The controversial ban on flavored tobacco in the U.S. city of Brunswick has divided experts. While a coalition of health groups supports a proposal to ban the sale of flavored products to protect children, some researchers worry it could be a step backwards for public health.

Mango Pineapple. Blue Raz Lemonade. Strawberry Banana.

The names may conjure up images of the candy aisle, but these are just some of the 15,000 vaping products that have exploded in popularity since widespread use a decade ago. Spend some time at any high school and you're likely to find students surreptitiously using electronic nicotine delivery systems.

But in Brunswick, those days may be numbered.

On April 4, Brunswick Town Council will hold a public hearing on a proposed ordinance that would ban the sale of all flavored tobacco products, including flavored e-cigarette packs and menthol cigarettes, effective June 1.

The ordinance would make Brunswick the third city in Maine to ban these products after Portland and Bangor. Advocates of the proposal hope the move will encourage lawmakers in Augusta to pass a statewide ban this summer.

However, even as numerous groups including the American Heart Association, Maine Public Health Association and the Christian Citizens Union have come out in support of the measure, some prominent researchers worry that the policy is wrong and even dangerous. They worry that it will harm public health by prompting more people - young and old - to smoke.

Abigail Friedman, an associate professor of health policy at the Yale School of Public Health, said: "Anyone who paints this question as black and white with an obvious answer is oversimplifying it. I know that's not what advocates want to hear, but it's not simple.

protect children

The town councillor behind the proposed ordinance, Kathy E. Wilson, is well acquainted with the battle against nicotine addiction.

Kathy E. Wilson supports the proposed flavor ban, and the city council may vote directly after a public hearing on April 4. "I can't save the world," she said. "I need to do what I can for Brunswick and the children of Brunswick."

"I couldn't get through the night without smoking a cigarette," she said of the three-pack-a-day habit she broke 40 years ago. "I get up in the middle of the night, 2 a.m. every night. I have to smoke a cigarette to get back to sleep."

Today, Wilson wants to stop the tobacco industry from attracting a new generation as much as she did.

"I've talked to the teacher," she said. "I've talked to nurses, doctors, people in hospitals. If we don't ban it, we're actively contributing to the death of our teens."

The numbers speak for themselves, said Portland's BJ McCollister, campaign manager for Maine Flavor Hook Kids, an organization that has pushed for flavor bans across the state.

According to the 2019 Maine Comprehensive Adolescent Health Survey, 45 percent of Maine high school students said they had vaped at least once, and 29 percent said they had vaped in the past 30 days.

According to the 2021 National Youth Tobacco Survey, about 85 percent of U.S. high school students who use e-cigarettes prefer flavored products.

Teresa Gillis, who served two terms on the Brunswick school board, said protecting children is her goal. "I'm not trying to quit smoking," she said. "I'm trying to stop fifth graders from taking their first puff."

"Now, with the tobacco industry attracting another generation of smokers, Maine is far behind," McCollister said. "Lawmakers must act."

Although it is already illegal to sell tobacco products to anyone under the age of 21, there is no doubt that high school and even middle school students are exposed to tobacco products, says former Brunswick school board member and current Maine Flavor Hook Kids Person Teresa Gillis said she wanted a ban on the sale of all flavoured products she claimed were designed to appeal to children, which would limit their spread in schools.

"They're marketing this to children, which is totally immoral and wrong," Gillis said. "The bottom line is to stop the next generation before they start."

less deadly options

Still, some researchers worry that banning vaping products could actually harm public health.

"Flavor bans may reduce kids' vaping; I hope they will," said Kenneth Warner, professor of public health and dean emeritus of the University of Michigan's School of Public Health. "They may also reduce vaping use among adults, which means more adults will continue to smoke and more adults will continue to die."

While smoking rates have declined, it remains the leading cause of preventable death in the United States, according to the CDC. Each year, approximately 480,000 Americans die from smoking-related diseases.

Scientists don't know exactly how dangerous e-cigarettes are, but they generally agree that e-cigarettes are healthier than combustible cigarettes, Warner said.

The public and even many doctors overestimate the risks of vaping products, in part because of more than 60 vaping-related deaths in 2019, he said. However, the CDC attributes these deaths to additives in some marijuana products, not nicotine-containing e-cigarettes.

While supporters of the ban argue that e-cigarette users are more likely to try vaping, Warner noted that teen vaping has declined at the fastest rate since vaping became popular among high school students around 2014. In 2019, 5.8 percent of high school students reported smoking in the past 30 days, down from 12.7 percent in 2013, according to the CDC.

"These data are fundamentally inconsistent with the idea that e-cigarettes increase smoking," he said.

By pushing people away from vaping, lawmakers could push users, including teens, to use more dangerous combustible products, Friedman said, citing a recent Value Health article that puts state-level vaping and flavor bans on the table. linked to increased cigarette purchases.

"If you take away one option, people will choose another," she said. "The outside options they might pursue might be worse than what you're taking away, and that's something to consider carefully."

use debate

Researchers such as Friedman and Warner believe that using e-cigarettes makes it easier to quit the more dangerous combustible products.

But why is it important for potential quitters to simply ban fruit- and candy-flavored products when tobacco-flavored vaping products can still be used?

Flavored vaping products are useful because they help users avoid triggers associated with old habits, including tobacco's Smell and taste.

"That smell, that olfactory experience, is actually one of the strongest triggers for returning to something," he said. "Trying to get people to use only tobacco flavors is actually putting them at a disadvantage."

Friedman said that while consumers may associate fruity flavors with teens, adults also prefer these products. By making e-cigarettes less attractive, lawmakers may discourage smokers from switching to safer products.

"There are randomized controlled trials and meta-analyses linking regular habitual vaping with an increase in smoking cessation," Friedman said. "It is therefore entirely plausible that there may be a real difference between flavored e-cigarettes and tobacco-flavored e-cigarettes in terms of smoking cessation success."

The science surrounding vaping is still so new that the public health community is stuck on several issues.

Warner of the University of Michigan argues that some anti-vaping advocates have exaggerated the number of teens addicted to nicotine. The Maine Public Health Association argued last year that a study linking San Francisco's ban to increased smoking rates was flawed.

But at the heart of the question is a question that science may not be able to answer: Should we prioritize keeping healthy teens off nicotine or helping addicted adults kick the most dangerous habit?

"I'm concerned that people who are more politically engaged don't care about people who choose to smoke today," Warner said, noting that a disproportionate number of smokers are low-income, racially minority and mentally ill. They don't care about them, even if they are the ones who pay the price.

While they may disagree with that assessment, Wilson and her allies aren't hiding the fact that Brunswick's teens are their concern.

"It's adults' responsibility to protect them," said Wilson, who expected the city council to issue a ban. "For adults who want to use it, frankly, it's not my problem and it's not my problem."

She paused before adding the final amendment: I hope they drop out too.

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