In their effort to diminish youth vaping, policymakers in the City by the Bay have seemingly helped to increase youth combustible cigarette use – a reverse in a trend that had declined by over 50 percent between 2009 and 2017.

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In April 2018, the ban on flavored e-cigarettes and vapor products went into effect in San Francisco and in January, 2020, the city had implemented a full ban on any electronic vapor product. Unfortunately, these endeavors have failed to lower youth tobacco and vapor product use.

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Data from a snapshot of the 2019 Youth Risk Behavior Survey show that 16 percent of San Francisco high school students had used a vapor product on at least one occasion in 2019, an increase from 7.1 percent that had used an e-cigarette in 2017. Current daily use more than doubled from 0.7 percent of high school students in 2017 to 1.9 percent of San Francisco high school students reporting using an e-cigarette every day in 2019.

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Worse, despite nearly a decade of significant declines, youth use of combustible cigarettes seems to be on the rise in Frisco. In 2009, 35.6 percent of San Francisco high school students reported ever trying combustible cigarettes. This figure continued to decline to 16.7 percent in 2017.  In 2019, the declining trend reversed and 18.6 percent of high school students reported ever trying a combustible cigarette. Similarly, current cigarette use increased from 4.7 percent of San Francisco high school students in 2017 to 6.5 percent in 2019.

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Public health officials may be apt to attribute the increase use of combustible cigarettes to vaping products, yet in cities and states where looser regulations exist, youth combustible smoking continues to decline.

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In Seattle, WA, combustible cigarette use decreased between 2016 and 2018 among students between grades 6 and 12 as noted in the Seattle Public Schools Healthy Youth Survey. In 2016, 7.025 percent of Seattle youth between grades 6 and 12 reported smoking cigarettes 1 to 2 times in the 30 days prior to the survey, this decreased to 2.025 percent in 2018.

According to the Indiana Youth Survey, in Indiana-which in 2016 reversed a draconian law allowing for a monopoly on e-liquid in the Hoosier state – past 30-day use of combustible cigarettes among high school students declined from 9 percent in 2017 to 7.3 percent in 2018. Unfortunately, despite a decline between 2015 and 2017, e-cigarette use among Indiana students in grades 7 through 12 “increased significantly,” with 16.9 percent reporting using a vapor product on at least one day in the past month.  

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Although addressing youth tobacco and vapor product use is laudable, existing evidence continues to show that flavor bans don’t work and in fact, threaten harm reduction options for millions of American adults that have used e-cigarettes to quit smoking.

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Despite fear mongering, electronic cigarettes and vapor products are significantly less harmful with numerous public health groups noting as such, including Public Health England, the Royal College of Physicians, the National Academies of Sciences, Engineering, and Medicine, and the American Cancer Society. Indeed, a 2017 study in BMJ’s peer-reviewed journal Tobacco Control examined health outcomes using “a strategy of switching cigarette smokers to e-cigarette use … in the USA to accelerate tobacco control progress.” The authors concluded that replacing e-cigarettes “for tobacco cigarettes would result in an estimated 6.6 million fewer deaths and more than 86 million fewer life-years lost.”

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It is disingenuous that lawmakers continue with draconian prohibition policies that don’t reduce youth smoking and indeed may be leading to an increase in smoking rates. Lawmakers ought to revisit the drawing boards to come up with sensible policies that have a positive effect on youth substance use and do not restrict adults from tobacco harm reduction tools.