Stronger flavor policies, better outcomes for young people: comparing youth and young adult tobacco use behaviors in areas with and without flavored tobacco sales restrictions, by strength of policy, 2022

Although numerous US jurisdictions restrict the sale of flavored tobacco products, the comprehensiveness of policies varies greatly. This study assesses differences in tobacco product use and flavored tobacco use among youth and young adults residing in areas with and without flavored tobacco restriction policies other than federal-level restrictions, by strength of policy. Cross-sectional data come from Wave 1 (October 2022) of the nationally representative Tobacco Epidemic Evaluation Network (TEEN+) Study of US youth and young adults (N = 10 255). Respondents' latitude and longitude were used to assign flavor policy coverage as no policy (80.9%), partial policy (major exemptions, 11.1%), or strong policy (minor/no exemptions, 8.0%). Policy coverage varied by several demographic characteristics, including race and ethnicity (P < .001), household smoking (P < .01), and household e-cigarette exposure (P < .01). Compared with living in an area with no flavor policy, a lower prevalence of any tobacco product use (aPR = 0.76, P < .001) and a lower prevalence of any flavored tobacco product use (aPR = 0.70, P < .001) were observed for those covered by strong flavor policies in multivariable Poisson regressions, adjusting for other individual- and state-level covariates. Living in an area with a partial flavor restriction was not significantly associated with different prevalence of either outcome in adjusted models compared with living in an area with no flavor policy. However, currently only 1 in 12 young people are protected by strong flavored tobacco sales restrictions, with notable gaps by race and ethnicity. Strong flavored tobacco sales restrictions that protect everyone, everywhere might help accelerate declines in youth and young adult tobacco use.