Impact Analysis of Flavor Restrictions and Tobacco 21 Policies on Youth Tobacco Use
Impact Analysis of Flavor Restrictions and Tobacco 21 Policies on Youth Tobacco Use
Project Summary
Decreasing trends in adolescent tobacco use have been increasingly countered by use of alternative tobacco products, including electronic nicotine delivery systems. In 2019, 32.7% of adolescents used electronic nicotine delivery systems (ENDS) and 6.0% cigarettes, with over 70% using a flavored product. In response to rising rates of use, state and federal governments have begun enacting new policies seeking to interrupt youth transitions into ENDS and other tobacco products, including bans on flavored tobacco products and increased age limits to purchase tobacco products. This study will evaluate the impact of state flavor restrictions and state and federal age 21 tobacco purchasing policies on disparities in tobacco use among youth aged 14-24 years, as well as the role of COVID-19 policies (such as stay at home orders and business closures) which may have altered youth substance use behaviors.
Approach
This project will exploit the natural experiment of state and federal policy shifts over time to rigorously evaluate flavor restrictions and T21 policies on disparities in youth tobacco use. Data will be drawn from the Behavior Risk Factor Surveillance System (BRFSS; N=1,762,447), an annual phone-based survey of health-related behaviors among adults aged 18+ years from all 50 states and DC, and the Youth Risk Behavior Survey (YRBS; N=588,230), a biennial school-based survey of health-related behaviors from 44 states. Probit and zero inflated negative binomial difference-in-differences regression analyses will assess effects of policy shifts on youth use of ENDS, cigarettes, cigars, and smokeless tobacco products.