Sales of flavored tobacco products have been banned in San Francisco since 2018, when voters approved Proposition E, this ban went into effect in January 2019. Evidence of this ban causing an increase in combustible tobacco use emerged in 2021 when JAMA Pediatrics published their study titled: A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California.  

This study found that after San Francisco’s ban on flavored vapes and tobacco products, teenagers in the city’s high schools were more likely to take up smoking than teenagers in other US school districts. 

Flavor Bans Increase Cigarette Sales 

“Prior to the flavor ban, smoking rates in San Francisco paralleled many cities across the country, showing fewer teens using combustible cigarettes over time. After the city enacted its policy, the odds of smoking among its high school students, relative to trends in comparison school districts, more than doubled.” Alex Norcia reported back in 2021.  

This corresponds with an FDA sponsored study from last month which found that cigarette sales increase in areas with flavor bans. Which should not be a surprise since most adult vapers prefer added artificial fruit and menthol flavors to artificial tobacco notes.  

Despite flavor bans, adult demand remains high. A study by the University of California San Diego found after a state law banned retailers from selling most forms of flavored tobacco statewide, there was a spike in online shopping queries.  

Regulators Strike Back 

The San Francisco Department of Public Health has maintained a list of websites that sell tobacco products online, and the city suspects some of these businesses might be selling products unlawfully.   

As Attorney General David Chiu explained, “Vaping remains common among San Francisco high school students despite heavy restrictions on the products. Flavored e-cigarettes are hooking a new generation on nicotine. They’re putting millions of people at risk and threatening decades of progress. We want to make it very clear that these products are incredibly harmful and their sale to San Franciscans will not be tolerated…Online sales are, unfortunately, the next frontier of this public health crisis.” 

Flavor Fallacy 

Strong words. But the statement made by Chiu is false. Youth vaping has decreased nationwide per the newly released data from the National Youth Tobacco Survey. The next frontier for this public health crisis seems much more likely to be when millions of adult vapers are funneled back onto combustible cigarettes, rather than a renewed increase in underage vaping.  

The data show a significant drop in high school vaping — the lowest in nearly a decade. Current e-cigarette use (defined as use on one or more days during the past 30 days) declined from 14.1% in 2022 to 10% in 2023 among high school students. More than half a million fewer U.S. high school students vaped in 2023 compared to 2022.    

On top of this false claim, this kind of messaging misleads adult smokers. Instead of taking his talking points from the Orwellian-named Truth Initiative, Chiu should look instead to the United Kingdom and their NHS, which hosts the website “Vaping to Quit Smoking.”  

The single payer UK system is quick to discard any health modality which is not cost effective, including those with influential backers, such as herbal medicine and homeopathy.  Yet they continue to champion the efficacy of vaping.  

Perhaps Chiu should consider why San Francisco has chosen to betray their laudable track record of humane public health policies. This is a city which offers needle exchanges for IV drug users, NARCAN at every library, and has that has long since stopped prosecuting minor drug offenses. But this forbearance and compassion grinds to a halt when it comes to legal age adults attempting to purchase flavored nicotine products.