A differential analysis of youth smoking and a ban on the sale of flavored tobacco products in San Francisco, California

Restrictions on the sale of flavored tobacco products are becoming increasingly common. Five U.S. states and hundreds of local governments have implemented them in the past few years alone. However, to my knowledge, only one study has examined how electronic nicotine delivery systems and complete flavor bans applied to combustible tobacco products relate to tobacco use without retailer exemptions. In a convenient sample of San Francisco, California residents aged 18 to 34 years who had used tobacco products, tobacco use decreased substantially and combustible tobacco use (smoking) increased slightly and substantially following the city's flavor ban. increased significantly. 18 to 24 years old.1 Without a comparison group, however, it is impossible to ascertain whether existing trends drove these findings.

Friedman AS. Differential analysis of youth smoking and the ban on the sale of flavored tobacco products in San Francisco, California. JAMA Pediatrics. published online May 24, 2021. doi: 10.1001 / jamapediatrics.2021.0922

Commentary

This study showed a smoking rate of 6.2% (95% CI, 5.2%-7.1%) and 5.6% (95% CI, 5.3%-5.9) in an analytic sample of 100,695 minors, with similar trends in San Francisco and other neighborhoods before 2018 when comparing recent smoking rates by wave. The results show that the trend is similar in San Francisco and other districts before 2018. A difference-in-differences analysis showed that San Francisco's flavor ban was associated with more than double the odds of recent smoking among underage high school students, compared to changes that occurred simultaneously in other districts.

Thus, the study found that San Francisco's ban on the sale of flavored tobacco products was associated with increased smoking among underage high school students compared to other school districts, but the policy applied to all tobacco products. Because of the higher use of flavored cigarettes among youth who smoked cigarettes, the results may have been greater among youth who smoked cigarettes than those who did not.

This phenomenon may have raised concerns that reducing access to flavored e-nicotine delivery systems may motivate youth to smoke e-cigarettes instead of smoking, and an analysis of how the minimum legal sales age for e-nicotine delivery systems is associated with youth smoking also suggests such an alternative.

The limitation of this result, however, is its generalizability, and there is still a need to assess whether future estimates will hold over time and in other regions, and to consider how policy heterogeneity might alter the consequences of such a ban.