Impact of state cigarette and e-cigarette flavors bans on smoking, vaping and dual use in the United States

Background and aims: Some states have banned flavors in various tobacco products. This can reduce use of banned products and induce substitution towards non-banned products. The net impact must be determined empirically. The aim of this study is to evaluate the impacts of these bans on both use and substitution. Setting: US tobacco market. Participants: 3220 individuals aged 18–41 in the United States who smoked and/or vaped (past 30-day use) completed an online survey. Measurements: Multinomial logistic models regressed changes in tobacco product use between two time periods on: states with and without bans on flavored e-cigarettes and menthol cigarettes, individuals’ characteristics, and other state-level tobacco policies. Estimated models were used to simulate impacts of flavor bans for people who dual use. Results: Policies’ impacts were only observed for those who dual use cigarettes and e-cigarettes. Most who dual use did not change their tobacco product use regardless of state policy. Some significant differences were found by states for those who quit both products. Massachusetts, with bans on both flavored e-cigarettes and menthol cigarettes, had the greatest predicted rate of quitting both products (9 %) compared to states without (3 %). States with e-cigarette flavors bans had higher cessation of e-cigarette use among those who dual use. Conclusions: Flavor bans on cigarettes and e-cigarettes were associated with reduced vaping among those who dual use. Massachusetts saw a higher proportion of quitting all tobacco products, likely because people who smoked in Massachusetts could not substitute with flavored e-cigarettes which had been banned.