Category: Flavors

  • ‘Carcinogens Among Permitted Additives’

    ‘Carcinogens Among Permitted Additives’

    Photo: New Africa

    Canada’s proposed list of permitted vapor product additives includes dangerous ingredients, according to Imperial Tobacco Canada (ITCAN).

    “To put it bluntly, the list contains at least one known substance that could cause cancer,” said ITCAN Vice President, Corporate and Regulatory Affairs Eric Gagnon in a statement.

    According to ITCAN, several ingredients on the flavor ban proposal list of permitted ingredients are substances that its parent company, British American Tobacco, categorically avoids in its vaping products.

    The company says BAT’s toxicological risk assessment prevents the use of substances classified as having carcinogenic, mutagenic or reprotoxic (CMR) properties, as per the Globally Harmonized System for classification and labelling of substances.

    “It is shocking that the government would include a proven and classified CMR substance in its lists of permitted additives for vaping products,” ITCAN wrote on its website. “The effect of a regulation that formally permits such ingredients is simply an encouragement to manufacturers—particularly smaller producers with limited access to scientific literature—to use an inherently unsafe substance in a product that is designed to be inhaled into the lungs.”

    Gagnon cited isophorone as an example. “This substance is classified by the European Union as cancer-causing and acutely toxic. It is also banned by Canadian food and drug regulations from use in human cosmetics,” he said.

    “We encourage Health Canada to reconsider the list and consult with experts to determine the best way forward.”

  • Policies May Perpetuate Health Disparities

    Policies May Perpetuate Health Disparities

    A Fralin Biomedical Research Institute study published in Nicotine and Tobacco Research was the first to use data from the Experimental Tobacco Marketplace to examine how policies restricting flavors of nicotine and tobacco products influence health equity. (Photo: clayton metz/Virginia Tech)

    Restricting menthol flavor in cigarettes while making nicotine replacement therapy more available and affordable has the potential to reduce socioeconomic disparities in tobacco use.

    That was one of the findings in a study published in May in Nicotine and Tobacco Research that marks a new use of existing data from the Fralin Biomedical Research Institute at VTC’s Addiction Recovery Research Center. Researchers analyzed data from their Experimental Tobacco Marketplace to look beyond broad effects of tax and regulatory policies for the journal’s special issue on the health equity effects of restricting flavored nicotine.

    Smoking also accounts for more than 30 percent of the difference in life expectancy among socioeconomic groups, according to the study’s lead author, Assistant Professor Roberta Freitas-Lemos.

    Freitas-Lemos said the team saw an opportunity to use the marketplace to extend the Fralin Biomedical Research Institute’s work in addressing equity and inclusion in health research.

    “We realized we could use an existing data set, split the sample in two based on socioeconomic status, and compare how policies implemented affected purchase behaviors of different groups,” she said in a statement. “The study has shown us that flavor restrictions may decrease tobacco-related disease and death rates.”

    According to the researchers, it also points to the need to evaluate tobacco restrictions in a broader context, as cigarette substitution is highly dependent on what other products are available.

    In the Experimental Tobacco Marketplace, study participants use an online account to purchase tobacco and nicotine products based on their reported use. Researchers adjust the product mix and pricing to predict their effects on purchase behavior. The marketplace applies the economic concept of substitution effect, in which decreased sales of a product can be attributed to purchasers switching to alternatives as prices rise.

    “We came up with a methodology, endowed it with an Amazon-like interface, and we give study participants an amount to spend based on their reported use,” said Warren Bickel, professor with the Fralin Biomedical Research Institute and director of the Addiction Recovery Research Center. “In the process, we’re understanding how new policies may change consumers’ behavior.”

    What’s critical, he said, is understanding the interplay of policies. “We’ve shown there’s a policy that ameliorates disparity, but if you implement a second, different policy simultaneously, it destroys that effect,” Bickel said. “We think this is an exciting outcome. If we can actually start addressing and forecasting the impact of policy on health disparity, that’s a game-changer.” 

    Bickel also is director of the institute’s Center for Health Behaviors Research and a psychology professor with Virginia Tech’s College of Science. Freitas-Lemos also is assistant professor in the College of Science and is part of the Fralin Biomedical Research Institute’s Center for Health Behaviors Research and Cancer Research Center.

    In addition to Freitas-Lemos and Bickel, Fralin Biomedical Research Institute authors on the study include Research Assistant Professor Allison Tegge and Assistant Professor Jeffrey Stein.

    The research is supported by the National Cancer Institute of the National Institutes of Health. “This elegant work by Dr. Freitas-Lemos, Dr. Bickel, and their colleagues spans behavioral neuroscience and tax policy. It represents an emerging area of importance in cancer research that is becoming a major area of emphasis at the National Cancer Institute,” said Michael Friedlander, Virginia Tech’s vice president for health sciences and technology and executive director of the Fralin Biomedical Research Institute. “We are very fortunate to have such an array of talent among our research community that is poised to move the needle in this important new focus for both initial cancer prevention and relapse.”

    The team focused on data that simulated the effects of a menthol cigarette ban and a flavored electronic cigarette ban on study subjects based on education and income levels. The analysis examined four conditions: one that mirrored the current market environment, one that imposed only menthol cigarette ban, one that imposed only e-cigarette flavor restrictions, and one that restricted both menthol cigarettes and flavored e-cigarettes.

    Researchers saw significant differences under the one that mirrored the current market: Participants in the high socioeconomic status group purchased fewer cigarettes, more e-cigarettes, and more nicotine replacement therapy. The lower-status group purchased more cigarettes, fewer e-cigarettes, and fewer replacement-therapy products. Researchers speculate that menthol allows users to inhale more deeply, potentially allowing smokers with restricted resources to optimize their nicotine intake.

    The main finding was that a menthol cigarette flavor ban only significantly decreased disparities with the group with lower socioeconomic status purchasing fewer cigarettes and more nicotine replacement therapy than the group with higher socioeconomic status.

    They also found that flavor restrictions lessened differences between the groups’ purchases of nicotine replacement therapy.

    The journal’s special issue inspired the current research, but the team has been looking for opportunities to extend a health equity lens to the experimental marketplace.

    “We see the prevalence of cigarette use decreasing in the United States, but the disparities are increasing,” Lemos said. “Having an experimental model that can investigate that is important to the field of tobacco research.”

  • Revenant Rule

    Revenant Rule

    Image: MarijaBazarova

    Canada’s new health minister is breathing new life into a 2021 proposal to ban vape flavors nationwide.

    By Stefanie Rossel

    Thomas Kirsop

    There’s life in the old dog yet: In March 2024, Canada relaunched a three-year-old plan to ban all vape flavors except tobacco, mint and menthol. The regulations were first published in June 2021 in the Canada Gazette, signaling the government’s intention to implement the flavor ban within six months after the obligatory public consultation. But the rule that was supposed to launch in January 2022 never came, and Canada’s health authorities never mentioned the flavor ban again—until Health Minister Mark Holland, in office since July last year, recently revived the idea.

    Outrage about the proposed ban among vapers, consumer advocacy groups and the vape industry was as huge in 2021 as it is now: Canada’s planned rule goes further than most flavor bans, which tend to prohibit only certain “characterizing flavors” or flavor descriptors. Under the Canadian proposal, all sweeteners in vaping products would be prohibited, and vape manufacturers would be allowed to create their liquids using only approved ingredients.

    They would have to select from a list of 82 approved compounds, 40 of which can be used to impart a tobacco flavor and 42 of which can be used to impart flavor of mint, menthol or a combination of the two. “Menthol tobacco” or a “mint tobacco” are off limits under the rules.

    “Should the flavor ban be adopted as it was written in 2021, Canadian users of vaping products will see the removal of nearly all existing flavor profiles in the legitimate vaping products market within 180 days of publication of the proposed order and regulation from 2021,” says Thomas Kirsop, managing director of Canada’s Vaping Industry Trade Association (VITA).

    “The only two products on the market that would not require removal or reformulation would be ‘unflavored’ liquids and unadulterated ‘menthol.’ All existing ‘tobacco’-flavored vaping products would need to be removed from the market, reformulated to remove sweeteners and flavoring compounds not on the permitted constituents list and then reintroduced to the Canadian market.”

    The proposed rule would also prescribe “sensory attributes standards,” which are defined only vaguely, stipulating, for example, that a vaping product or its emissions should not have “sensory attributes that result in a sensory perception other than one that is typical of tobacco or mint/menthol,” thus limiting manufacturers’ ability to make vape products that have “a highly pleasant smell or taste.”

    “Sensory attributes regulations are referenced over 40 times in the proposal, but there is no specific section explaining how these regulations would be drafted, implemented or enforced in a clear manner,” says Kirsop. The VITA interprets this part of the planned regulation as meaning that manufacturers can make their liquids using the 82 permitted compounds, and at some time in the future, the government will pay a third party to smell, taste and possibly vape this product. “If that third party thinks that the liquid does not align with the permitted flavor profiles or is ‘too palatable,’ then that formulation will be prohibited regardless of its adherence to all the objective standards in legislation,” says Kirsop.

    Relapse to Combustibles Expected

    The impact of such a regulation on Canada’s 1.5 million vapers would be dramatic, according to Kirsop. His organization anticipates a major relapse to combustible cigarettes among consumers. “The number of cigarettes consumed per capita will increase,” he says. “It is well understood that vaping products and combustible products are economic substitutes in the nicotine market. A regulatory impact on one will result in an inverse reaction of the other.”

    Kirsop refers to a 2023 study by Abigail Friedman that investigated the effects of e-cigarette flavor restrictions on tobacco product sales in the U.S. and found that while the flavor restriction did impact vaping rates in the manner intended, the impact on legitimate cigarette sales was substantial, with 12 extra cigarettes sold in the legitimate market for every 0.7 mL pod not sold due to a flavor ban. The VITA has similarly calculated that a nationwide flavor ban in Canada would result in additional cigarette sales of almost 4 billion sticks per year.

    For the country’s independent vape manufacturers and estimated 1,800 specialty vaping product shops, such a measure would have a significant, possibly existential, impact, according to Kirsop. “It is the variety of flavored vaping products that make a specialty store economically viable,” he says. The illicit market, by contrast, would receive a boost, especially if the flavor ban comes on top of the 12 percent federal vape product tax hike planned for July.

    “From any historical reference point, the removal of a product with significant consumer demand from the legitimate market will result in that demand being met by the illicit market,” says Kirsop. “Our investigations lead us to believe that the black market will expand quite rapidly to fill the void. Our only question is whether that illicit trade will favor small players, producing flavored liquids in garages and basements, if it will follow the Australian model, with organized crime groups importing flavored disposable vaping products from overseas, or if it will be some hybrid combination of both.”

    There are plenty of cautionary examples close to home. Six of Canada’s 13 provinces and territories have already restricted the sales of e-cigarettes to tobacco-flavored varieties. “In Nova Scotia, over 40 percent of specialty vape stores closed immediately following the flavor ban, and when VITA commissioned an investigations company to survey the market, we found significant illicit trade and a consumer outlook that supported that illicit trade,” says Kirsop. “News reports showed that in the year after the flavor ban, tobacco excise collection increased 13.6 percent. We also identified that consumers are starting to adapt by adding their own third-party commercial flavoring products to vaping liquids.”

    Goal Missed

    Maria Papaioannoy

    Kirsop says it’s too early to determine the impact of flavor bans on youth usage. However, the VITA has found no data that differentiate Nova Scotia, which was the first province to ban flavored vaping products, from provinces that kept them on the market or banned them at a later date. “Nova Scotia shows youth past-30-day vaping behavior has dropped from 25.1 percent to 23 percent since their flavor ban,” says Kirsop. “However, all provinces except Quebec saw youth vaping rates drop in the same category during that time frame, and some of them did significantly better. Alberta saw youth use drop from 19.9 [percent] to 14.8 percent, British Columbia 27.6 [percent] to 16 percent, Manitoba 21.5 [percent] to 16.7 percent and Saskatchewan 29.6 [percent] to 23.7 percent. All the latter have no bans on flavors.”

    So, while the intended impact on adolescents remains questionable, the effect on adults would be devastating, according to Maria Papaioannoy of Rights4Vapers. “Flavors are a critical part of what makes vaping such an effective alternative to cigarettes,” she wrote in a letter to Prime Minister Justin Trudeau. “If a person who smokes decides to move to vaping, they do not want to be reminded of the taste of tobacco.” A ban on flavors as proposed, she argues, would mean a prohibition of the entire category through the back door. “Who would pay for an unpalatable product?”

    In 2021, Rights4Vapers started a letter-writing campaign, resulting in more than 20,000 Canadians submitting arguments to Health Canada against the proposed regulation. Papaioannoy has organized a similar campaign now. To date, the government has received more than 27,000 letters from adult consumers raising concerns over this ban. In mid-March, Papaioannoy spoke at Health Canada’s stakeholder meeting but left disillusioned. “Consumers had a huge voice in vaping regulation with previous health ministers,” she says. “In this call, all I felt from Health Canada representatives was sympathy, not compassion.”

    Like many, Papaioannoy believes that the proposed flavor prohibition is not so much an action of bureaucracy but a mandate being driven by Holland, who formerly worked for the nongovernmental organization Heart and Stroke, a known opponent of vaping.

    Both tobacco harm reduction activists hope that as lawmakers debate the measure, reason will prevail. “The wild card is the minister of health,” says Kirsop. “Generally, one would think that policy decisions that could impact millions of Canadian smokers and 1.5 million adult Canadian users of vaping products would be based on scientific data and academic literature and not driven by emotional talking points and flag waving.

    “This minister has demonstrated that he has no grounding in literature or the science, and it does not appear at this point that he cares much for it if it does not align with his ideology or that of his former peer group. Ideology forms a very poor starting point for public health decisions.”

    Papaioannoy is more optimistic, noting that the proposal still has to go through the Treasury Board of Canada, with the time frame between proposing and enacting being long and opposition strong against a measure that would affect small businesses. “Besides, I believe in the institution,” she says. “Someone from the government will raise the flag.”

    Stefanie Rossel is Tobacco Reporter’s editorial contributor. An experienced trade journalist, she combines sharp reporting skills with in-depth knowledge of the tobacco and vapor industries. Prior to joining Tobacco Reporter, Stefanie was editor-in-chief at Tobacco Journal International, where she worked for a decade. Fluent in English, German and French, Stefanie covers tobacco news around the world. She is based in Germany.
  • Flavor Bans Threaten Smoke-Free Ambitions

    Flavor Bans Threaten Smoke-Free Ambitions

    Image: Arcady

    The Tholos Foundation has launched three white papers exposing the risks of banning flavors in vaping products at an event in Brussels hosted by Parliament Magazine and featuring contributions from Swedish MEP Johan Nissinen. The reports cover the impact of flavor bans in the real world and best practices to educate adult smokers and restrict underage usage and analyzes the public response to the European Commission’s 2023 public consultation.

    Surveys commissioned by the Tholos Foundation and conducted by Ipsos in multiple countries have shown that a significant majority of vapers use flavors other than tobacco to help reduce and quit smoking. Notably, 83 percent of vapers in Germany stated that flavors are crucial in their decision to vape, with similar high percentages reported in Belgium, the Netherlands and Sweden. The research also showed that, in countries where flavors were banned, many vapers went back to smoking or for black market alternatives and references numerous scientific studies confirming that flavors are essential for the effectiveness of vaping products in smoking cessation.

    With European elections due to take place shortly, the Tholos Foundation believes it is imperative policymakers take heed of voters’ concerns and reject extensive restrictions on smoking alternatives.

    “The evidence is clear: Flavors in vaping products are critical to helping smokers quit,” said co-author Tim Andrews in a statement. “Banning flavors will create a black market and drive people back to smoking. Our reports offer an evidence-based approach that combines rigorous law enforcement, education and technological innovations to reduce underage experimentation while preserving the benefits for adult smokers.

    “With the European elections approaching, it is crucial for policymakers to understand the importance of harm reduction strategies. Our findings support a balanced approach that protects public health and helps smokers transition to safer alternatives.”

    The Tholos Foundation is an international nongovernmental organization, affiliated with Americans for Tax Reform, dedicated to advocating for consumers.

  • Spain Urged to Keep Vape Flavors Legal

    Spain Urged to Keep Vape Flavors Legal

    Photo: nyker

    The Independent European Vape Alliance (IEVA) has asked Spain to refrain from banning flavored vapes.

    According to the group, the proposed measure presents several risks.

    “The effective ban of e-liquids in the Spanish market will lead to a boom in black market activities with dangerous, non–compliant products,” the IEVA wrote in a statement.

    In addition, the group warned, it will cause a rise in smoking rates and put at risk more than 3,000 jobs in the Spanish vaping industry, leading to a reduction in government revenues by reducing tax collection.

    The IEVA shared its concerns in a contribution to the public consultation that is currently underway.

  • Oregon Court Approves Local Flavor Ban

    Oregon Court Approves Local Flavor Ban

    Credit: Mehaniq 41

    The Oregon Court of Appeals upheld a Washington County ban on flavored tobacco sales.

    Washington County commissioners approved Ordinance 878 in 2022, but it was not enforced because a circuit court judge overturned it.

    In his opinion, Circuit Judge Andrew Erwin wrote that prohibiting the sale of flavored tobacco must come from the state, not the county, according to media reports.

    The county appealed the judge’s decision, and the court found that the county is not preempted by state law. According to Washington County’s website, businesses will be inspected each year to ensure compliance with the ordinance.

    Tony Aiello, Jr., the attorney for the plaintiffs-respondents, released a statement, saying, in part, “My Clients are disappointed with the decision by the Court of Appeals today and intend to seek review by the Oregon Supreme Court.

    “We read the Court of Appeals’ decision to conflict with itself in several places and are optimistic that the Oregon Supreme Court will reach a different conclusion if our case is granted review.”

  • ‘Quebec Lobby Groups Blind to Illicit Trade’

    ‘Quebec Lobby Groups Blind to Illicit Trade’

    Photo: Thorsten

    Imperial Tobacco Canada is taking anti-tobacco groups to task for their silence about the boom in illicit sales following Quebec’s ban on flavored e-cigarettes.

    “You cannot claim ‘Mission Accomplished’ by simply passing regulations,” said Eric Gagnon, vice president of corporate and regulatory affairs for Imperial Tobacco Canada, in a statement. “The regulations must work. And these ones don’t. Flavored vapor products are still being sold in Quebec. The problem is that they are now being sold illegally.”

    Quebec banned flavored vapes Oct. 31, 2023, following years of pressure by anti-tobacco groups. According to Imperial Tobacco Cananda, the same groups refuse to acknowledge that there is a problem with the regulations and will not call on the government to fully enforce the regulations.

    “It’s time that the Coalition Quebecoise pour le controle du tabac and other so-called health groups acknowledge that there is a problem with the regulations and push to fix it,” Gagnon said. “If the real objective of the regulations was to ban flavors, where are these health groups now that flavored vapor products are being sold illegally?”

    Imperial Tobacco Canada noted that some of the lobby groups have ties to the provincial government and receive funding from them.

    “It is time for the public to see the real intentions behind these anti-tobacco lobby groups,” said Gagnon. “They hide behind the virtue of public health, but their recent silence demonstrates that their only real objective is going after tobacco companies, even if this means pushing consumers to illegal products.”

    “It is astonishing to see that Quebec’s anti-tobacco lobbyists prefer turning a blind eye to illegal flavored vaping products rather than recognizing that this is a failed policy and working with us to demand concrete enforcement measures to Minister Dube,” said Gagnon. “This says a lot about the real intention behind the individuals leading these organizations.”

  • U.S. Menthol Decision Delayed Again

    U.S. Menthol Decision Delayed Again

    Photo: Alicia

    The Biden administration has again delayed its decision on whether to ban menthol cigarettes in the United States.

    “This rule has garnered historic attention, and the public comment period has yielded an immense amount of feedback, including from various elements of the civil rights and criminal justice movement,” said Secretary of Health and Human Services Xavier Becerra in a statement. “It’s clear that there are still more conversations to have, and that will take significantly more time.”

    Government officials declined to provide a new target date for the measure, saying they needed more time to hear from outside groups, especially civil rights activists.

    Menthols account for more than a third of all cigarettes sold in the U.S. each year and are predominantly used by Black and Latino smokers.

    According to The Wall Street Journal, lawmakers have been weighing the potential public health benefits of banning minty smokes against the political risk of angering Black voters in an election year.

    A November poll commissioned by Altria Group found that 54 percent of “core” Biden voters—defined as minority voters or non-conservative white voters under age 45—oppose the proposed ban.

    Anti-tobacco groups were aghast by the latest delay. “It is unacceptable and deeply harmful to public health that the Biden administration today has once again delayed issuing the final rule to prohibit menthol cigarettes,” said Yolonda C. Richardson, president and CEO of the Campaign for Tobacco-Free Kids, in a statement. “This decision prioritizes politics over lives, especially Black lives.” 

    The FDA formally proposed the ban in April 2022, saying there were 18.5 million smokers who preferred menthol brands in the United States.

    Anti-smoking activists say the cooling sensation of the menthol flavor makes it easier to start smoking and harder to quit. The FDA estimates that the menthol ban could reduce smoking by 15 percent in 40 years. Studies project that as many as 650,000 smoking-related deaths could be avoided.

    Researchers looking at similar moves in other nations estimated that a ban could result in nearly a quarter of smokers quitting, with the rest moving to nonmenthol cigarettes or managing to keep smoking menthols.

    In recent months, dozens of groups have met with administration officials to discuss the proposal. Among other concerns, opponents of the measure cite job losses and aggressive police targeting of Black smokers. An estimated 85 percent of U.S. Black smokers prefer menthol brands, according to market data. The FDA insists that enforcement would be against manufacturers rather than consumers.

    Critics, however, contend that tobacco companies are financing and fueling those fears. Richardson said she was disturbed to see the administration “parrot the false claims of the tobacco industry about support from the civil rights community.”

    “The fact is the menthol rule is overwhelmingly supported by Black civil rights, faith, public health, medical and other organizations,” she said.

    While other jurisdictions, including the European Union, have banned menthol cigarettes, the impact of such a measure would likely be greater in the U.S. because of their large market share. Reynolds American Inc. (RAI), which makes the market-leading Newport brand, earns about $7 billion from menthol cigarette sales a year, research by Goldman Sachs shows.

    Convenience store, gas station and wholesaler groups predict a loss of $34 billion in sales from menthol cigarettes and snacks and drinks purchased by customers. Some House Republicans have sent letters to the administration warning that the ban could have a disastrous effect on small businesses and that it could encourage cigarette smuggling that would benefit terrorist groups.

    Altria spokesman David Sutton said the company was also concerned about illicit sales as well as lost tax revenue and jobs.

    A study on the impact of a state flavor ban in California suggests the measure spawned a large market for illegal products there.

  • Canada Relaunches Flavor Ban

    Canada Relaunches Flavor Ban

    Photo: DD Images

    Canada is set to enact a three-year-old flavor ban, according to Vaping360. The regulations were first published in June 2021 in the Canada Gazette but then never went into effect. Now, however, Health Minister Mark Holland has reinvigorated the ban.

    Holland previously worked at Heart and Stroke, where he was the national director of children and youth. “I was with Heart and Stroke when we dealt with the issue of vaping,” he said, “and there were many voices at that time, when information was uncertain, who said, ‘Let this exist as a cessation tool. Don’t take action.’ The result of that, unfortunately, was that the tobacco industry was able to addict a whole new cohort of young people—who had no exposure to nicotine—to something that’s absolutely deadly for their health. It has had very injurious outcomes for our health system.”

    Vaping proponents warned that the measure could backfire. “As presented, Minister Holland’s proposal will not achieve the desired public health objectives and could, on the contrary, seriously harm a significant number of Canadian adult ex-smokers, the Vaping Industry Trade Association (VITA) wrote in a press release.

    “This appears to be a personal legacy project for the Minister of Health, supported strongly by his former peers at the Heart and Stroke Foundation, the Canadian Cancer Society, the Canadian Lung Association and some smaller anti-smoking NGOs [nongovernmental organizations],” said VITA Managing Director Thomas Kirsop.

    The ban would give manufacturers a list of fewer than 100 allowable flavoring ingredients that can only be used to create e-liquid in tobacco, mint and menthol flavors. Sweeteners of any kind would be banned. The regulations will also “prescribe sensory attributes standards to prevent a sensory perception other than one that is typical of tobacco or mint/menthol.”

  • 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.

    Neil McKeganey is director of the Center for Substance Use Research in Glasgow, Scotland.
    Gabriel Barnard is a director of the Center for Substance Use Research in Glasgow, Scotland.
    Christopher Russell is director of Russell Burnett Research and Consultancy in Glasgow, Scotland.