Restricting flavored vapes could harm smoking cessation efforts, finds study

Restricting the choice of flavored vapes, also known as e-cigarettes, could have an adverse effect on the many adults who use them to reduce or quit smoking, according to a new University of Bristol-led study published in the journal Harm Reduction.

In March/April 2023, the proportion of children experimenting with vaping had grown by 50% year on year, from one in 13 to one in nine. Concerns about children becoming hooked on vapes has led the UK government to consider banning flavors to make them less attractive to young people.

Some countries have already restricted the sale of flavored e-liquids, allowing only tobacco and menthol flavors. While these restrictions aim to reduce the appeal of vaping they may affect adults who use vapes to stop smoking.

In this study, researchers aimed to understand how UK adults who smoke, or used to smoke and now vape, feel about unflavored e-liquids and how potential flavor restrictions might impact them. The team recruited 24 adults ranging in age from 19 to 62 years. Of these, 12 adults smoked daily and 12 adults vaped daily but had stopped smoking within a year prior to the study (as daily vaping is strongly associated with smoking cessation). The group included two adults who smoked 20 or more cigarettes per day and two adults who vaped daily but used to smoke 20 or more cigarettes per day.

Participants were asked to use an unflavored vape for four hours instead of their usual flavored e-liquid. They were then asked to complete a survey and participate in an online interview giving their thoughts on whether they would be tempted to use them again.

Results found the participants had mixed opinions about unflavored e-liquids. While some felt unaffected by the lack of flavors, others thought it might lead them back to smoking. Many of the participants described the unflavored e-liquids as unenjoyable or thought they were "all right."

Overall, while many participants thought flavors played a crucial role in their vaping behavior, especially in trying to quit smoking, other factors like nicotine dependence, social influences—given vaping's trendy image— and health perceptions were noted as important drivers. Participants in this study generally believed a flavor ban would negatively impact smoking cessation efforts more than it would prevent young people from vaping.

Dr. Jasmine Khouja, the study's lead author and lecturer at Bristol's School of Psychological Science and a member of the University's Tobacco and Alcohol Research Group, said, "While flavor restrictions might reduce youth vaping, our interview responses suggest that they could also discourage adults from using e-cigarettes to help them quit smoking, potentially leading those who vape return to smoking and leading more people who currently smoke to continue smoking. There are also concerns that people may try and get flavors from abroad or make their own flavors, which may expose them to toxicants or chemicals that have not been approved for use in vapes.

"Policymakers need to consider these varied impacts if the UK government decide to ban flavors in vapes."