The impact of flavored e-cigarette bans on e-cigarette use in three US states

INTRODUCTION: Beginning in 2019, several U.S. states implemented temporary or permanent bans on the sale of flavored e-cigarettes. This study examined the impact of flavor bans on adult e-cigarette use in Washington, New Jersey, and New York. METHODS: Adults who used e-cigarettes at least once a week before the flavor bans were recruited online. Respondents reported their e-cigarette use, primarily used flavor, and ways of obtaining e-cigarettes before and after the bans. Descriptive statistics and multinomial logistic regression models were applied. RESULTS: After the ban, 8.1% of respondents (N=1624) quit using e-cigarettes, those primarily used banned menthol or other flavors declined from 74.4% to 50.8, those using tobacco-flavored declined from 20.1% to 15.6%, and those using non-flavored increased from 5.4% to 25.4%. More frequent e-cigarette use and smoking cigarettes were associated with being less likely to quit e-cigarettes and more likely to use banned flavors. Of those primarily using banned flavors, 45.1% obtained e-cigarettes from in-state stores, 31.2% from out-of-state stores, 32% from friends, family, or others, 25.5% from Internet/mail sellers, 5.2% from illegal sellers, 4.2% mixed flavored e-liquids themselves, and 6.9% stocked up on e-cigarettes before the ban. CONCLUSIONS: Most respondents continued to use e-cigarettes with banned flavors post-ban. Compliance of local retailers with the ban was not high, and many respondents obtained banned-flavor e-cigarettes through legal channels. However, the significant increase in the use of non-flavored e-cigarettes post-ban suggests that these may serve as a viable alternative among those who used previously used banned or tobacco flavors.