Friedman Abigail S, Pesko Michael F, Whitacre Travis R
Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
Department of Economics, University of Missouri, Columbia.
JAMA Health Forum. 2024 Dec 6;5(12):e244594. doi: 10.1001/jamahealthforum.2024.4594.
More than one-quarter of US residents live in states or localities that restrict sales of flavored electronic nicotine delivery systems (ENDS), often as a means to reduce youth vaping. Yet, how these policies affect young adult vaping and smoking remains unclear.
To estimate the effects of ENDS flavor restrictions on ENDS use and cigarette smoking among young adults (age 18-29 years) in the US.
DESIGN, PARTICIPANTS, AND SETTING: This quasi-experimental analysis used annual survey data from the 2016 to 2023 Behavioral Risk Factor Surveillance System (BRFSS), a series of nationally- and state-representative, repeated cross-sectional surveys of noninstitutionalized civilian adults in the US. Two-way fixed-effects specifications were estimated to assess how ENDS flavor restrictions affect young adults' use of ENDS and cigarettes. Analyses were adjusted for potential confounders including concurrent tobacco control policies, respondent demographic characteristics, and socioeconomic factors. Data analyses were conducted in November 2023 and repeated in October 2024 to incorporate newly released 2023 survey data.
Current and daily use of ENDS and of cigarettes as measured in the BRFSS.
Balanced panel analyses of 242 154 individuals aged 18 to 29 years consistently found that state ENDS flavor restrictions were associated with statistically significant reductions in daily vaping and increases in daily cigarette smoking. Estimates were similar across robustness checks, with the main specification showing 3.6 (95% CI, -5.0 to -2.1) percentage point (ppt) reductions in daily vaping and 2.2 ppt increases in daily cigarette smoking (95% CI, 1.0 to 3.4) relative to changes in states without restrictions. These estimates are equivalent to an 80% reduction in daily vaping and 22% increase in daily smoking compared with 2018 mean rates.
The findings of this quasi-experimental analysis of BRFSS survey data indicate that state restrictions on flavored ENDS sales were associated with reduced vaping among young adults but may have unintentionally increased cigarette smoking, potentially offsetting public health gains. These findings suggest that alleviating the burden of tobacco-related disease will require regulatory strategies that balance reducing vaping with preventing increases in more lethal, combustible tobacco use.
超过四分之一的美国居民生活在限制调味电子尼古丁传送系统（ENDS）销售的州或地区，这通常是减少青少年电子烟使用的一种手段。然而，这些政策如何影响年轻成年人的电子烟使用和吸烟情况仍不清楚。
评估ENDS口味限制对美国年轻成年人（18至29岁）使用ENDS和吸烟的影响。
设计、参与者和背景：这项准实验分析使用了2016年至2023年行为风险因素监测系统（BRFSS）的年度调查数据，该系统是一系列针对美国非机构化平民成年人的全国性和州代表性重复横断面调查。估计双向固定效应模型以评估ENDS口味限制如何影响年轻成年人对ENDS和香烟的使用。分析针对潜在混杂因素进行了调整，包括同期烟草控制政策、受访者人口特征和社会经济因素。数据分析于2023年11月进行，并于2024年10月重复进行，以纳入新发布的2023年调查数据。
BRFSS中测量的ENDS和香烟的当前使用情况及每日使用情况。
对242154名18至29岁个体的平衡面板分析一致发现，州ENDS口味限制与每日电子烟使用的统计学显著减少以及每日吸烟的增加相关。在稳健性检验中估计结果相似，主要模型显示，相对于无限制州的变化，每日电子烟使用减少3.6个百分点（95%CI，-5.0至-2.1），每日吸烟增加2.2个百分点（95%CI，1.0至3.4）。与2018年平均水平相比，这些估计相当于每日电子烟使用减少80%，每日吸烟增加22%。
这项对BRFSS调查数据的准实验分析结果表明，州对调味ENDS销售的限制与年轻成年人电子烟使用减少相关，但可能无意中增加了吸烟，可能抵消了公共卫生方面的收益。这些发现表明，减轻烟草相关疾病的负担将需要监管策略，以平衡减少电子烟使用与防止更致命的可燃烟草使用增加之间的关系。
