Restricting flavored tobacco could curb youth use

(Reuters Health) - Policies that restrict flavored tobacco access can reduce teen use in as little as six months, a study in Massachusetts suggests.

Researchers compared two towns 30 miles apart and found that after one community passed a restrictive policy in 2016, flavored tobacco availability and use dropped the next year. There was little change in the other community, according to the results in the American Journal of Preventive Medicine.

“Given recent nationwide increases in youth tobacco use, largely driven by youth e-cigarette use, and the recent emergence of lung disease linked to e-cigarette use and vaping, it is critically important to implement and evaluate strategies to curb youth use,” said lead study author Melody Kingsley of the Massachusetts Department of Public Health in Boston.

Public health experts are trying to find the best tactics to slow youth use of all types of tobacco products, including bans on flavors, which tend to appeal to kids.

“The majority of youth who use tobacco begin with flavored products, which are available in thousands of flavors with youth appeal,” Kingsley told Reuters Health by email. “To date, a few studies have found that flavored tobacco restriction policies reduce sales and availability of flavored tobacco, but to our knowledge, no prior evidence exists on the short-term impact.”

The two towns in the study were Lowell, where a such a policy took effect in October 2016, and Malden, a town without a policy. The two communities have similar demographics, retailer characteristics and point-of-sale tobacco policies.

The researchers analyzed the inventories of tobacco stores and surveyed more than 500 high school students in both places. About six months later, they surveyed students again and measured inventories of flavored cigars, cigarillos, hookah, smokeless tobacco and e-cigarettes.

The researchers found that availability of flavored tobacco products plummeted in Lowell, from 77% of retailers to 7%. No changes occurred in Malden.

Among teen current- and ever-users of tobacco products, use of both flavored and non-flavored tobacco decreased in Lowell - by 5.7% for flavored tobacco and 6.2% for non-flavored tobacco – while it increased slightly in Malden.

“Even though the flavored tobacco restriction did not directly impact availability of non-flavored tobacco, these findings may be due in part to changes in social norms around use of all tobacco products,” Kingsley said. “It is encouraging to see that these changes can happen very quickly after policy implementation.”

Her team is interested in the long-term impact of these policies, including the age when teens start using tobacco. Some Massachusetts towns have also started to include menthol in their list of banned products, since the marketing of menthol-flavored tobacco has historically targeted people of color, low-income communities and LGBTQ individuals, she said.

“We expect that flavored tobacco restrictions that include menthol will have an even greater impact on youth tobacco use,” she said.

Researchers also want to know other factors that may influence policy, such as enforcement. Retail compliance in this case was high, and Massachusetts is known for strict tobacco enforcement and education efforts, said Melissa Harrell of the University of Texas School of Public Health in Austin, who wasn’t involved in the study.

“Some of the results are a bit ‘perplexing’ to me,” she told Reuters Health by email. “Lowell consistently showed reductions in tobacco use across almost every measure.”

These may not be due to the ban alone, particularly in such a short period, Harrell noted. Other efforts around the same time, such as news coverage or education programs at the schools, could have influenced the changes, she said, which is an important area for future research.

SOURCE: American Journal of Preventive Medicine, online October 24, 2019.