Flavored Tobacco Product Use Among California Adolescents Before and Immediately After a Statewide Flavor Ban.

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In December 2022, a California law banned the retail sale of most flavored tobacco products (including e-cigarettes). This investigation evaluates adolescents' use of flavored tobacco before and after enactment. The Teens Nicotine and Tobacco Project included online surveys of California adolescents (age 12-17) in 2022 (N=5127) and 2023 (N=5015) that assessed past 30-day use of various tobacco products, flavored product use, and perceived access to flavored e-cigarettes. Eight focus groups conducted in 2023 and 2024 (total N=35) queried flavored tobacco experiences and perceptions. Among participants who used specific products, the prevalence of flavored product use declined for cigarettes (2022: 72.0%; 2023: 57.2%), cigars (2022: 87.2%; 2023: 67.4%), and smokeless tobacco (2022: 93.1%; 2023: 83.1%) but not for e-cigarettes (2022: 91.0%; 2023: 90.7%) or hookah (2022: 88.1%; 2023: 85.6%; the flavor law exempted some hookah sales). In 2023, 10.2% of all participants used any flavored tobacco product (2022: 10.0%), primarily flavored e-cigarettes (2022: 8.6%; 2023: 8.8%). In 2023, 22.0% of all participants were aware of the statewide flavor ban, including 44.1% of participants who reported tobacco use. Few focus group participants were aware of the statewide law or perceived difficulties accessing flavored e-cigarettes. Shortly following a statewide flavor ban, adolescent use of flavored cigarettes, cigars, and smokeless tobacco declined, but flavored e-cigarette use was unchanged. More time for implementation and enforcement may be needed to see full policy impact. These finds suggest that a statewide flavored tobacco policy in California was followed shortly by declines in adolescent use of some flavored tobacco products. Additional time for implementation and enforcement, along with potential further actions, such as greater restrictions on online sales, could be necessary to curb youth access to flavored e-cigarettes.