# The effects of flavored e-cigarette sales bans on tobacco-use behaviors among youth and adults

> **NIH NIH R21** · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 2024 · $193,750

## Abstract

PROJECT SUMMARY
In 2022, more than 2 million middle and high school students reported current e-cigarette use. The availability
of flavored e-liquids makes e-cigarettes particularly appealing to youth, with nearly 85% reporting use of
flavored e-cigarettes. The Food and Drug Administration (FDA) has taken action to regulate flavored e-
cigarettes. In 2020, the agency banned prefilled, single-use cartridges containing e-liquids in ‘non-tobacco’
flavors (e.g., fruit, candy). It later targeted flavored disposable e-cigarettes—a previously unregulated device
type that quickly gained popularity among youth following the initial flavor ban. Until last April, the FDA did not
have regulatory authority over synthetic nicotine (vs. tobacco-derived nicotine), which some companies used
as a loophole to keep selling flavored e-cigarettes. The ‘partial’ nature of the FDA’s prior regulations enabled e-
cigarette manufacturers and retailers the opportunity to circumvent flavor regulations. However, six states (MD,
RI, NJ, NY, MA, UT) enacted additional flavored e-cigarette bans, which serve as natural experiments to
investigate whether more restrictive flavor bans are more effective in curtailing youth e-cigarette use.
Conversely, e-cigarettes may also function as potentially less harmful alternatives for adults who smoke
(AWS). Recent clinical trials report greater cigarette cessation rates among participants assigned to e-
cigarettes compared to nicotine replacement or counseling only, suggesting potential benefits for those
interested in quitting. Since flavored e-liquids are also highly preferred by AWS, e-cigarette flavor bans aimed
at reducing AYA e-cigarette use may unintentionally discourage AWS from switching to potentially less harmful
products. Thus, the project will examine the public health effects of stricter flavored e-cigarette regulations,
taking into account both the potential benefits and risks. Using the Population Assessment of Tobacco and
Health (PATH) Survey, we will investigate mechanisms by which statewide flavored e-cigarette bans affect e-
cigarette and other tobacco product use (risks) as well as smoking cessation and reduction (benefits). We will
leverage the longitudinal attribute of PATH to assess individual behavioral changes between subsequent
waves. Using a quasi-experimental event study difference-in-differences estimation design, we will examine (1)
changes in e-cigarette and cigarette use across age groups (12-17; 18-24 and 25+) and (2) use of e-cigarettes
as a tool to quit or reduce smoking among AWS. PATH also includes a rich dataset of tobacco-related
biomarkers, which we will analyze to further explore the impact of flavor bans. This study will contribute highly-
relevant data on the positive and negative impact of flavored e-cigarette bans. The proposal aligns with the
priorities outlined in RFA-OD-21-003 by examining the use pattern of flavored tobacco products and changes
in tobacco use following bans on flavored e-cig...

## Key facts

- **NIH application ID:** 10920457
- **Project number:** 5R21DA059793-02
- **Recipient organization:** WAKE FOREST UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Rachel Denlinger-Apte
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $193,750
- **Award type:** 5
- **Project period:** 2023-09-15 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10920457

## Citation

> US National Institutes of Health, RePORTER application 10920457, The effects of flavored e-cigarette sales bans on tobacco-use behaviors among youth and adults (5R21DA059793-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10920457. Licensed CC0.

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