E-Cigarette Flavor Restrictions Linked to Reduced Use, Unintended Increases in Cigarette Use Among Youths

Strategic Insights -

Research from Ewha Womans University, published in the JAMA Network Open, has explored the impact of e-cigarette flavor restrictions on tobacco product use among young people. The study, conducted in the US between 2015 and 2023, analyzed data from the Youth Risk Behavior Survey (YRBS) and the Behavioral Risk Factor Surveillance System (BRFSS) to estimate annual state-level prevalences of e-cigarette and cigarette use among different age groups.

Key Takeaways:

  • Seven states in the US have policies restricting the sale of flavored e-cigarettes, but the evidence for their effectiveness in reducing tobacco use among young people is limited.
  • According to the study, e-cigarette use prevalence decreased among youths in policy states (24.1% to 14.0% from 2019 to 2023), but increased in control states among young adults (17.0% to 20.4% from 2019 to 2023).
  • Cigarette use prevalence decreased in policy and control states, with policy states exhibiting lower prepolicy prevalence and attenuated postpolicy decreases.
  • The study found that flavor restrictions were associated with reduced e-cigarette use among young adults in 2022 (average treatment effect among the treated [ATT], -6.7 percentage points) and adults aged 25 years or older in 2023 (ATT, -1.2 percentage points).
  • However, the study also found unintended increases in cigarette use among youths in 2021 (ATT, 1.8 percentage points) and young adults in 2021, 2022, and 2023 (ATT, 3.7 percentage points, 2.7 percentage points, and 3.2 percentage points, respectively).

Statistics:

  • 109 states in the US do not have policies restricting the sale of flavored e-cigarettes.
  • Between 2015 and 2023, e-cigarette use prevalence decreased among youths in policy states from 24.1% to 14.0%, while it increased in control states among young adults from 17.0% to 20.4%.
  • The study analyzed data from 186 (YRBS) and 386 (BRFSS) state-years for e-cigarettes and 191 (YRBS) and 456 (BRFSS) state-years for cigarettes.
  • Flavor restriction policies were associated with reduced e-cigarette use among young adults in 2022 (ATT, -6.7 percentage points; 95% CI, -1.3 to -12.1 percentage points) and adults aged 25 years or older in 2023 (ATT, -1.2 percentage points; 95% CI, -2.0 to -0.4 percentage points).

Sources:

  • Ewha Womans University (2025) State E-Cigarette Flavor Restrictions and Tobacco Product Use in Youths and Adults. JAMA Network Open, 8(7).
  • JAMA Network Open (2025) Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.