Cigarette Use Before and After the 2009 Flavored Cigarette Ban

Purpose: On September 22, 2009, the U.S. Food and Drug Administration's national ban on flavored cigarette products went into effect, barring the sale of flavored cigarettes with the exception of menthol. Flavored 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. Methods: 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 flavored 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. Results: The flavor 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. Conclusions: Findings support the effectiveness of flavored cigarette bans at reducing cigarette use among young people and suggest a substitution effect between flavored tobacco products.