Flavoured Tobacco Product Restrictions in Massachusetts Associated with Reductions in Adolescent Cig
Monday, March 22, 2021
Posted by: Natalia Gromov
Hawkins
SS, Kruzik C, O'Brien M, et al.
Flavoured Tobacco Product
Restrictions in Massachusetts Associated with Reductions in Adolescent
Cigarette and e-Cigarette Use.
Tobacco Control Published Online First: 27 January 2021. doi:
10.1136/tobaccocontrol-2020-056159
Background.
In the USA, many states do not pre-empt municipalities from enacting stricter
tobacco-control policies than state or federal laws. Several municipalities in
Massachusetts have passed progressive local laws aimed at reducing adolescent
tobacco use. We exploited this variability to examine the associations between
county-level flavoured tobacco product restrictions, tobacco 21 policies and
smoke-free laws prohibiting e-cigarettes with adolescent cigarette and
e-cigarette use in Massachusetts, and to assess whether policy effects varied
by age.
Methods.
We conducted difference-in-differences models to link changes in county-level
tobacco-control policies to changes in adolescents’ use of cigarettes and
e-cigarettes using 2011–2017 biennial Massachusetts Youth Health Surveys.
Results. Counties
with greater implementation of flavoured tobacco product restrictions were
associated with a decrease in the level of cigarette use among users (incidence
rate ratio −1.56; 95% CI −2.54 to −0.58). A significant interaction (p=0.03)
revealed the largest reductions among 14 and 18 year olds. Increasing flavoured
tobacco product restrictions were also associated with reductions in the
likelihood of e-cigarette use (OR −0.87; 95% CI −1.68 to −0.06). Increasing
tobacco 21 restrictions were associated with decreases in cigarette use only
among 18 year olds, while there was no evidence of associations between
smoke-free laws with use of either tobacco product.
Conclusions.
Adolescents in Massachusetts decreased their use of cigarettes and e-cigarettes
in response to local restrictions that limited the sale of flavoured tobacco
products to adult-only retail tobacco stores. Local legislation can reduce
adolescent tobacco use and municipalities should enact stricter tobacco-control
policies when not pre-empted by state law.
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