Measuring the Public Health Impact of State-Level Flavored Tobacco Bans on Youth and Adult Tobacco Use

项目总结。马萨诸塞州是全国第一个限制所有口味食品零售的州 包括电子烟、可燃和无烟烟草在内的烟草产品向21家及以上烟店出售。 新的MA法提供了一个有时间限制的机会，可以获得关于以下项目最初影响的基线信息 关于青少年和成年人烟草使用和成年人戒烟尝试的法律在该法实施后。它也是 在此期间检查在全州范围内实施法律条款的障碍和促进者至关重要 最初的时期。从这项研究中获得的知识将提供急需的和时间敏感的证据 将额外限制的好处或意外影响告知其他州。我们的长期目标是 防止青少年使用各种形式的烟草产品，并协助青少年和成年烟草使用者提供证据-- 以戒烟为主的治疗。这项研究的目的是评估新MA法的初步影响 青少年和成人烟草使用行为和成人戒烟尝试的对比研究 与新英格兰相邻的州，并确定障碍和协调者在 贯彻实施并购管理法。我们的科学理论基础是综合执行和调解 烟草控制政策的模式。我们将获得烟草使用和戒烟尝试的法律前数据(2019年青年 风险行为调查和行为风险因素监测系统)，并通过 每月对13-17岁青年(n=1800)和成人当前烟草进行重复横断面在线调查 18岁以上的用户(n=1800)。使用准实验设计，我们将执行倾向得分差异-在- 差异(DID)分析，以估计法律实施前和法律实施后研究结果的变化 MA和4种控制状态(NH、VT、RI和CT)。我们将检查法律出台后的月度研究结果趋势 在MA和4个对照状态下。我们将对MA(学区)的32个利益相关者进行关键线人访谈 主管、校长、保健提供者、卫生部门官员、烟草零售商)以评估 新法律实施的促进者和障碍。我们的具体目标是：1)评估法律实施前和实施后的情况 与4个对照组相比，MA组青少年和成人烟草制品的使用和成人戒烟尝试的变化 国家(NH、VT、RI和CT)，2)审查青少年和成年人使用烟草产品的法律后趋势，并 成人在MA和4种控制状态(NH、VT、RI和CT)下的戒烟尝试，3)确定策略实施 并购中关键利益相关者之间的促进者和障碍。影响：这项研究将提供对时间敏感的数据 评估新MA法对烟草使用和戒烟尝试的初步影响，与限制较少的尝试相比 控制新英格兰各州的政策。研究结果将有助于实施循证医学 各州的烟草控制法规，以防止青少年吸烟并减少对人口健康的危害 烟草使用。

PROJECT SUMMARY. Massachusettsis the first state inthe nation to restrict retail sales of all flavored tobacco products including e-cigarettes, combustible and smokeless tobacco to 21-and over smoke shops. The new MA law presents a time-limited opportunity to obtain baseline information on the initial impacts of the law on youth and adults' tobacco use and adults' quit attempts following the law's implementation. It is also critical to examine barriers and facilitators of implementing the law's provisions across the state during this initial period. Knowledge gained from this research would provide much needed and time-sensitive evidence to inform other states on the benefits or unintended effects of additional restrictions. Our long-term goals are to prevent all forms of tobacco product use among youth and assist youth and adult tobacco users with evidence- based cessation treatments. The objectives of this study are to estimate the initial impacts of the new MA law on tobacco use behaviors among youth and adults and quit attempts among adults in MA compared with four adjacent New England states and to identify the barriers and facilitators during the initial period of implementing the MA law. Our scientific rationale is based on the Integrated Implementation and Mediation Model of Tobacco Control Policy. We will obtain pre-law data of tobacco use and quit attempts (2019 Youth Risk Behavioral Survey and Behavioral Risk Factor Surveillance System) and collect post-law data through monthly repeated cross-sectional online surveys among youth ages 13-17 (n=1800) and adult current tobacco users ages 18+ (n=1800). Using a quasi-experimental design, we will perform propensity score difference-in- differences (DID) analyses to estimate changes in the study outcomes pre- and post-law among participants in MA and 4 control states (NH, VT, RI, and CT). We will examine the post-law monthly trends in study outcomes in MA and 4 control states. We will conduct key informant interviews with 32 stakeholders in MA (school district superintendents, principals, health providers, health department officials, tobacco retailers) to assess facilitators and barriers of implementing the new law. Our specific aims are: 1) Estimate the pre- and post-law changes in youth and adult use of tobacco products and adult quit attempts in MA compared with 4 control states (NH, VT, RI, and CT), 2) Examine the post-law trends in youth and adult use of tobacco products and adult quit attempts in MA and 4 control states (NH, VT, RI, and CT), 3) Identify policy implementation facilitators and barriers among key stakeholders in MA. Impact: This study will provide time-sensitive data to evaluate the initial impacts of the new MA law on tobacco use and quit attempts compared with less restrictive policies in control states in New England. The study findings will aid in implementing evidence-informed tobacco control regulations in states to prevent youth tobacco use and reduce the population health harms of tobacco use.