Local Flavor Policies to Enhance Equity in Tobacco

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ABSTRACT Policies restricting the sale of flavored tobacco products (FTP) are being enacted in localities around the US. We seek to expand the evidence base about the extent to which these policies decrease access to FTPs and exposure to flavored tobacco marketing and would likely reduce use of tobacco among youth and young adults. Additionally, few studies examine the potential of these policies to reduce tobacco-related health disparities among youth/young adult populations of color and those of lower socioeconomic status (SES). These vulnerable populations use flavored products at higher rates and FTPs are heavily marketed in communities where these vulnerable groups live. Determining the impact of FTP policies overall and on populations of color and lower SES youth/young adults in these communities can make sure that policies are structured to ensure equitable reach and reduce tobacco use disparities. The purpose of this study is to determine the impact of flavor policies on reducing exposure to and use of FTPs among vulnerable youth/young adults. Using the Policy Implementation Framework and the Elaboration Likelihood Model as our theoretical guides, we combine national, local and individual data to examine the equity impact of flavor policies around the US. To accomplish the study purpose we will conduct several aims. (1) We will use a longitudinal national dataset of youth and young adults (n=13,892) followed for nine waves twice a year from 2014 to examine changes in tobacco marketing exposure and FTP and non-FTP use in those exposed to an FTP policy with no FTP policy exposure over time, focusing on differences by race/ethnicity and SES. (2) We will compare marketing exposure to and appeal of FTP/non-FTPs between emerging adults in communities covered by flavor policy variants through ecological momentary assessment (EMA), evaluating differences in outcomes by SES and race/ethnicity at the individual and neighborhood level. (3) Finally, among EMA participants, we will assess the predictive validity of exposure to FTP/non-FTP marketing exposure on use of FTP and non-FTPs at 6-month follow-up, and evaluate whether these outcomes are associated with SES and race/ethnicity. For all of these activities, we will partner with national and local FTP policy experts who will disseminate lessons learned to communities who have or are considering an FTP policy. Achieving the aims of this R01 will expand the evidence base of the impacts of FTP policies on reducing tobacco use and potential equity impact of these policies to reduce tobacco, and ultimately cancer disparities.