Researchers at the University of California, San Diego found that California’s local ban on flavored tobacco sales was associated with a decrease in youth e-cigarette intake over time, without increasing smoking. The findings were based on an analysis of more than 2.8 million middle school and high school students and were published in the journal April 10, 2026. JAMA Health Forum.
Our findings suggest that local flavored tobacco bans can be an effective strategy to reduce e-cigarette use among youth. Importantly, we found no evidence that these policies led to young people switching to cigarettes, a major concern raised in the policy debate. ”
Eric Ries, Ph.D., MPH, assistant professor at the Herbert Wertheim School of Public Health and Human Geriatric Sciences at the University of California, San Diego, and senior author of this study
Electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes or e-cigarette products, are widely used by adolescents in the United States. National data shows youth e-cigarette use peaked in 2019 with more than a quarter of high school students reporting e-cigarette use, but the prevalence has since declined. Despite this decline, frequent use remains common among current users, raising concerns about nicotine dependence and long-term health risks.
One approach that policymakers have used to reduce e-cigarette smoking among youth is to restrict the sale of flavored tobacco products that include fruit, candy, or mint flavors that appeal to youth users. Previous research has shown that flavored products are a major factor in youth e-cigarette use.
To better understand the impact of these policies, the research team analyzed responses from 2,805,708 students who participated in the California Healthy Kids Study between 2017 and 2022. The survey included 7th, 9th, and 11th grade students and asked about their use of tobacco products in the past month.
The researchers compared tobacco use among students attending schools in areas where flavored tobacco is prohibited with that of students attending schools in areas without such policies. The study used a dynamic difference-in-differences design to account for variations in when different cities adopted bans and tracked how the results changed over time. A dynamic difference-in-differences design approach allowed the researchers to see whether there was a change in youth e-cigarette use after flavored tobacco bans were adopted in different cities, and whether that change increased over several years, rather than just looking at simple before-and-after comparisons.
Youth e-cigarette use rates were lower in areas where flavored tobacco was banned. In areas with a ban, 6.2% of students reported currently using e-cigarettes, compared to 7.7% in areas without a ban. The study found that over time, these policies were associated with sustained declines in vaping among youth.
In contrast, this study found no significant association between flavored tobacco bans and youth smoking. Tobacco use remained roughly the same in areas with and without the policy.
The lag in e-cigarette reductions may reflect how policies evolve and are enforced over time. After initial adoption, many local governments have gradually strengthened their regulations, for example by expanding the definition of flavored products or adding mandatory provisions. Resources and support for enforcing these laws have also increased over time, allowing communities to better enforce regulations, especially after California’s statewide ban went into effect.
California voters approved a statewide ban on the sale of flavored tobacco in 2022, which went into effect in 2023. Researchers say these local policies provide an opportunity to study the long-term effects of flavor bans, as many cities implemented their own restrictions years ago, some starting in 2011.
The authors note that the study focuses on California, which has historically had strong tobacco control policies and relatively low youth smoking rates compared to other states. As a result, the magnitude and timing of effects may differ in locations with different policy environments.
Future research will be needed to understand the long-term effects of statewide bans and how similar policies affect youth tobacco use in different regions and communities.
“Local policies have given us a unique opportunity to understand how flavored tobacco regulations affect youth behavior over time,” said study lead author Giovanni Apollon, MPH, who conducted the study as part of his experiential learning as a doctoral candidate in the joint doctoral program in public health at the University of California, San Diego and San Diego State University. “As more jurisdictions adopt these policies, continued monitoring will help determine how enforcement, policy design, and community context shape public health impacts.”
sauce:
University of California, San Diego
Reference magazines:
Apollon, G. others. (2026). Local flavored tobacco bans and youth use of electronic nicotine delivery systems. JAMA Health Forum. DOI: 10.1001/jamahealthforum.2026.0631. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2847325
