Flavoured cigarette ban significantly reduced youth smoking – Study

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A study by George Mason University, just published in the Journal of Adolescent Health, has found that the 2009 ban of flavoured cigarettes in the United States reduced smoking by underage youth by 43% and young adults by 27%.

Despite a general decline in US tobacco use since the 1950’s, tobacco use is still prevalent and a significant threat to public health, writes Danielle Hawkins in a 15 July 2020 article for the university. Previous research has shown that flavoured cigarettes largely appeal to and are disproportionately used by underage smokers.

Nearly 90% of smokers begin smoking by age 18, according to the US Department of Health and Human Services. To reduce long-term health consequences and improve public health, preventing smoking initiation is key as is reducing the draw of flavoured tobacco products.

On 22 September 2009, the US Food and Drug Administration’s national ban on flavoured cigarettes products went into effect. This banned the sale of flavoured cigarettes other than menthol, but there was little information about the potential impact of this ban on youth smoking.

The new research led by Dr Matthew Rossheim, assistant professor of global and community health in George Mason University’s College of Health and Human Services.

Researchers found that the flavoured cigarette ban reduced smoking among youth (ages 12-17 years) by 43% and young adults (ages 18-25 years) by 27%.

“Our study suggests that the ban of flavoured cigarettes was extremely effective at reducing smoking among young people,” explains Rossheim. “This shows incredible promise for future comprehensive bans of flavoured tobacco products, including those in e-cigarettes, which to-date have received significant exemptions.

“Policy-makers should take note of the evidence from this study and pass legislation to extend flavour bans to other tobacco and nicotine products.”

Rossheim and colleagues examined cigarette use among young people and adults from the 2002-2017 National Survey on Drug Use and Health data. This included nationally representative data collected every quarter each year, providing a more sensitive measure to detect changes in smoking behaviours than previous research, as well as an adult comparison group to test whether there was an overall reduction in smoking that could have been a result of other factors.

Rossheim and colleagues did not see a similar reduction in smoking among older smokers, which suggests that this ban was effective at reducing smoking specifically among young people and that the reduction was caused by the ban and not by other influences.

“We observed an increase in smoking of menthol cigarettes among youth right after the ban took effect,” adds Rossheim. “It appears that young people smoke menthol cigarettes more when other flavour options are no longer available.”

Menthol flavour was excluded from the 2009 ban. Prior research has also shown that menthol-flavoured tobacco products are disproportionately used by African Americans, which may explain observed health disparities.

Rossheim and colleagues suggest that, to maximise their effectiveness among young people and to avoid increasing health disparities among African Americans, flavour bans should include all flavours and tobacco products.


Cigarette Use Before and After the 2009 Flavored Cigarette Ban

Journal of Adolescent Health. Published 13 July 2020


Matthew E Rossheim, Melvin D Livingston, Jenna R Krall, Dennis L Thombs, Kayla K McDonald and Gilbert W Gimm.


On 22 September 2009, the US Food and Drug Administration’s national ban on flavoured cigarette products went into effect, barring the sale of flavoured cigarettes with the exception of menthol. Flavoured cigarettes largely appeal to and were disproportionately used by youth (under age 18 years).

However, little research has evaluated the effects of the ban. This study examined past 30-day cigarette use among youth (12–17 years), young adults (18–25 years), adults (26–49 years), and older adults (≥50 years) before and after the implementation of this ban.


Analyses were conducted using 2002–2017 National Survey on Drug Use and Health (NSDUH) data ( n = 893,226). Regression models – weighted for national representation – were used to examine past 30-day cigarette use before and after the flavoured cigarette ban in different age groups, using a quasi-experimental design incorporating elements of interrupted time series and difference-in-differences design.

This design was used to examine differences in pre- versus post-ban smoking within age groups and heterogeneous policy effects between age groups, to help adjust for the generally stronger tobacco control environment over time.


The flavour ban was associated with statistically significant immediate increases as well as reductions over time in youth and young adult use of any cigarettes and menthol cigarettes, compared to older adults.

In 2017, the predicted probability of youth and young adult cigarette smoking were reduced by 43% and 27%, respectively, compared to the model predicted probability in absence of the ban. No such effect was observed for older adults. The predicted probability of menthol use was reduced by 60% and 55% for youth and young adults, respectively.


Findings support the effectiveness of flavoured cigarette bans at reducing cigarette use among young people and suggest a substitution effect between flavoured tobacco products.


Flavored Cigarette Ban Significantly Reduced Youth Smoking, New Study Finds


Cigarette Use Before and After the 2009 Flavored Cigarette Ban

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