Up In Smoke: How Vape Bans Increase Tobacco Use

I remember my local pub a decade ago. 

Just outside, the smokers would gather, sipping their beer and blowing streams of smoke into the air by the road. Even when I vaped, I would join them, as quite often that was where the most interesting conversations were.

How different it is now. 

One by one, the smokers took their last puff and switched to vaping. They’ll still gather outside when it’s warm, but it’s vapour, not smoke, that fills the air around them. 

They’re not alone. 

In the UK millions of people have switched from smoking to vaping. According to ASH England, more than 2 million of them have also gone on to stop using nicotine entirely. It’s a situation replicated around the world, with over 60 million smokers quitting since vaping was introduced. 

The UK government has recognised that vaping is both the most popular and effective way to quit smoking, while a Cochrane review – considered the gold standard of scientific reviews – is finding increasingly strong evidence that vaping is both an effective way to stop smoking and is likely more effective than NRT. 

Yet around the world, vapers are now facing restrictions and even bans on vaping. 

What does this mean for smoking rates? Let’s find out…

What the data says about vaping bans and restrictions

When British army soldiers went on an exercise in the Oman desert, researchers William, Fuller and Smith must have seen an opportunity for data gathering. 

While Oman allows the sale of cigarettes, electronic cigarettes are banned. The British army, always a stickler for rules, forbade the use of vaping by the soldiers while they were on exercise in the country. 

William and co tracked smoking rates among the soldiers. The result? By the end of the exercise the number of soldiers smoking had increased by more than 5%.

Even when there isn’t a full ban, restrictions on vaping can cause a smoking uplift. For example, in Novia Scotia, Canada a flavour ban was put in place. According to data released by the government and analysed by a vaping advocacy group, there was a 5.6% increase in cigarette consumption over the following year – while other regions with no flavour ban continued to see a fall in smoking rates. 

Other studies found the same result, with increases in smoking rates in San Francisco after a flavour ban and in Massachusetts due to both a vaping ban and the linking of vaping to an EVALI outbreak (which was in fact caused by Vitamin E Acetate in illegal THC products). 

Even well meaning legislation can have unintended consequences. For example, one study by Pesko et al found that imposing vaping age restrictions had no impact on smoking rates, but did reduce the amount of young people stopping smoking. That’s not surprising when NHS data suggests that one of the main reasons young people vape is to quit smoking.

The Australia Experience: One third of vapers could resume smoking

One real-world example where restrictions have held back vaping is Australia. Dr Colin Mendelsohn, a stop smoking expert and harm reduction advocate, told me:

We have perhaps the strictest tobacco control laws in the world. We have plain packaging, we have the highest cigarette prices, we have very strict smoke free and advertising laws, but our rate of decline has flattened out. England is flying past us, the US is flying past us, and I think vaping has played a big role in that.

Despite serious restrictions, such as only allowing vapers to import nicotine for personal use rather than buy it in the country, vaping has grown significantly. By 2019 there were 500,000 vapers (2.5% of the population), a number that had doubled since 2016, and Colin estimates there are now around 600,000 vapers. 

This number could fall significantly, with the government now requiring vapers to take out a prescription in order to vape. Vaping without a prescription could lead to a fine of up to $250,000 and, in some states, a jail sentence. 

Of course, some vapers will try to get a prescription. Unfortunately, doctors know little about vaping, and Colin says they are often reluctant to write one. 

People go to them all the time and they say ‘don’t know anything about this, I don’t know how to write a prescription, I don’t even know if I am allowed to’. It created medical legal problems, because the doctors are writing a prescription for an unapproved product, and if there is a problem the doctor is responsible for them.

It’s impossible to know exactly what the impact of this is, but a survey of 7,000 vapers gives a clue – one third of them said they would return to smoking if they were unable to obtain a prescription. Colin has personally met with several people who have already gone back to smoking because they couldn’t get a prescription. It’s also going to make it even harder for Australia’s three million smokers to quit smoking.

Conclusion: This is about people, not numbers

We’ve talked a lot here about data. But the issue is not about numbers. It’s about people.

Try to imagine yourself in the shoes of one of them.

You smoked, maybe for decades. You tried many times to give up, but failed each time. Then you found vaping – which may not be perfect, but is at least 95% less harmful than smoking. 

Your health improves. You have more money in your pocket. The fire in your chest, the hacking cough in the morning, disappears. You can walk up the stairs without getting out of breath, your sense of taste and smell improves and the smell of wafting coffee once again greets you in the morning. 

You face a brighter future, one where you may well live years longer, and have precious extra time to spend with your loved ones and your children. 

Then, suddenly, and for no good reason you can identify, your government wants to take it away from you. You’re still addicted to nicotine, and revert back to smoking – left only with a grim and lasting anger at the society that would do this to you. 

Across the world today millions of people are in exactly this situation. If we have any compassion, and whether or not we are personally affected by bans and restrictions, it’s of vital importance that we fight for everyone’s right to vape.

Studies and Data on Vape Bans & Restrictions

Vaping restrictions leading to increased smoking rates

UK Military in Oman: With vaping banned in the country, vape devices were prohibited for UK military personnel on exercise. By the end of the exercise there had been a 5.4% increase in smoking rates amongst the soldiers. 

Indoor vaping restrictions: Using a panel model, Cooper et al found that indoor vaping restrictions increased smoking rates amongst pregnant women by 2%. 

San Francisco flavour ban: This banned both combustible and non-combustible products. Cigarette smoking increased after the vape ban. Most users of flavoured tobacco products were able to circumvent the ban.

Massachusetts: Cigarette purchases increased after several bans on e-cigarettes and after (wrongly) linking nicotine vaping to an outbreak of lung diseases caused by illegal THC products. 

Novia Scotia: After there was a ban on flavoured vaping products, the region saw a 5% increase in smoking rates. Other areas in Canada saw a decline in smoking rates in the same period. 

Vape restrictions leading to reduced smoking cessation

Minimum age laws and smoking cessation in pregnancy:  Pesko et al found that imposing minimum age restrictions had no impact on smoking rates, but did lead to a decrease in smoking cessation.

Adding vaping restrictions to smoke-free air laws: Friedman et al found that adding vape restrictions to smoking bans likely undermines the effectiveness of smoking bans.   

Limits on nicotine strength: Goldenson et al research suggested that limiting nicotine strength to 20mg might lead to a reduction in the number of people switching, as the strength may not be suitable for heavier or more dependent smokers.

Vaping restrictions increasing black market sales

EU regulations lead to an increase in black market products: Ward et al found that while consumers were reassured by some aspects of the legislation, product restrictions lead to an increase in the black market, putting consumers’ health at risk.