Reduced vaping and smoking prevalence among people using e-cigarettes after implementation of an e-cigarette flavour ban in the Netherlands

INTRODUCTION: The appeal of e-cigarettes is concerning as vaping is harmful to health. Flavoured e-cigarettes are particularly appealing, including to youth. Therefore, the Dutch government implemented a ban that limits e-cigarette products to tobacco flavours and unflavoured options only. This study aimed to evaluate the impact of the ban on e-cigarette use in pre-ban users. METHODS: We conducted a retrospective cross-sectional online survey, 9 months following the ban's implementation. A research agency with a certified participant pool recruited 548 adolescents and young adults (ages 13-24) and 457 adults (25+ years), all of whom used e-cigarettes pre-ban. RESULTS: As a result of the ban, 40% (95% CI 36% to 43%) of respondents reduced vaping, including 22% (95% CI 20% to 25%) who quit entirely, with no differences between the two age groups. Most consumers (73%) who quit vaping due to the ban did not use a substitution product. Six per cent of all participants started cigarette smoking and attributed this initiation to the e-cigarette flavour ban. Yet, overall prevalence of cigarette, cigar(illo) and waterpipe smoking declined post-ban, by 8 percentage points (ppt), 3% ppt and 5% ppt, respectively, indicating that more users quit than started using potential substitution products. The use of non-tobacco flavours in e-cigarettes declined by 44 ppt. Among those continuing to use banned flavours, the largest group (36%) purchased them in physical shops abroad. CONCLUSION: The e-cigarette flavour ban effectively reduced e-cigarette use among pre-ban users, potentially benefiting public health. To enhance policy impact, we recommend international adoption of similar measures or other strategies to restrict cross-border purchasing.