Impact Analysis of Flavor Restrictions and Tobacco 21 Policies on Youth Tobacco Use

项目摘要 青少年吸烟减少的趋势越来越多地被替代烟草的使用所抵消。 烟草制品. 2019年，32.7%的青少年使用电子尼古丁输送系统（ENDS），6.0%的青少年使用电子尼古丁输送系统（ENDS）。 香烟，超过70%使用调味产品。随着越来越多的证据表明， 从ENDS到香烟和长期烟草使用，需要创新政策。最近，7个国家 颁布了调味烟草产品的禁令。16个州和DC颁布了全州范围的烟草21（T21） 在2019年12月通过联邦T21法律之前的政策。然而，没有对下列项目进行评价： 全州范围内的口味限制或联邦T21法律对青少年烟草使用的整体或使用的差异。 这项研究的首要目标是研究州风味限制的影响， 联邦T21关于14 - 24岁青少年烟草使用差异的政策。行为风险因素 监测系统（BRFSS），一项针对老年人健康相关行为的年度电话调查 来自所有50个州和DC的18年以上，在2016年引入了关于ENDS的问题。青少年危险行为调查 （YRBS）是一项两年一度的基于学校的健康相关行为调查，来自44个州， 2015年结束。各州烟草控制政策的差异创造了一个自然的实验，使我们能够 使用这些具有代表性的数据集评估其效果。 该项目有三个具体目标。在目标1中，我们将评估风味限制和T21的影响 各年龄段（18 - 20岁与21 - 24岁）的烟草使用政策（香烟、ENDS、无烟烟草） 以及研究两种烟草政策对烟草使用的不同影响 在社会人口阶层中。在目标2中，我们将评估风味限制和T21政策对 各年龄段的烟草使用（香烟、ENDS、无烟烟草、雪茄）（14 - 17岁与18岁） 在YRBS中，并研究两种烟草政策对社会各阶层烟草使用的不同影响， 人口阶层在此背景下，2020年3月中旬，新冠肺炎疫情被宣布为全国紧急状态 各州也发布了一系列政策，包括关闭非必要企业和留在 家里的命令。虽然2019年至2020年青少年烟草使用的减少可能是由于 尽管最近颁布了烟草控制政策，但这些政策尚未得到正式评估。在目标3中，我们将研究 Covid-19各州关闭和重新开放对整体、年龄和社会烟草使用的进一步影响 人口阶层，除了口味限制和T21政策。 我们建议进行影响分析，严格评估风味限制和T21政策， 青年烟草使用的差异。这项研究的目标是为FDA中心的政策提供信息， 烟草制品监管当局有关青少年烟草使用以及减轻烟草负担 以及青年中与烟草相关的健康差异。

Project Summary Decreasing trends in adolescent tobacco use have been increasingly countered by use of alternative tobacco products. In 2019, 32.7% of adolescents used electronic nicotine delivery systems (ENDS) and 6.0% cigarettes, with over 70% using a flavored product. As evidence mounts on the increased risk of transitioning from ENDS to cigarettes and longer-term tobacco use, innovative policies are needed. Recently, 7 states have enacted bans on flavored tobacco products. Sixteen states and DC enacted state-wide tobacco 21 (T21) policies prior to passage of the federal T21 law in Dec 2019. However, there have been no evaluations of state-wide flavor restrictions or the federal T21 law on adolescent tobacco use overall nor on disparities in use. The overarching goals of the study are to examine the impact of state flavor restrictions and state and federal T21 policies on disparities in tobacco use among youth aged 14-24 years. The Behavior Risk Factor Surveillance System (BRFSS), an annual phone-based survey of health-related behaviors among adults aged 18+ years from all 50 states and DC, introduced questions on ENDS in 2016. The Youth Risk Behavior Survey (YRBS), a biennial school-based survey of health-related behaviors from 44 states, introduced questions on ENDS in 2015. Differences in state tobacco control policies create a natural experiment, allowing us to evaluate their effects using these representative datasets. This project has three Specific Aims. In Aim 1, we will evaluate the impact of flavor restrictions and T21 policies on tobacco use (cigarettes, ENDS, smokeless tobacco) across age (18-20-year-olds versus 21-24- year-olds) in the BRFSS as well as examine the differential impact of both tobacco policies on tobacco use across socio-demographic strata. In Aim 2, we will evaluate the impact of flavor restrictions and T21 policies on tobacco use (cigarettes, ENDS, smokeless tobacco, cigars) across age (14-17-year-olds versus 18-year-olds) in the YRBS as well as examine the differential impact of both tobacco policies on tobacco use across socio- demographic strata. Against this backdrop, Covid-19 was declared a national emergency in mid-March 2020 and states have issued a patchwork of policies, including closure of non-essential businesses and stay-at- home orders. While the decrease in adolescent tobacco use from 2019 to 2020 may be attributable to the enactment of recent tobacco control policies, they have not been formally evaluated. In Aim 3, we will examine the further impact of Covid-19 state closures and re-openings on tobacco use overall, by age and across socio- demographic strata, in addition to flavor restrictions and T21 policies. We propose to conduct an impact analysis that rigorously evaluates flavor restrictions and T21 policies on disparities in youth tobacco use. The goals of this research will be to inform policies within the FDA’s Center for Tobacco Products regulatory authority related to youth tobacco use as well as to reduce the burden of tobacco and tobacco-related health disparities among youth.