key: cord-0966829-5pqs2czh
authors: Ali, Fatma Romeh M.; Vallone, Donna; Seaman, Elizabeth L.; Cordova, Jamie; Diaz, Megan C.; Tynan, Michael A.; Trivers, Katrina F.; King, Brian A.
title: Evaluation of Statewide Restrictions on Flavored e-Cigarette Sales in the US From 2014 to 2020
date: 2022-02-10
journal: JAMA Netw Open
DOI: 10.1001/jamanetworkopen.2021.47813
sha: 5cdd02d1d3cba268abc7ac07f66798e324345b67
doc_id: 966829
cord_uid: 5pqs2czh

IMPORTANCE: e-Cigarettes are the most commonly used tobacco product among US youths. Flavors are among the most cited reasons for use of e-cigarettes among youths, and therefore, some states have imposed restrictions on flavored e-cigarette sales. To our knowledge, no study has compared e-cigarette sales between states with statewide flavored e-cigarette restrictions and states without such restrictions while controlling for co-occurring events. OBJECTIVE: To assess whether implementation of statewide restrictions on flavored e-cigarette sales in Massachusetts, New York, Rhode Island, and Washington was associated with a reduction in total e-cigarette unit sales from 2014 to 2020. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study with difference-in-differences analysis used e-cigarette retail sales data from Massachusetts, Rhode Island, and Washington, which implemented restrictions on flavored e-cigarette sales in October 2019; New York, which implemented these restrictions in May 2020; and 35 states without these restrictions (control states). Sales were summed into 4-week periods from August 24, 2014, to December 27, 2020, for a total of 2988 state-period observations. MAIN OUTCOMES AND MEASURES: A difference-in-differences analysis was conducted to compare e-cigarette unit sales in the 4 states with flavor restrictions (before and after implementation) with those in the 35 control states. The model controlled for other population-based policies and emergent events (eg, the COVID-19 pandemic). Data on 4-week e-cigarette unit sales were sorted into 4 flavor categories (tobacco, menthol, mint, and other). Unit sales were standardized to reflect the most common package sizes for each product type. RESULTS: Statewide restrictions on non–tobacco-flavored e-cigarette sales were associated with the following reductions in mean 4-week total e-cigarette sales in intervention states compared with control states from October 2019 to December 2020: 30.65% (95% CI, 24.08%-36.66%) in New York, 31.26% (95% CI, 11.94%-46.34%) in Rhode Island, and 25.01% (95% CI, 18.43%-31.05%) in Washington. In Massachusetts, the comprehensive sales prohibition of all e-cigarette products was associated with a 94.38% (95% CI, 93.37%-95.23%) reduction in 4-week sales compared with control states. Except in Massachusetts, where all sales of flavored e-cigarettes decreased, reductions were found only for non–tobacco-flavored e-cigarette sales in the other states with restrictions. Among control states, mean sales decreased by 28.4% from August 2019 to February 2020 but then increased by 49.9% from February through December 2020. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, statewide restrictions on the sale of flavored e-cigarettes in Massachusetts, New York, Rhode Island, and Washington were associated with a reduction in total e-cigarette sales. These findings suggest that not all e-cigarette users who purchased non–tobacco-flavored e-cigarettes switched to purchasing tobacco-flavored e-cigarettes after policy implementation.

1-9 cases 0.24 (0 to 1) 0.24 (0 to 1) 0.24 (0 to 1) 0.24 (0 to 1) 0.05 ( 200-249 cases 0 0 0 0 0.01 (0 to 1) a This variable represents the percentage of state population covered by comprehensive smoke-free air (SFA) laws (bars, restaurants, and workplaces) b This variable represents state laws restricting tobacco product sales to persons under 21 c This variable represents tobacco control funding as a percentage of CDC recommended funding level. d This variable represents mean inflation-adjusted after-tax e-cigarette price per standardized unit. This variable was constructed by dividing after-tax total dollar sales by total standardized unit sales for each UPC product, and adjusting for inflation and averaging across all UPC products in each state in each period. 

Rhode Island Flavored E-cigarette Prohibition

Dependent variables were 4-week log per capita of e-cigarette unit sales in each state. Each DID model controlled for state fixed effects, 4-week period fixed effects, logarithm of mean real (after tax) price per standardized unit, unit sales share of menthol cigarettes, state characteristics (population by race/ethnicity and age group, median annual household income, and monthly state unemployment rates), state tobacco control policies (percentage of state population covered by comprehensive smoke-free laws, Tobacco 21 laws, state tobacco control program funding per capita, and state cigarette tax)

Wyoming), excluding the bordering states; for Massachusetts