BACKGROUND: Since 2019, the Monitoring Tobacco Product Use Among Youth and Young Adults project has generated scientifically-defensible and rapidly-available data to assess e-cigarette flavor restrictions in the United States, with a specific focus on youth and young adults. This project provides vital information on policies implemented at the federal, state and local levels using multiple data sources.
METHODS: E-cigarette retail sales data (Multi Outlet + Convenience) from January 2020 through the duration of the project are licensed from Circana, LLC. E-cigarettes are investigated at the UPC-level and analyzed by flavor and product type using supplemental coding through internet searches. The Tobacco Epidemic Evaluation Network Study (TEEN+) Study, a longitudinal cohort of youth and young adults in the U.S. and California, has fielded semiannually since 2022. TEEN+ utilizes address-based sampling to invite 13-to-24-year-olds to complete an online survey of tobacco use and related behaviors.
RESULTS: Retail sales trends provide sentinel signals for new types and classes of products: flavors and devices intended to circumvent policy restrictions, high-capacity e-cigarettes, smart vapes and nicotine analogues. Given the rapidly changing policy and product landscape, nationally-representative, longitudinal data are imperative to understanding within-person behavior change over time. TEEN+ yields insights into new and emerging tobacco products and patterns of use among young people. For example, TEEN+ analyses illustrate that young people who are protected by strong flavor restriction policies have lower prevalence of tobacco use compared to those not covered by a policy.
CONCLUSIONS: Lessons learned from this project help inform global tobacco control. This U.S. case study highlights the tobacco industry’s strategies and how they’ve adapted to a changing policy landscape by developing different products and flavors designed to entice youth and evade regulation. Other countries can use findings to plan policy interventions and ensure they keep pace with the tobacco industry and protect community health.