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Youth tobacco use before and after flavoured tobacco sales restrictions in Oakland, California and San Francisco, California
  1. Jessica Liu1,
  2. Lester Hartman2,
  3. Andy S L Tan3,
  4. Jonathan P Winickoff4
  1. 1 Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 Westwood-Mansfield Pediatric Associates, Boston, Massachusetts, USA
  3. 3 Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4 MassGeneral Hospital for Children, Boston, Massachusetts, USA
  1. Correspondence to Dr Jonathan P Winickoff, MassGeneral Hospital for Children, Boston, MA 02114, USA; JWINICKOFF{at}


The tobacco industry has used recent findings from the Youth Risk Behavior Surveillance System Survey (YRBSS) to claim that a sales restriction on flavoured tobacco products might increase youth combustible cigarette use. In this special communication, we examined YRBSS data and reached the opposite conclusion. We observed the patterns in youth cigarette smoking in Oakland, California following its 2017 convenience store flavoured tobacco sales restriction. We also found that 2019 YRBSS data from San Francisco, California cannot be used to evaluate the effect of the sales restriction on all flavoured tobacco products in San Francisco as the YRBSS data for this city were collected prior to enforcement of the sales restriction. For future studies, we suggest triangulating with corroborating sales, behavioural and qualitative data over time to assess the effects of tobacco control policies on youth tobacco use. We recommend that policy enactment and enforcement dates, as well as the exact data collection periods for population health surveys, be published to facilitate more rigorous policy evaluation.

  • Public policy
  • Nicotine
  • Prevention

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  • Contributors All authors contributed to the conceptualising, drafting and revising of the paper.

  • Funding JL was funded by the Cancer Prevention Fellowship from the National Cancer Institute and Harvard T.H. Chan School of Public Health—National Institutes of Health grant number 2T32CA057711-27.

  • Competing interests JPW is a paid expert witness in litigation against tobacco companies. We also want to disclose that we originally submitted a less detailed version of this manuscript as a Research Letter to JAMA Pediatrics as a response to an analysis published in the same journal: Friedman AS. A Difference-in-Differences Analysis of Youth Smoking and a Ban on Sales of Flavored Tobacco Products in San Francisco, California. JAMA Pediatr. 2021;175(8):863–865. doi:10.1001/jamapediatrics.2021.0922.

  • Provenance and peer review Not commissioned; externally peer reviewed.