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Influence of the Flavored Cigarette Ban on Adolescent Tobacco Use

  • Charles J. Courtemanche
    Correspondence
    Address correspondence to: Charles J. Courtemanche, Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Box 3992, Atlanta GA 30302-3992
    Affiliations
    Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia

    National Bureau of Economic Research, Cambridge, Massachusetts

    Institute for the Study of Labor (IZA), Bonn, Germany
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  • Makayla K. Palmer
    Affiliations
    Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
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  • Michael F. Pesko
    Affiliations
    Division of Health Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York
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Published:January 09, 2017DOI:https://doi.org/10.1016/j.amepre.2016.11.019

      Introduction

      This paper estimated the association between the U.S. Food and Drug Administration’s 2009 ban on flavored cigarettes (which did not apply to menthol cigarettes or tobacco products besides cigarettes) and adolescents’ tobacco use.

      Methods

      Regression modeling was used to evaluate tobacco use before and after the ban. The analyses controlled for a quadratic time trend, demographic variables, prices of cigarettes and other tobacco products, and teenage unemployment rate. Data from the 1999–2013 National Youth Tobacco Surveys were collected and analyzed in 2016. The sample included 197,834 middle and high schoolers. Outcomes were past 30–day cigarette use; cigarettes smoked in the past 30 days among smokers; rate of menthol cigarette use among smokers; and past 30–day use of cigars, smokeless tobacco, pipes, any tobacco products besides cigarettes, and any tobacco products including cigarettes.

      Results

      Banning flavored cigarettes was associated with reductions in the probability of being a cigarette smoker (17%, p<0.001) and cigarettes smoked by smokers (58%, p=0.005). However, the ban was positively associated with the use by smokers of menthol cigarettes (45%, p<0.001), cigars (34%, p<0.001), and pipes (55%, p<0.001), implying substitution toward the remaining legal flavored tobacco products. Despite increases in some forms of tobacco, overall there was a 6% (p<0.001) reduction in the probability of using any tobacco.

      Conclusions

      The results suggest the 2009 flavored cigarette ban did achieve its objective of reducing adolescent tobacco use, but effects were likely diminished by the continued availability of menthol cigarettes and other flavored tobacco products.
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      References

      1. CDC. Trends in the prevalence of tobacco use. www.cdc.gov/healthyyouth/yrbs/pdf/trends/us_tobacco_trend_yrbs.pdf. Accessed August 30, 2015.

        • Delnevo C.D.
        Smokers’ choice: what explains the steady growth of cigar use in the U.S.?.
        Public Health Rep. 2006; 121: 116-119
      2. Tobacco Advisory Group of the Royal College of Physicians. Harm reduction in nicotine addiction: helping people who can’t quit. 2007.www.sfata.org/wp-content/uploads/2013/06/Harm-Reduction-in-Nicotine-Addiction.pdf. Accessed October 4, 2015.

        • Manning K.C.
        • Kelly K.J.
        • Comello M.L.
        Flavoured cigarettes, sensation seeking and adolescents’ perceptions of cigarette brands.
        Tob Control. 2009; 18: 459-465https://doi.org/10.1136/tc.2009.029454
        • Carpenter C.M.
        • Wayne G.F.
        • Pauly J.L.
        • Koh H.K.
        • Connolly G.N.
        New cigarette brands with flavors that appeal to youth: tobacco marketing strategies.
        Health Aff (Millwood). 2005; 24: 1601-1610https://doi.org/10.1377/hlthaff.24.6.1601
      3. Food and Drug Administration. Candy and fruit flavored cigarettes now illegal in the United States; step is first under new tobacco law. 2009. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm183211.htm. Accessed August 30, 2015.

      4. Food and Drug Administration. Flavored tobacco product fact sheet. www.fda.gov/syn/html/ucm183198#1. Accessed August 30, 2015.

        • Klein S.M.
        • Giovino G.A.
        • Barker D.C.
        • Tworek C.
        • Cummings K.M.
        • O’Connor R.J.
        Use of flavored cigarettes among older adolescent and adult smokers: United States, 2004–2005.
        Nicotine Tob Res. 2008; 10: 1209-1214https://doi.org/10.1080/14622200802163159
        • Ambrose B.K.
        • Day H.R.
        • Rostron B.
        • et al.
        Flavored tobacco product use among U.S. Youth aged 12-17 years, 2013-2014.
        JAMA. 2015; 314: 1871-1873https://doi.org/10.1001/jama.2015.13802
        • Oliver A.J.
        • Jensen J.A.
        • Vogel R.I.
        • Anderson A.J.
        • Hatsukami D.K.
        Flavored and nonflavored smokeless tobacco products: rate, pattern of use, and effects.
        Nicotine Tob Res. 2013; 15: 88-92https://doi.org/10.1093/ntr/nts093
      5. Food and Drug Administration. Preliminary scientific evaluation of the possible public health effects of menthol versus nonmenthol cigarettes. 2013. www.fda.gov/downloads/UCM361598.pdf. Accessed February 8, 2016.

        • Giovino G.A.
        • Villanti A.C.
        • Mowery P.D.
        • et al.
        Differential trends in cigarette smoking in the USA: Is menthol slowing progress?.
        Tob Control. 2015; 24: 28-37https://doi.org/10.1136/tobaccocontrol-2013-051159
        • Nonnemaker J.
        • Hersey J.
        • Homsi G.
        • Busey A.
        • Allen J.
        • Vallone D.
        Initiation with menthol cigarettes and youth smoking uptake.
        Addiction. 2013; 108: 171-178https://doi.org/10.1111/j.1360-0443.2012.04045.x
        • Smith S.S.
        • Fiore M.C.
        • Baker T.B.
        Smoking cessation in smokers who smoke menthol and non‐menthol cigarettes.
        Addiction. 2014; 109: 2107-2117https://doi.org/10.1111/add.12661
        • Orzechowski W.
        • Walker R.
        The Tax Burden on Tobacco, Historical Compilation. Volume 49. Orzechowski & Walker Consulting, Arlington, VA2014
        • Galyan P.E.
        Truth Tobacco Industry Documents. Confidential memo from Marketing Research Dept. C/C Product Category Identification.(MRD#06e208).
        RJ Reynolds, Winston-Salem, NC1970
        • Dancer-Fitzgerald-Sample, Inc
        Pilot study of CC concepts.
        RJ Reynolds, Winston-Salem, NC1970
        • Cullen J.
        • Mowery P.
        • Delnevo C.
        • et al.
        Seven-year patterns in U.S. cigar use epidemiology among young adults aged 18–25 years: a focus on race/ethnicity and brand.
        Am J Public Health. 2011; 101: 1955-1962https://doi.org/10.2105/AJPH.2011.300209
        • U.S. Government Accountability Office
        Large disparities in rates for smoking products trigger significant market shifts to avoid higher taxes.
        GAO, Washington DC2012
        • Delnevo C.D.
        • Hrywna M.
        “A. Whole ‘Nother Smoke” or a cigarette in disguise: How RJ Reynolds reframed the image of little cigars.
        Am J Public Health. 2007; 97: 1368-1375https://doi.org/10.2105/AJPH.2006.101063
      6. Convenience Store News. CSP Category Management Handbook 2014: Tobacco, cigars. 2014. www.cspnet.com/sites/default/files/magazine-files/Tobacco_Cigars_CMH_2014.pdf.

      7. Federal Trade Commission. Federal Trade Commission report to Congress on cigar sales and advertising and promotional expenditures for calendar years 1996 and 1997. Washington, DC: Federal Trade Commission. www.ftc.gov/system/files/documents/reports/1999-report-cigar-sales-advertising-promotion/1999cigarrepor.pdf. Accessed February 12, 2016.

      8. Bureau of Labor Statistics. Consumer Price Index Frequently Asked Questions. 2016. www.bls.gov/cpi/cpifaq.htm#Question_10. Accessed July 26, 2016.

      9. U.S. DHHS. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: U.S. DHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2012. www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/index.html. Accessed December 5, 2016.

      10. Farley SM, Johns M. New York City flavoured tobacco product sales ban evaluation. Tob Control. In press. Online February 12, 2016.

        • Tauras J.A.
        • Levy D.
        • Chaloupka F.J.
        • et al.
        Menthol and non‐menthol smoking: the impact of prices and smoke‐free air laws.
        Addiction. 2010; 105: 115-123https://doi.org/10.1111/j.1360-0443.2010.03206.x
        • Tauras J.A.
        • Powell L.
        • Chaloupka F.
        • Ross H.
        The demand for smokeless tobacco among male high school students in the United States: The impact of taxes, prices, and policies.
        Appl Econ. 2008; 39: 31-41https://doi.org/10.1080/00036840500427940
        • Dave D.
        • Saffer H.
        Demand for smokeless tobacco: Role of advertising.
        J Health Econ. 2013; 32: 682-697https://doi.org/10.1016/j.jhealeco.2013.03.007