E-Cigarette Flavor Restrictions’ Effects on Tobacco Product Sales

Abstract

More than 385 US localities and 7 states have implemented restrictions on sales of flavored electronic nicotine delivery systems (ENDS), yet these policies’ effects remain unclear. Utilizing comprehensive data on tobacco product flavor policies linked to retail sales data from January 2018 through March 2023, we estimate the effects of these restrictions. Our findings reveal that ENDS flavor restrictions yield substantial decreases in total ENDS sales, primarily owing to significant declines in flavored ENDS sales alongside nonsignificant increases in unflavored ENDS sales. Further analyses find that ENDS flavor restrictions increase sales of combustible cigarettes, a more harmful product: 11 to 15 additional cigarettes are purchased for every 1 less 0.7 mL ENDS pod sold because of these policies. This uptick in cigarette sales stems primarily from non-menthol cigarettes and includes brands disproportionately used by underage youth. These findings suggest that the public health benefits from reducing ENDS sales via flavor restrictions may be offset by the public health costs of consequent increases in cigarette consumption.