Longer-Term Impact of the Flavored Tobacco Restriction in Two Massachusetts Communities: A Mixed-Methods Study

Abstract

Introduction In response to high rates of youth tobacco use, many states and localities are considering regulations on flavored tobacco products. The purpose of this study was to assess whether flavored tobacco restrictions (FTRs) in Massachusetts curb youth tobacco use over time, and whether a dose-response effect of length of policy implementation on tobacco-related outcomes exists. Methods Using a quasi-experimental design, two municipalities with a FTR (adopting municipalities) were matched to a comparison municipality without a FTR. Surveys were administered before (December 2015) and after (January and February 2018) policy implementation to high school students in these municipalities (over 2,000 surveys completed at both timepoints). At follow-up, adopting municipalities had a policy in place for one and two years, respectively. In 2019, focus groups were conducted with high school students in each municipality. Results Increases seen in current tobacco use from baseline to follow-up were significantly smaller in adopting municipalities compared to the comparison (-9.4% [-14.2%, -4.6%] and -6.3% [-10.8%, -1.8%], respectively). However, policy impact was greater in one adopting municipality despite shorter length of implementation. Focus groups indicated reasons for differential impact, including proximity to localities without FTRs. Conclusions Restrictions implemented in adopting municipalities had positive impacts on youth tobacco awareness and use one to two years post-implementation. Policy impact varies depending on remaining points of access to flavored tobacco, as such policy effectiveness may increase as more localities restrict these products.

The actual and anticipated effects of restrictions on flavoured electronic nicotine delivery systems: a scoping review

“…Again using DiD, Kingsley et al [ 40 ] evaluated the impact of flavoured tobacco restrictions on high school student tobacco use in the cities of Salem and Attleboro compared to Gloucester, MA. They report that ever and current use of flavoured and non-flavoured or menthol tobacco increased in all three cities from baseline to follow-up, but current use of flavoured and non-flavoured or menthol tobacco was significantly smaller in adopting municipalities.…”

“…They report that ever and current use of flavoured and non-flavoured or menthol tobacco increased in all three cities from baseline to follow-up, but current use of flavoured and non-flavoured or menthol tobacco was significantly smaller in adopting municipalities. They also conducted focus groups where some respondents discussed leaving the county or state to purchase products [ 40 ]. Olsen et al [ 41 ] found similar effects in Minnesota, where any tobacco product use among youths remained flat following the 2016 ban on any flavoured products in Minneapolis and St. Paul but rose in the rest of the state.…”

The impact of two state-level approaches to restricting the sale of flavored tobacco products

“…These reductions stand in stark contrast to the limited decreases observed in New Jersey, where only menthol-flavored e-cigarettes decreased. The differences observed further illustrate the importance of comprehensive flavor laws in the near term that can lead to decreases in youth use one to two years post implementation [ 32 ].…”

Associations between living in localities with e-cigarette sales restrictions and e-cigarette use change among young adults in Los Angeles County

“…To assess the potential impact of ESRs, especially flavoured ESRs, among localities and states, an increased number of research studies were conducted. These studies mainly examined the retail sales data for e-cigarette products9–12 in the localities of interest (or in comparison with similar or adjacent localities) or assessed individuals’ tobacco use behaviour data to examine the change of current or recent e-cigarette use cross-sectionally at one or multiple points in time 13–16. Specifically, studies using e-cigarette retail sales data most consistently found an impact of flavoured ESRs on reducing retail sales of e-cigarette products 9–12.…”

“…Specifically, adult e-cigarette users who also smoke cigarettes may be less likely to be influenced by ESR policies than e-cigarette users who are non-smokers 18 19. Lastly, almost all previous research examining the impact of ESRs or flavoured ESRs was conducted before the COVID-19 pandemic 9–15. Evidence has shown that the pandemic may disrupt local public health policy enforcement20 21 and retailer compliance with local tobacco control measures22 23 as well as change individuals’ tobacco-related consumption and purchasing behaviours 24–26.…”