Research published in September 2025 in Health Economics has revealed that comprehensive state bans on flavored e-cigarettes or vaporized nicotine products may be unintentionally driving young adults toward greater use of traditional cigarettes. The study, conducted by a team of health economists, raises concerns about the unintended consequences of well-meaning tobacco control policies implemented across multiple states.
Substitution Effect: Public Health Concerns Emerge as Flavored E-Cigarette Bans Drive Substitution to Cigarettes
Background: Policy Context and Research Motivation
The study was led by Henry Saffer of the National Bureau of Economic Research and the Graduate Center of the City University of New York, along with Selen Ozdogan, Michael Grossman, Daniel L. Dench, and Dhaval M. Dave. Their work focused on analyzing how comprehensive statewide flavor bans influenced tobacco use behaviors.
Researchers employed a difference-in-differences econometric model. They specifically used nationally representative survey data to evaluate shifts in vaping and cigarette use across states that enacted bans and those that did not. This allowed them to measure both intended reductions in vaping and potential increases in cigarette smoking.
A phenomenon called the substitution effect was measured by looking at changes in cigarette use that occurred when e-cigarette use fell after flavor bans. The effect was inferred by the parallel movement in opposite directions—a decrease in vaping paired with an almost identical increase in smoking—linked directly to the timing of flavor bans.
Their analysis was conducted across three age groups: minors under eighteen years, young adults aged eighteen to twenty-four years, and adults aged twenty-five years and older. This age-specific design enabled the team to determine whether the impacts of flavored e-cigarette bans varied across different demographic categories of tobacco users.
Findings: Evidence of Unintended Consequences
• Decrease in E-Cigarette Use Among Young Adults
Young adults aged 18 to 24 experienced a decline of 2 to 3 percentage points in e-cigarette use after the implementation of statewide bans. This demonstrated that the restrictions were effective in discouraging vaping within this vulnerable age group.
• Increase in Cigarette Smoking Among Young Adults
Traditional cigarette smoking rose by nearly the same magnitude as the young adult group. This indicated a substitution effect in which some individuals replaced vaping with cigarettes when flavored alternatives were unavailable.
• Suggestive Increase in Minor or Below-18 Smoking
Evidence indicated a possible increase in cigarette use among minors under 18. Statistical significance was weaker than for young adults. This still suggests that bans may also push a portion of underage individuals toward cigarette smoking.
• Absence of Significant Impact on Older Adults
There were no measurable changes in either vaping or smoking behaviors among adults aged 25 and older. This suggests that older individuals were largely unaffected by the bans, perhaps due to more established tobacco smoking habits.
The aforementioned findings are not isolated. A Mass General Brigham study covering the period between 2019 and 2023 reported that prohibitions on flavored e-cigarettes did reduce vaping among young adults by 6.7 percentage points but consequently led to higher-than-expected cigarette smoking among both youths and young adults in affected states.
Moreover, findings from a quasi-experimental analysis, which was published in 2024 in JAMA Health Forum, confirmed that restricting flavored e-cigarettes reduced vaping but was consistently associated with an increase in cigarette smoking among young adults. This mirrored the substitution effect seen in the Health Economics study
The study above referenced the Behavioral Risk Factor Surveillance System data and showed that daily vaping among adults aged eighteen to twenty-nine fell by 3.6 percentage points in states with restrictions. However, daily smoking rose by 2.2 percentage points, reinforcing evidence that comprehensive bans can trigger unintended behavioral trade-offs.
Implications: Reconsidering Policy Effectiveness
The referenced studies above demonstrate a consistent pattern. Flavored e-cigarette bans reduce vaping among younger groups but simultaneously increase cigarette smoking, particularly among young adults. This substitution effect suggests that such policies may fail to achieve the intended overall improvements in public health without complementary measures.
Public health experts argue that policymakers must weigh potential unintended consequences when implementing bans. More nuanced approaches may be needed. These include targeted education campaigns, cessation support programs, and regulatory frameworks that discourage both vaping and smoking without inadvertently driving substitution.
FURTHER READINGS AND REFERENCES
- Cheng, D., Lee, B., Jeffers, A. M., Stover, M., Kephart, L., Chadwick, G., Kruse, G. R., Evins, A. E., Rigotti, N. A., and Levy, D. E. 2025. “State E-Cigarette Flavor Restrictions and Tobacco Product Use in Youths and Adults.” JAMA Network Open. 8(7): e2524184. DOI: 1001/jamanetworkopen.2025.24184
- Friedman, A. S., Pesko, M. F., and Whitacre, T. R. 2024. “Flavored E-Cigarette Sales Restrictions and Young Adult Tobacco Use.” JAMA Health Forum. 5(12): e244594. DOI: 1001/jamahealthforum.2024.4594
- Saffer, H., Ozdogan, S., Grossman, M., Dench, D., and Dave, D. 2025. “Comprehensive E‐Cigarette Flavor Bans and Tobacco Use Among Youth and Adults.” Health Economics. DOI: 1002/hec.70030