Dataset Information

Early evidence of flavored tobacco product restrictions in Massachusetts and New York State.

ABSTRACT:

Introduction

With many US states and localities enacting policies that restrict flavored e-cigarette sales, evaluation of these restrictions is critical to inform future efforts. This study analyzed both survey and retail scanner data to assess early-stage impacts of flavored tobacco sales restrictions in Massachusetts and New York State on e-cigarettes sales and product use among young people.

Methods

This study uses state-level e-cigarette retail sales data and survey data from youth and young adults (aged 13-24 years). Cross-sectional surveys were conducted at two time points in Massachusetts (both post policy implementation) and New York (pre and post policy implementation); retail sales data in both states were analyzed from 2019 through 2020 and compared to sales in control states.

Results

E-cigarette unit sales decreased significantly following the implementation of statewide restrictions on flavored e-cigarettes in both Massachusetts and New York State (p<0.001). Survey data showed a decrease in mint flavored e-cigarette use in Massachusetts and an increase in tobacco flavored e-cigarette use in New York State over time (p=0.001). In both states, a greater proportion of respondents reported using disposable e-cigarettes at Time 2 compared to Time 1 (p=0.001). Among those who reported using fruit-flavored e-cigarettes in New York State, a significantly greater proportion reported disposable device use at Time 2 compared to Time 1 (p=0.004).

Conclusions

Findings from these case studies from two US states suggest that statewide policies reduce the availability of e-cigarettes and have the potential to reduce use of many youth-appealing flavors. The increase in use of disposable e-cigarettes likely reflects existing loopholes in federal policy, which may be attenuating the potential impact of strong state-level policies.

SUBMITTER: Schillo B

PROVIDER: S-EPMC10594628 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Early evidence of flavored tobacco product restrictions in Massachusetts and New York State.

Schillo Barbara B Seaman Elizabeth L EL Cuccia Alison A Ali Fatma R M FRM Cordova Jamie J Mills Sarah S Kreslake Jennifer J

Tobacco induced diseases 20231024

<h4>Introduction</h4>With many US states and localities enacting policies that restrict flavored e-cigarette sales, evaluation of these restrictions is critical to inform future efforts. This study analyzed both survey and retail scanner data to assess early-stage impacts of flavored tobacco sales restrictions in Massachusetts and New York State on e-cigarettes sales and product use among young people.<h4>Methods</h4>This study uses state-level e-cigarette retail sales data and survey data from ...[more]

PMID: 37881173

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Project description:IntroductionFlavored tobacco sales restrictions (FTSRs) are implemented to reduce access to flavored tobacco products. We examined the association between seven cities with local FTSRs implemented in 2018/2019 and e-cigarette use among high school students in the California Bay Area.Aims and methodsWe analyzed data from the California Healthy Kids Survey using a difference-in-differences (D-I-D) strategy. We compared pre- and post-policy changes one year after implementation in current and ever e-cigarette use among students attending school in a city with a FTSR (exposed) (n = 20 832) versus without (unexposed) (n = 66 126). Other outcomes included ever marijuana use in an e-cigarette and ease of access to e-cigarettes.ResultsPre- to post-policy, the adjusted odds of current and ever e-cigarette use did not significantly change among students exposed and unexposed to a FTSR. In the adjusted D-I-D analysis, the odds of current (aOR: 1.25, 95% CI: 0.95, 1.65) and ever e-cigarette use (aOR: 1.06, 95% CI: 0.89, 1.26) did not significantly change by exposure group. However, one year post-implementation, the odds of ease of access to e-cigarettes significantly increased among exposed (aOR: 1.57, 95% CI: 1.27, 1.95) and unexposed students (aOR: 1.54, 95% CI: 1.39, 1.70). Similarly, the odds of ever using marijuana in an e-cigarette significantly increased among exposed (aOR: 1.35, 95% CI: 1.19, 1.53) and unexposed students (aOR: 1.29, 95% CI: 1.20, 1.39).ConclusionsLocal FTSRs in the California Bay Area were not associated with a change in e-cigarette use one year post-implementation. Increased ease of access and marijuana use may be explanatory factors.ImplicationsFTSRs were not associated with a decrease in current or ever e-cigarette use among high school students in the California Bay Area one-year post-implementation. Potential explanatory factors are that ease of access to e-cigarettes and using marijuana in an e-cigarette increased. More research is needed to understand the influence of these factors on youth access and behaviors. To address the youth e-cigarette epidemic, a comprehensive approach is needed, including policies, media campaigns, education programs, and cessation tools targeted to youth.

Project description:ImportanceMore than one-quarter of US residents live in states or localities that restrict sales of flavored electronic nicotine delivery systems (ENDS), often as a means to reduce youth vaping. Yet, how these policies affect young adult vaping and smoking remains unclear.ObjectiveTo estimate the effects of ENDS flavor restrictions on ENDS use and cigarette smoking among young adults (age 18-29 years) in the US.Design, participants, and settingThis quasi-experimental analysis used annual survey data from the 2016 to 2023 Behavioral Risk Factor Surveillance System (BRFSS), a series of nationally- and state-representative, repeated cross-sectional surveys of noninstitutionalized civilian adults in the US. Two-way fixed-effects specifications were estimated to assess how ENDS flavor restrictions affect young adults' use of ENDS and cigarettes. Analyses were adjusted for potential confounders including concurrent tobacco control policies, respondent demographic characteristics, and socioeconomic factors. Data analyses were conducted in November 2023 and repeated in October 2024 to incorporate newly released 2023 survey data.Main outcomes and measuresCurrent and daily use of ENDS and of cigarettes as measured in the BRFSS.ResultsBalanced panel analyses of 242 154 individuals aged 18 to 29 years consistently found that state ENDS flavor restrictions were associated with statistically significant reductions in daily vaping and increases in daily cigarette smoking. Estimates were similar across robustness checks, with the main specification showing 3.6 (95% CI, -5.0 to -2.1) percentage point (ppt) reductions in daily vaping and 2.2 ppt increases in daily cigarette smoking (95% CI, 1.0 to 3.4) relative to changes in states without restrictions. These estimates are equivalent to an 80% reduction in daily vaping and 22% increase in daily smoking compared with 2018 mean rates.Conclusions and relevanceThe findings of this quasi-experimental analysis of BRFSS survey data indicate that state restrictions on flavored ENDS sales were associated with reduced vaping among young adults but may have unintentionally increased cigarette smoking, potentially offsetting public health gains. These findings suggest that alleviating the burden of tobacco-related disease will require regulatory strategies that balance reducing vaping with preventing increases in more lethal, combustible tobacco use.

Project description:ObjectiveTo analyze the effects of health reform efforts in two large states--New York and Massachusetts.Data sources/study settingNational Health Interview Survey (NHIS) data from 1999 to 2008.Study designWe take advantage of the "natural experiments" that occurred in New York and Massachusetts to compare health insurance coverage and health care access and use for adults before and after the implementation of the health policy changes. To control for underlying trends not related to the reform initiatives, we subtract changes in the outcomes over the same time period for comparison groups of adults who were not affected by the policy changes using a differences-in-differences framework. The analyses are conducted using multiple comparison groups and different time periods as a check on the robustness of the findings.Data collection/extraction methodsNonelderly adults ages 19-64 in the NHIS.Principal findingsWe find evidence of the success of the initiatives in New York and Massachusetts at expanding insurance coverage, with the greatest gains reported by the initiative that was broadest in scope--the Massachusetts push toward universal coverage. There is no evidence of improvements in access to care in New York, reflecting the small gains in coverage under that state's reform effort and the narrow focus of the initiative. In contrast, there were significant gains in access to care in Massachusetts, where the impact on insurance coverage was greater and a more comprehensive set of reforms were implemented to improve access to a full array of health care services. The estimated gains in coverage and access to care reported here for Massachusetts were achieved in the early period under health reform, before the state's reform initiative was fully implemented.ConclusionsComprehensive reform initiatives are more successful at addressing gaps in coverage and access to care than are narrower efforts, highlighting the potential gains under national health reform. Tracking the implications of national health reform will be challenging, as sample sizes and content in existing national surveys are not currently sufficient for in-depth evaluations of the impacts of reform within many states.

Project description:IntroductionIQOS was authorized by the U.S. Food and Drug Administration (FDA) as a modified-risk tobacco product. We conducted a pharmacokinetic study evaluating the nicotine delivery and subjective effects of IQOS use among current menthol cigarette smokers to better understand if IQOS is an acceptable cigarette alternative in light of the proposed menthol cigarette ban.Aims and methodsParticipants were adult smokers of >4 menthol cigarettes per day. After 14-hour nicotine abstinence, participants were provided an IQOS device and menthol heatstick to puff every 20 seconds for a total of 14 puffs. Blood samples were collected at baseline and during active use to calculate nicotine boost from baseline to peak concentration. Nicotine withdrawal symptoms were collected before and after IQOS use. In addition, a modified Product Evaluation Scale for IQOS was collected after use.ResultsParticipants (n = 8) were a mean age of 43.9 years, 63% were female, 88% identified as White, and they smoked a mean of 17.1 menthol cigarettes per day. After IQOS use, the mean nicotine boost obtained was 15.96 ng/mL (SD = 6.91) (range 9.31 to 30.55 ng/mL). Most (75%) participants reported enjoying use of the product "a lot" or greater and more than half (62.5%) reported reduced cigarette cravings. Most participants reported no side effects after use; however, two experienced dry mouth, three experienced dizziness, one experienced throat irritation, and one experienced headache.ConclusionWe found that directed use (14 puffs) of menthol IQOS delivered a mean nicotine boost of 15.96 ng/mL which reduced craving for a cigarette. The majority of participants enjoyed use of IQOS and reported mild side effects.ImplicationsMenthol IQOS delivered a sufficient dose of nicotine perceived as satisfying by menthol cigarette smokers and it reduced craving with mild side effects. Menthol IQOS has potential to serve as a less harmful alternative for menthol cigarette smokers. The availability of modified risk products like IQOS should be considered by FDA's Comprehensive Plan for Tobacco and Nicotine Regulation.

Dataset Information

Early evidence of flavored tobacco product restrictions in Massachusetts and New York State.

Introduction

Methods

Results

Conclusions

Publications

Early evidence of flavored tobacco product restrictions in Massachusetts and New York State.

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