• May 23, 2024

A Risky Strategy

 A Risky Strategy
Photo: kurgu128

Banning e-liquid flavors may not achieve the outcomes that proponents have in mind.

By Neil McKeganey, Gabriel Barnard and Christopher Russell

In the world of drug development, very clever people spend a lot of time determining what chemicals need to be combined, in what quantities, over what duration and with what frequency, for a medication to have maximum therapeutic effect. By contrast, much less attention is directed at determining the color, shape, taste or aroma of the pill or capsule involved. If we think of e-cigarettes principally as drug delivery systems, with the drug in question being nicotine, we similarly may come to think that issues of taste and flavor are of secondary importance. In reality, flavors may exert a huge influence in shaping how, why, when and whether adults who smoke use e-cigarettes as an alternative to smoking.

Faced with concerns around youth vaping, there have been increasingly strident calls to ban all e-liquid flavors other than those that tase and smell like tobacco or menthol. The belief here is that by restricting e-cigarette flavors in this way, fewer youth will vape while leaving adults who smoke able to access at least a couple of the flavors that have been available for use.

The risks here are considerable. First, there is the possibility that, even in the face of a ban of e-liquids containing characterizing flavors, youth interest in and use of e-cigarettes remain unchanged. That possibility is by no means unlikely given that the U.S. National Youth Tobacco Survey has shown that flavors lag well behind “curiosity” and “family and friends use” in terms of youths’ reasons for vaping. Second, there is the risk that by reducing the range of available e-liquid flavors, fewer adults will use e-cigarettes as a route out of smoking.

At the moment, e-cigarettes are very popular. They are typically cheaper than regular cigarettes, available in a huge range of flavors, can be discretely used in a wide range of settings, and they can help adults to quit smoking. As e-cigarettes sit increasingly in the crosshairs of regulatory control, we can see each of these benefits steadily being reduced as a result of initiatives to ban flavors, raise taxes, shrink the number of outlets selling e-cigarettes and increase restrictions on where people can vape. The upshot of those accumulated restrictions may be that youth vaping remains largely unchanged while fewer adults use e-cigarettes as a way out of smoking.

In the past, when faced with an increase in rates of volatile solvent abuse (glue sniffing) among U.K. youth and ingestion of Tide Pod detergents by youth in the U.S., the call to ban these products was resisted in favor of restrictions that were placed on how these products could be displayed and sold in retail outlets. In the case of volatile solvent-based products, out went the open shelves of solvent-based glues and cleaning products and in came the locked glass cabinets and the requirement to ask sales staff directly to provide access to the desired product.

Through restricting how these items could be displayed, we found a way to ensure a useful household product could continue to be sold while reducing youth access to harmful chemicals. The case for trying to do the same with e-cigarettes is even greater and more compelling. The price of failure here is not simply the loss of a range of helpful household products, for which there were available alternatives, but the loss of what may be the single most impactful innovation in promoting adult smoking cessation.

The options are stark. In the face of proposals to ban characterizing flavors, it will become increasingly important for industry to support independent research showing what role flavors play in consumers’ decisions as to whether to vape, what to vape and, most importantly, whether to continue or cease smoking. Where flavor bans are initiated, it will be important to monitor what happens once the range of preferred flavors are no longer available; will adults who have already switched from smoking to vaping with the help of now-banned flavors revert back to smoking instead of using the narrowed range of available vape flavors to “stay switched?” Will fewer adults who smoke adopt and use e-cigarettes as a route out of smoking? In addition, industry would be wise to consider ways in which flavored e-cigarettes can be packaged and displayed that actually reduce youth interest in and access to these products.

If we fail to find a way to balance the need for youth protection and the importance of adult consumer choice in promoting smoking cessation, there is a real risk that we will have undermined vaping as a popular, permanent road away from smoking. The cost of that failure will be measured not in the loss of a range of useful household products, as was the case with volatile solvents and Tide detergent pods, but in the loss of millions of lives of adults who smoke.