San Francisco to vote on banning all flavors in tobacco products

The next big fight in tobacco legislation will focus on the role of flavors in e-cigarettes: Whether it’s dangerously appealing to young people who then pick up smoking or can be a harm reduction tool, to shift adult smokers from cigarettes.

In San Francisco on Tuesday, voters passed Proposition E, a ban on the sale of flavors in all tobacco products, including vaping devices, hookahs and menthol cigarettes.

It was the first referendum on the issue. Neighboring Oakland was able to pass a ban on tobacco flavors in 2017. Yet in San Francisco, Big Tobacco pushed back on the proposed ordinance, creating a fight against health advocates and drawing comparisons to David verses Goliath.

On the “Yes” side were two nonprofit health groups that raised more than $5 million. An estimated $3 million was donated by billionaire and former New York City Mayor Michael Bloomberg.

The “No on Prop E” campaign had raised more than $11.5 million with funding largely from tobacco company R.J. Reynolds, which makes Newport, Camel and Pall Mall cigarettes.

Surveys by the Centers for Disease Control and Prevention estimate that about 2 million youths used e-cigarettes in 2016, down from 3 million in 2015. Yet public health researchers say that young people don’t view their vaping habits as typical e-cigarette use and that the actual number is underreported.

Flavored cigarettes were banned by the Food and Drug Administration in 2009, although this didn’t apply to menthol and smokeless tobacco products, and heat-not-burn devices.

Researchers at Georgia State University last year evaluated the effects of the ban and found it had the intended effect of reducing adolescent tobacco use, although there was a slight increase in the use of menthol products, cigars and pipes.

The FDA is evaluating how to regulate flavors in e-cigarette and vape products. It is eliciting public comments and scholarly research on potential benefits and harms.

“Here we’re seeking comments and data, science and information on the role that flavors are playing in tobacco products, good or bad,” Mitch Zeller, director of the FDA Center for Tobacco Products, said last month at an e-cigarette conference in Washington. “The role that they are playing in getting kids to initiate on tobacco products and the role they may be playing in helping addicted adult cigarette smokers successfully switch away form combustible tobacco products.”

Advocates for keeping flavors in e-cigarettes say their taste attracts cigarette smokers to make the switch; there is little evidence to support that. A 2016 study in the journal Tobacco Control found that, among other things, people who reported using flavored tobacco products were no more likely to succeed at quitting than those who didn’t use flavors.

More effective in getting people to quit smoking is offering money, not free e-cigarettes, according to a study published last month in the New England Journal of Medicine.

Further, a study published in Tobacco Control in March said that adolescents consider flavors the most important feature of trying e-cigarettes and were more likely to initiate vaping if the product was flavored.

In May, the FDA issued 13 warning letters to companies for packaging e-liquid products to look like popular kids treats — like candy, cookies and juice boxes.

“No child should be using any tobacco product, and no tobacco products should be marketed in a way that endangers kids — especially by using imagery that misleads them into thinking the products are things they’d eat or drink,” FDA Commissioner Dr. Scott Gottlieb said in a statement.

JUUL, a novel e-cigarette that has captured more than half of sales of the entire market, advertises flavors like cucumber, creme brûlée, fruit medley and tobacco. Their popularity has soared among teenagers.

“There’s lots of data out there that youth would not have started a tobacco product if it were not flavored,” Bonnie Halpern-Felsher, a developmental psychologist and pediatrics professor at Stanford University School of Medicine said in an interview with The Washington Times in April. “Youth, first of all, think that the flavors are for them, not for adults, and they are definitely more flavor sensitive than are adults.”

Yet the problems of addiction often boils down to nicotine, with e-liquids for vaping devices ranging from zero nicotine to the equivalent of a pack of cigarettes. The FDA’s overall goal is to reduce nicotine in all tobacco products to a non-addictive level.