Yale Study: Flavor Bans Can Make Vaping More Dangerous


Increased rates of vaping nicotine and marijuana products in the U.S. did not result in more e-cigarette or vaping-related lung injuries (EVALI) cases, according to a new study from the Yale School of Public Health (YSPH).

“If e-cigarette or marijuana use per se drove this outbreak, areas with more engagement in those behaviors should show a higher EVALI prevalence,” said assistant professor Abigail Friedman, the study’s author. “This study finds the opposite result. Alongside geographic clusters of high EVALI prevalence states, these findings are more consistent with locally available e-liquids or additives driving the EVALI outbreak than a widely used, nationally-available product.”

Published in the Journal Addiction, the research estimates the relationship between a state’s total number of reported cases of EVALI per capita as of January 2020, and pre-outbreak rates of adult vaping and marijuana use, according to a release from the YSPH. Results show that higher rates of vaping and marijuana use are associated with fewer EVALI cases per capita.

The U.S. Centers for Disease Control and Prevention (CDC) announced in February that it had officially classified vitamin E acetate, an additive long linked to EVALI and most common in THC e-liquids that are informally-sourced—i.e., purchased off the street or home-mixed—as “a primary cause of EVALI.”

The EVALI outbreak has motivated a variety of state and federal legislation to restrict sales of nicotine e-cigarettes, including a temporary ban on all e-cigarette sales in Massachusetts in late-2019 and bans on flavored e-cigarette sales in several states and localities. However, if the goal was to reduce EVALI risks, the study suggests that those policies may have targeted the wrong behavior.

The study found that the five earliest states to legalize recreational marijuana—Alaska, California, Colorado, Oregon and Washington—all had less than one EVALI case per 100,000 residents aged 12 to 64, according to the release. None of the highest EVALI-prevalence states—Utah, North Dakota, Minnesota, Delaware and Indiana—allowed recreational marijuana use.



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