The Behavioral Impact of the Massachusetts Flavored Tobacco Products Ban on Cigarette Smoking Among Adults Aged ≥21 Years

Abstract

Introduction

In June of 2020, Massachusetts became the first state to implement a statewide ban on flavored tobacco. To date, no study has analyzed the behavioral outcomes of a comprehensive statewide ban on flavored tobacco products among representative state samples of adults aged ≥21 years.

Methods

Using a difference-in-difference model from repeated cross-sectional data (Behavioral Risk Factor Surveillance System), the authors compared cigarette smoking prevalence in Massachusetts before (January 2017–May 2020) with that after (June 2020–December 2022) the implementation of a flavor ban, with 35 states serving as a comparison. Sensitivity analyses were conducted to ensure the robustness of the difference-in-difference findings.

Results

There was a consistent decline in smoking prevalence in Massachusetts (14.1% in 2017 to 10.7% in 2022) and comparator states (18.5% in 2017 to 14.8% in 2022). When adjusting for sociodemographic and the year-fixed effect, the analysis indicated significant effects of time (AOR=1.05; 95% CI=1.00, 1.11, p=0.0428) and treatment (AOR=0.89; 95% CI=0.84, 0.95, p=0.0002) but not for the difference-in-difference estimate (AOR=0.94; 95% CI=0.85, 1.03, p=0.1621).

Conclusions

The results indicate that the comprehensive flavor ban in Massachusetts did not significantly impact smoking prevalence relative to that in comparator states without flavor bans.