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Flavored tobacco initiation among youth and young adults

Institution: University of California, San Francisco
Investigator(s): Shannon Watkins, Ph.D.
Award Cycle: 2019 (Cycle 28) Grant #: 28FT-0016 Award: $62,243
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Postdoctoral Fellowship Awards

Initial Award Abstract

Tobacco products such as e-cigarettes and hookah are sold in thousands of flavors, which hide the harsh taste of tobacco and associate tobacco products with candy. In California, although the overall prevalence of cigarette smoking has continued to decline, use of e-cigarettes and other often-flavored products has increased. Disparities in tobacco use persist, in part due to high prevalence of menthol cigarette use among racial and ethnic minority smokers. In light of these patterns, the California Medical Association has noted that flavored tobacco may threaten the progress achieved by tobacco control in the state.

While evidence is strong that young tobacco users use flavors more than older tobacco users and disparities exist in menthol cigarette use, less is known about the profile of young flavored tobacco users across products, and whether and to what extent flavors lead young people to try tobacco and become an established user. Across California, local governments are proposing and adopting “flavor bans” of all flavored tobacco products including menthol cigarettes. The impact of California flavor bans depends on how much flavors encourage tobacco use progression and relieve or worsen disparities. Accordingly, this project has two research goals: (1) identify sociodemographic, environmental, and behavioral characteristics that are associated with flavored tobacco initiation of youth and young adults, and (2) determine whether and to what extent initiation of tobacco use with a flavored product is related to subsequent tobacco use and nicotine exposure.

This quantitative study will include youth (age: 12-17) and young adults (age: 18-24) from three waves (2013-2016) of the Population Assessment of Tobacco and Health (PATH) Study. The population-based longitudinal PATH study has information on flavored tobacco use for many products, chemically verified biomarkers of nicotine exposure for adults, and a large sample size necessary for subgroup analysis. Relationships will be tested using statistical techniques. Findings will illuminate how flavor bans will impact youth and young adult tobacco use and tobacco use disparities in California and will inform the development of local ordinances regulating menthol cigarettes and other flavored tobacco. Findings will be shared with community organizations, municipalities, and policy makers in the state.