Jeff Smith at Primo Glass vape store in Brunswick says a proposed town ban on the sale of flavored tobacco products would slash the store’s business by half. John Terhune / The Forecaster
Mango Pineapple. Blue Razz Lemonade. Strawberry Banana.
The names might conjure images of the candy aisle, but these are just some of the 15,000 flavors of vaping products that have exploded in popularity since they became widely available a decade ago. Spend time in any high school, and you’ll likely catch students sneaking sticky-sweet puffs from an electronic nicotine delivery system.
But those days may be numbered in Brunswick.
On April 4, the Brunswick Town Council will hold a public hearing on a proposed ordinance that would prohibit the sale of all flavored tobacco products, including flavored vaping cartridges and menthol cigarettes, effective June 1.
The ordinance would make Brunswick the third municipality in Maine to ban these products, after Portland and Bangor. The proposal’s advocates hope the move will encourage lawmakers in Augusta to pass a statewide ban this summer.
Yet even as a dizzyingly high number of organizations — including the American Heart Association, the Maine Public Health Association and the Christian Civic League — have come out in support of the measure, some prominent researchers fear the policy is misguided and even dangerous. They worry it could harm public health by pushing more people – young and old – to smoke cigarettes.
“Anyone who’s painting this as a black and white, there’s-an-obvious-answer issue is oversimplifying,” said Abigail Friedman, an associate professor of health policy at the Yale School of Public Health. “I know that this is not what advocates want to hear, but it’s just not simple.”
PROTECTING KIDS
Kathy E. Wilson, the town councilor behind the proposed ordinance, is very familiar with the struggles of nicotine addiction.
Kathy E. Wilson has sponsored the proposed flavor ban, which the Town Council may vote on directly after a public hearing on April 4. “I can’t save the world,” she said. “I need to just do the best I can for Brunswick and Brunswick’s kids.” Contributed / Kathy E. Wilson
“I couldn’t go through the night without a cigarette,” she said of the three-pack-a-day habit she kicked 40 years ago. “I got up in the middle of the night, every night, at 2. I had to have a cigarette to go back to sleep.”
Today, Wilson hopes to prevent the tobacco industry from hooking a new generation the way it hooked hers.
“I’ve talked to teachers,” she said. “I’ve talked to nurses, doctors, people at the hospitals. If we don’t ban it, we are actively contributing to the death of our teenagers.”
The numbers speak for themselves, said Portland’s BJ McCollister, campaign manager at Flavors Hook Kids Maine, a group pushing for flavor bans across the state.
According to the 2019 Maine Integrated Youth Health Survey, 45% of Maine high school students said they had vaped at least once, and 29% said they’d vaped within the previous 30 days.
And among American high schoolers who use electronic cigarettes, about 85% prefer flavored products, according to the 2021 National Youth Tobacco Survey.
Teresa Gillis, who served two terms on the Brunswick School Board, said protecting kids is her goal. “I’m not working on cessation,” she said. I’m working on stopping fifth graders taking that first puff.” Contributed / Teresa Gillis
“Right now, Maine is falling incredibly far behind as the tobacco industry hooks another generation of smokers,” McCollister said. “Lawmakers have to take action.”
Though it’s already illegal to sell tobacco products to anyone under 21, there’s little question high school and even junior high students are getting their hands on them, according to Teresa Gillis, a former Brunswick School Board member and the current leader of Flavors Hook Kids Maine’s Brunswick campaign. She hopes that banning the sale of all flavored products, which she claims are designed specifically to attract kids, will limit their spread through schools.
“They are marketing this to children, which is just flat-out immoral and wrong,” Gillis said. “The bottom line is stopping the next generation before they start.”
THE LESS-LETHAL OPTION
Some researchers, though, fear banning vaping products could actually damage public health.
“The flavor bans may reduce vaping among kids; I would expect them to,” said Kenneth Warner, professor emeritus of public health and dean emeritus at the University of Michigan School of Public Health. “They may also reduce vaping among adults, which means that more adults are going to continue to smoke, and more adults are going to continue to die.”
While smoking rates have dropped, it is still the leading cause of preventable death in the United States, according to the CDC. Each year, about 480,000 Americans die from smoking-related diseases.
Scientists don’t know exactly how dangerous vaping is, but they generally agree it’s a substantially healthier option than combustible cigarettes, Warner said.
The public and even many doctors overestimate the risk of electronic tobacco products partly because of a 2019 spate of over 60 vaping-related deaths, he said. Yet the CDC has attributed these deaths to an additive found in some cannabis-based products, not nicotine-containing electronic cigarettes.
While proponents of the ban argue that electronic cigarette users are more likely to try smoking, Warner pointed out that youth smoking numbers have dropped at their fastest rates ever since vaping gained popularity among high schoolers around 2014. In 2019, 5.8% of high school students reported smoking within the previous 30 days, according to CDC data, down from 12.7% in 2013.
“The data are simply not consistent with the idea that vaping is increasing smoking,” he said.
By pushing people away from e-cigarettes, lawmakers may be pushing users, including teenagers, to more dangerous combustible products, according to Friedman, who cited a recent article in Value Health linking state-level e-cigarette and flavor bans to increased cigarette purchases.
“If you take away one option, people will go to another option,” she said. “That outside option they might pursue may be worse than the thing you took away, and that’s what needs to be thought about carefully.”
FRAMING THE DEBATE
Flavored tobacco products are displayed at Primo Glass in Brunswick. John Terhune / The Forecaster
Researchers like Friedman and Warner argue that electronic cigarettes use makes it easier to quit more dangerous combustible products
But why would simply banning fruit- and candy-flavored products matter to potential quitters when they would still have access to tobacco-flavored vaping products?
According to Alex Clark, a former smoker and the CEO of the Consumer Advocates for Smoke-free Alternatives Association, flavored vaping products are useful because they help users avoid the triggers they associate with their old habit, including the smell and taste of tobacco.
“That smell, that olfactory experience, is actually one of the strongest triggers for going back to something,” he said. “Trying to corral people into only using a tobacco flavor is actually putting them at a bit of a disadvantage.”
And while consumers might associate fruity flavors with teens, adults also prefer these products, according to Friedman. By making vaping less appealing, lawmakers may discourage smokers from switching to a safer product.
“There are both randomized, controlled trials and meta-analyses which link regular habitual vaping to increases in smoking cessation,” Friedman said. “So it’s entirely plausible that there could be a real difference here in the success with smoking cessation from flavored versus tobacco-flavored e-cigarettes.”
The science surrounding vaping is still new enough that the public health community is torn on several issues.
Warner at the University of Michigan believes some anti-vaping advocates have overstated the number of teens addicted to nicotine. The Maine Public Health Association argued last year that a study linking San Francisco’s ban to increased smoking rates was flawed.
But at the issue’s heart lies a question science may not be able to answer: Should we prioritize keeping healthy teenagers away from nicotine or helping addicted adults quit the most dangerous habit?
“I’m afraid that the more politically engaged people don’t care about people who choose to smoke today,” said Warner, who noted that a disproportionate number of smokers are low-income, members of racial minority groups and sufferers of mental illness. “They don’t care about them, even though they’re the ones who are paying the price.”
Though they may disagree with that assessment, Wilson and her allies don’t hide from the fact that Brunswick’s teens are their focus.
“It’s adults’ responsibility to protect them,” said Wilson, who expects the Town Council will enact the ban. “As far as adults who want to use it, quite frankly it’s not my issue or my problem.”
She paused before adding a final amendment: “I wish they’d quit too.”
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