Perceived difficulty of flavored tobacco purchase: Early effects of a statewide flavor policy among young people.

Introduction: In December 2022, California enacted a policy restricting the sale of flavored tobacco products. This study tested whether perceived difficulty of purchasing flavored tobacco products from retailers changed among youth and young adults following the enactment of California's policy.

Methods: Data were from the Tobacco Epidemic Evaluation Network (TEEN+) study, a probability-based national longitudinal cohort (aged 13-24 years) survey which fielded pre-policy (W1: July-October 2022) and post-policy (W2: March-June 2023). Respondents reported perceived difficulty (0=somewhat/very easy, 1=somewhat/very hard) at both waves. The analysis was restricted to respondents who had ever used tobacco by W1 (California n=527; rest of US n=2,220). Weighted GEE analyses tested for differences in PD at W2 versus W1.

Results: California respondents were significantly more likely to perceive difficulty in purchasing: flavored e-cigarettes (aOR: 2.12, P<0.001); menthol cigarettes (aOR: 2.16, P=0.007); and flavored cigars (aOR: 2.76, P=0.012) at W2 versus W1. Among the rest of US sample, no significant increases in perceived difficulty were observed for any product type at W2 versus W1. At W2, most California respondents perceived flavored products to be easy to purchase (flavored e-cigarettes: 73.8%; menthol cigarettes: 72.9%; flavored cigars: 83.2%).

Conclusions: California youth and young adults who had ever used tobacco were more likely to perceive difficulty in purchasing flavored tobacco products following California's policy, compared to pre-policy. Increases in perceived difficulty were not observed among other US respondents. Nonetheless, most perceive the purchase of flavored tobacco products to be somewhat or very easy following the California policy. Monitoring and enforcement are needed to ensure compliance with the statewide policy.