidence is asking harder questions than many policymakers seem willing to answer.

References

1. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2780248

2. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00498-0

3. https://www.urmc.rochester.edu/news/story/banning-fruity-flavors-did-not-deter-vapers

4. https://tobaccocontrol.bmj.com/content/tobaccocontrol/31/Suppl_3/s176.full.pdf

5. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4586701

6. https://onlinelibrary.wiley.com/doi/10.1002/hec.70030

7. https://academic.oup.com/ntr/article/26/8/1113/7492743?login=false

8. https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntae151/7697906?redirectedFrom=fulltext&login=false

9. https://montreal.citynews.ca/2024/10/31/more-people-vaping-quebec-ban

10. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2828404

11. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836918?linkId=847041042

12. https://pubmed.ncbi.nlm.nih.gov/41343944

13. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5705282

14. https://ideas.repec.org//p/umc/wpaper/2515.html