Despite a general decline in U.S. tobacco use since the 1950s, tobacco use is still prevalent and a significant threat to public health. Previous research has shown that flavored cigarettes largely appeal to and are disproportionately used by underage smokers. Nearly 90% of smokers begin smoking by age 18, according to the U.S. DHHS. To reduce long-term health consequences and improve public health, preventing smoking initiation is key as is reducing the draw of flavored tobacco products. Few longitudinal studies to date have examined the association between flavored tobacco product use and initiation or continuation of tobacco use, and these studies have largely been limited to menthol cigarettes. These studies highlight that menthol brand recognition is associated with smoking experimentation among youth, that adolescents who initiate smoking with menthol cigarettes are more likely to progress to established smoking by the end of 3 years than those who initiated with non-menthol cigarettes, and that prior initiation with a menthol cigarette compared with a non-menthol cigarette is associated with current cigarette smoking at follow-up among young adults.
On September 22, 2009, the U.S. FDA national ban on flavored cigarettes products went into effect. This banned the sale of flavored cigarettes other than menthol, but there was little information about the potential impact of this ban on youth smoking. A new research led by George Mason University College of Health and Human Services found that the flavored cigarette ban was linked to a significant reduction in smoking among youth and young adults. Dr. Matthew Rossheim, assistant professor of global and community health, led the study published in the Journal of Adolescent Health. Researchers found that the flavored cigarette ban reduced smoking among youth (ages 12-17 years) by 43% and young adults (ages 18-25 years) by 27%. Analyses were conducted using 2002-2017 National Survey on Drug Use and Health (NSDUH) data, a sample of 893,226 subjects. This included nationally representative data collected every quarter each year, providing a more sensitive measure to detect changes in smoking behaviors than previous research, as well as an adult comparison group to test whether there was an overall reduction in smoking that could have been a result of other factors.
Rossheim and colleagues did not see a similar reduction in smoking among older smokers, which suggests that this ban was effective at reducing smoking specifically among young people and that the reduction was caused by the ban and not by other influences. Menthol flavor was excluded from the 2009 ban. Prior research has also shown that menthol-flavored tobacco products are disproportionately used by African Americans, which may explain observed health disparities. Dr. Matthew Rossheim, assistant professor of global and community health, commented: “We observed an increase in smoking of menthol cigarettes among youth right after the ban took effect. It appears that young people smoke menthol cigarettes more when other flavor options are no longer available. Our study suggests that the ban of flavored cigarettes was extremely effective at reducing smoking among young people. This shows incredible promise for future comprehensive bans of flavored tobacco products, including those in e-cigarettes, which to-date have received significant exemptions. Policymakers should take note of the evidence from this study and pass legislation to extend flavor bans to other tobacco and nicotine products”.
Rossheim and colleagues suggest that, to maximize their effectiveness among young people and to avoid increasing health disparities among African Americans, flavor bans should include all flavors and tobacco products.
- Edited by Dr. Gianfrancesco Cormaci, PhD; specialist in Clinical Biochemistry.
Rossheim ME et al. J Adolescent Health 2020 Jul 13; S1054.
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