TCORS: Center for the Assessment of Tobacco Regulations (CAsToR)

Research Project 3: Assessing the Impact of Flavor Restrictions on Smoking and Vaping​

While hundreds of US localities and at least 7 states have restricted sales of flavored electronic nicotine delivery systems (ENDS), evidence on such measures’ effects is mixed, with some studies linking them to increases in combustible cigarette use (“smoking”). To clarify these policies’ immediate impacts and model longer run effects on behaviors, health outcomes, and disparities, nationally generalizable estimates of their effects on cigarette, cigar, and ENDS use are needed. To this end, Project 3 will use quasi-experimental research designs—methods designed to produce causal estimates in the absence of randomized assignment—to estimate state and local ENDS flavor restrictions’ effects on cigarette, cigar, and ENDS use in nationally representative survey data; test for variations in responses to flavor restrictions by urbanicity and socioeconomic status (SES), and estimate implications for both urban-rural and SES disparities in smoking and vaping; assess how flavor restrictions’ effects differ between localities with more vs. less restrictive tobacco control policy environments; and use results to estimate implications for the effectiveness of a federal flavor ban, given observed variation in local policies. To further aid FDA in evaluating new policies’ effects, retail sales data analyses will provide rapid assessments of new federal flavor regulations’ relationships to tobacco/nicotine product sales and consider associations with sales of newer non-nicotine flavoring products in order to understand if/how their availability modifies flavor laws’ effects. Beyond clarifying ENDS flavor restrictions’ effects on youth and adult cigarette, cigar, and ENDS use, our findings will provide key parameters to inform CAsToR’s modeling of flavor restrictions’ long-term public health impacts, in order to aid CTP in assessing the impact of FDA flavor policies.

Aims

  • Aim 1 will estimate ENDS flavor restrictions’ effects on youth and adult smoking and vaping.
  • Aim 2 will then test whether responses to flavor restrictions vary across urban vs. rural jurisdictions; assess the extent to which this might be explained by geographic factors vs. differences in resident characteristics (e.g., SES); and, estimate implications for both urban-rural and SES disparities in smoking and vaping.
  • Aim 3 will assess how flavor restrictions’ effects differ between localities with more vs. less restrictive tobacco control policy environments.
  • Aim 4 will use retail sales data to provide rapid analyses of new federal flavor regulations’ relationships to tobacco/nicotine product sales.

Leads

  • Abigail Friedman, PhD
    Abigail Friedman, PhD
    Yale University
    Abigail Friedman, PhD
    Yale University: Associate Professor of Health Policy
    Position: Research Project 3
    Dr. Abigail Friedman is Co-Investigator of Project 3 and co-PI of the Yale CAsToR site. An Associate Professor of Health Policy at the Yale School of Public Health and a faculty affiliate of the Yale Program in Addiction Medicine, she is a health economist by training, with interests focused on the policy determinants of nicotine and tobacco use. Her research applies quasi-experimental research designs to estimate state and local policies’ effects on these behaviors and disparities therein, in order to inform policymaking to improve public health and health equity. Her recent work includes papers estimating the effects of e-cigarette taxes, smoke- and vape-free worksites laws, flavor restrictions, and tobacco-21 laws on conventional and electronic cigarette use among youth and young adults.
  • David Levy, PhD
    David Levy, PhD
    Georgetown University
    David Levy, PhD
    Georgetown University: Professor, Georgetown University Medical Center
    Positions: Administrative (ADMIN) Core; CAsToR Principal Investigator; Research Project 1; Research Project 3
    Dr. David Levy is PI for CAsToR at Georgetown University. Dr. Levy received his PhD in Economics from UCLA (USA), and is currently a Professor of Oncology at Georgetown University. He has published over 250 articles, in renowned journals such as the American Economic Review, BMJ, AJPH, JAMA, The Lancet, Tobacco Control, and PLOS Medicine. He has been principal investigator of grants from the CDC, WHO, the National Cancer Institute, and Bloomberg/Gates Foundation. Dr. Levy currently oversees the design and development of the SimSmoke tobacco policy simulation model, for which he has developed models for over 40 countries covering 85% of the world’s population, and has recently developed models of smokeless tobacco and e-cigarette use. In addition to being a principal investigator on the TCORS grant, he is currently a principal investor on a National Cancer Institute grant with the International Tobacco Control Policy Evaluation Project (the ITC Project) in which he has developed models of e-cigarette use for Canada, England and France; and is a principal investigator on the National Cancer Institute CISNET Lung Group. He has recently published articles providing a public health framework for evaluating e-cigarettes and showing the potential benefits of e-cigarettes, as well as papers on the cigarette and e-cigarette markets.