Population coverage and comprehensiveness of flavoured tobacco sales restrictions in the USA, 2010-2023.

Introduction: Flavoured tobacco products (FTPs) are associated with tobacco initiation and sustained tobacco use. Federal, state and local governments in the USA have enacted policies to restrict FTPs. This paper estimates the percentage of the US population (national and state levels) covered by state and local FTP sales restrictions of different comprehensiveness levels.

Methods: Truth Initiative's FTP sales restrictions database was merged with 2020 Census data. Population coverage estimates were generated for first quarter (Q1) 2010 to Q4 2023. Estimates were subset by product inclusions and policy comprehensiveness (levels 1-6; 6 being most comprehensive).

Results: Population coverage by FTP sales restrictions increased rapidly in 2020. Until 2019, a greater percentage of US residents were covered by FTP sales restrictions for cigars and smokeless tobacco compared with other products. From late 2019 to 2023, population coverage was highest for policies including e-cigarettes. Additionally, coverage by policies of level 2 comprehensiveness was most common due to menthol or key product (ie, cigarettes, smokeless tobacco, cigars and/or e-cigarettes) exemptions. During Q4 2023, 28.0%, 18.6%, 18.3% and 15.7% of US residents were covered by FTP sales restrictions for e-cigarettes, cigars, smokeless tobacco and menthol cigarettes, respectively.

Conclusions: Implementation of FTP sales restrictions rapidly increased from 2019 to 2023, with policies varying in product, flavour and retailer inclusions. During Q4 2023, over one-quarter of US residents were covered by flavour policies; however, coverage by policies in the South and by menthol cigarette policies was limited. These data may be used to longitudinally evaluate the impacts of FTP policies.