The U.S. Food and Drug Administration (FDA) has implemented a ban on the sale of many flavored e-cigarettes, with some exceptions. However, a survey by researchers from the University of Rochester Medical Center (URMC) found that the ban did not lead adults to quit e-cigarette use and may even prompt some to return to traditional cigarettes. The researchers attribute the failure to a policy loophole that allowed continued use and access to e-cigarettes.

Vaping is the act of inhaling and exhaling an aerosol, a vapor containing a mixture of chemicals, including nicotine, flavorings and other additives. Smoking was originally marketed as a safer alternative to smoking traditional cigarettes because it produced no smoke or ash. However, studies have shown that smoking can have negative health effects, and it has been linked to lung damage and other respiratory problems.

The findings, published in Tobacco Control, show that of the 3,500 adult e-cigarette users who responded to the survey, less than 5% had given up on vaping because of the flavored e-cigarette ban. The remaining respondents switched to other forms or flavors of e-cigarettes or other types of tobacco products not covered by the ban.

Tobacco research expert Deborah J. Ossip, Ph.D., professor in URMC's Department of Public Health Sciences and Center for Community Health and Prevention, said: "There is a growing body of literature showing that e-cigarette flavors themselves cause damage when inhaled, so banning flavors makes sense. Makes sense." But this particular ban doesn't seem to be working. People -- including young people -- still have access to products in a variety of flavors and are still using them. "

Study lead author Dr. Dongmei Li, associate professor of clinical and translational research, obstetrics, and public health sciences at URMC, said a large part of the problem was that the ban did not cover newer products such as disposable e-cigarettes and smoking hookahs instead of pipes/ Smoke sticks for electronic cigarettes.

"Other forms of flavored e-cigarettes, especially disposable e-cigarettes, became very popular following FDA policy," Lee said. FDA policy also did not ban mint or tobacco flavored products -- our research shows that many people in the Switched to mint flavored e-cigarettes after the ban. It seems like a lot of people find mint to be a good flavor as well."

According to the study, nearly 30 percent of respondents switched to canned or disposable e-cigarettes, and another 30 percent switched to mint or tobacco flavored pods. Some reported switching directly to traditional tobacco products. 14% switched to combustible products such as cigarettes, 5% switched to smokeless tobacco (i.e. chewing or dipping), and less than 5% of respondents gave up electronic use after the FDA ban cigarette.

The study authors used statistical models to look for factors associated with these changes in e-cigarette use behavior. Hookah use and disagreement with the FDA's flavor enforcement policy was most closely associated with switching to other flavored e-cigarettes. Using mint-flavored e-cigarettes in the past 30 days was associated with switching to mint-flavored e-cigarettes. Those who reported smoking daily or on certain days were more likely to switch to tobacco-flavored e-cigarettes or combustible tobacco products.

On the other hand, people who used flavored e-cigarettes without nicotine were more likely to quit vaping. While the study wasn't designed to show cause and effect, the association supports previous research that lowering the nicotine levels in cigarettes can help smokers quit. However, further research is needed to better understand the relationship between low-nicotine e-cigarette use and smoking cessation.

Going forward, the policy could be effective if it covers all flavors of e-cigarettes (including menthol and all e-cigarette types), and if policy implementation and compliance are actively monitored. Both are important in helping to reduce the prevalence of vaping among young Americans.

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