Cigarette Pack Prices and Sales Following Policy Changes in California, 2011-2018

Impacts of Tax and Flavor Tobacco Policies on San Francisco Bay Area Tobacco Prices

California Proposition 56 increased the state tobacco tax by $2 per cigarette pack effective April 1, 2017. Between 2015-2020 San Francisco (SF) and some cities in Alameda County enacted local flavored tobacco sales restrictions. SF also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in 2020. Compare the change in tobacco prices before (2015) and after (2019/20) the implementation of a $2 increase in tobacco excise tax and local flavored tobacco policies in SF and Alameda Counties. Descriptive study of the pre-to-post policy analysis design. We drew a proportional random sample of retailers (N=463) in SF and Alameda Counties, by city. Using multivariable, single- and multiple-level linear regressions, we compared inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and by flavor policy, accounting for socio-demographics. Change in inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and flavor policy, accounting for socio-demographics. Between 2015-2019/20, the increase in cigarette prices was higher than the $2 tax increase, and higher in SF than Alameda County (+$4.6 vs +$2.5). SF retailers stopped selling Newport menthol cigarettes and Blu brand menthol e-cigarettes in 2019/20. Adjusted average cigarette prices increased significantly more in SF and Alameda County cities with comprehensive or partial flavor policies versus cities without flavor policies (by $3.23 and $2.11). Local flavor policies affected menthol product availability and may have had positive spillover effects and indirectly increased pack prices.

A Rapid Evaluation of the US Federal Tobacco 21 (T21) Law and Lessons From Statewide T21 Policies: Findings From Population-Level Surveys

BACKGROUND

On December 20, 2019, the minimum age for purchasing tobacco in the US was raised nationally to 21 years. We evaluated this law (Tobacco 21 [T21]) 1 year after implementation. We also compared states with versus without T21 policies during 2019 to explore potential equity impacts of T21 policies.

METHODS

We examined shifts in tobacco access among 6th through 12th graders using the National Youth Tobacco Survey. To explore equity of state T21 policies among youths and young adults, the associations with tobacco use were explored separately for race and ethnicity by using data from the 2019 Behavioral Risk Factor Surveillance System (for persons aged 18 to 20 years) and the 2019 Youth Risk Behavior Survey (for high school students).

RESULTS

The overall percentage of 6th to 12th graders perceiving that it was easy to buy tobacco products from a store decreased from 2019 (67.2%) to 2020 (58.9%). However, only 17.0% of students who attempted buying cigarettes in 2020 were unsuccessful because of their age. In the 2019 BRFSS, those aged 18 to 20 years living in a state with T21 policies had a lower likelihood of being a current cigarette smoker (adjusted prevalence ratio [APR], 0.58) or smoking cigarettes daily (APR, 0.41). Similar significant associations were seen when analyses were restricted to only non-Hispanic White participants but not for participants who were non-Hispanic Black, non-Hispanic Asian, Hispanic, or of other races or ethnicities. Consistent findings were seen among high school students.

CONCLUSION

Greater compliance with the federal T21 law is needed as most youth who attempted buying cigarettes in 2020 were successful. Comparative analysis of states with versus states without statewide T21 policies in 2019 suggest the policies were differentially more protective of non-Hispanic White participants than other participants. Equitable and intensified enforcement of T21 policies can benefit public health.

The Association of Cannabis Use and Cigarette Smoking with Psychological Distress Among Adults in California

BACKGROUND

In November 2016, California voters passed the Adult Use of Marijuana Act making recreational cannabis sales legal to adults aged 21and older starting January 1st, 2018. This study aims to understand the relationship of cannabis use and cigarette smoking with serious psychological distress (SPD) in California in light of the legalization of recreational cannabis sales.

METHODS

This cross-sectional study included 42,313 adult participants from the 2017 to 2018 California Health Interview Surveys. We used the Kessler-6 (K6) scale to measure psychological distress in the past 30 days. Multiple logistic regression models were used to examine the association between cannabis/cigarette use and SPD.

RESULTS

Cannabis use was positively associated with SPD (AOR = 2.48, 95% CI = 1.57, 3.91), but this association was not significantly different before and after recreational cannabis sales legalization in California (AOR = 0.82, 95% CI = 0.72, 2.05). Cigarette smoking was also positively associated with SPD (AOR = 2.76, 95% CI = 2.05, 3.71). Compared to those who used neither cannabis nor cigarettes, sole cannabis users (AOR = 2.51, 95% CI = 1.75, 3.60), sole cigarette smokers (AOR = 3.23, 95% CI = 2.28, 4.60), and dual users of cannabis and cigarettes (AOR = 5.65, 95% CI = 4.04, 7.89) were more likely to report SPD. Dual users were also more likely to report SPD than sole cannabis users (AOR = 2.25; 95% CI = 1.48, 3.43) and sole cigarette smokers (AOR = 1.75; 95% CI = 1.18, 2.59).

CONCLUSIONS

These findings provide evidence for the need to develop effective cessation intervention strategies targeting individuals with SPD to reduce their cannabis use and dual-use of cannabis and cigarettes.

Tobacco price and use following California Proposition 56 tobacco tax increase

BACKGROUND

California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017.

METHODS

Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011-2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a "synthetic" California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted.

RESULTS

The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products.

CONCLUSION

Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco.

Smoking behavior in 18-20 year-olds after tobacco 21 policy implementation in California: A difference-in-differences analysis with other states

In June 2016, California implemented a Tobacco 21 (T21) policy that increased the minimum sale age of tobacco products from 18 to 21. This study examined the association between California's T21 policy and smoking behavior (ever, current, daily, and nondaily) in 18-20 year-olds using data from the 2012-2019 Behavioral Risk Factor Surveillance System (n = 15,863). The annual change in odds of smoking among 18-20 year-olds post-policy (July 2016-December 2019) was compared with the pre-policy period (January 2012 - June 2016) 1) within California and 2) compared with states without a T21 policy. As a sensitivity analysis, 21-23 year-olds in California were used as the referent. Difference-in-difference estimates (D-I-D) were calculated using adjusted logistic regression and compared the post to pre-policy change in trends in California to the referent groups. Before California's T21 policy, there was an 11% annual decrease in the odds of ever smoking among 18-20 year-olds in California and a 6% decrease in the referent states. After the policy, these trends did not change significantly. Results for current smoking were similar. For daily smoking, there was an 8% annual decrease before the policy and a 26% annual decrease after the policy among 18-20 year-olds in California; D-I-D estimates were 0.80 (95% CI: 0.57, 1.14) using referent states as the comparison and 0.62 (95% CI: 0.41, 0.95) using 21-23 year-olds in California as the comparison. There was an association between California's T21 policy and a decrease in daily smoking among 18-20 year-olds, compared with 21-23 year-olds, more than three years post-implementation.

Implementation of a comprehensive flavoured tobacco product sales restriction and retail tobacco sales

OBJECTIVE

San Francisco's comprehensive restriction on flavoured tobacco sales applies to all flavours (including menthol), all products and all retailers (without exemptions). This study evaluates associations of policy implementation with changes in tobacco sales in San Francisco and in two California cities without any sales restriction.

METHODS

Using weekly retail sales data (July 2015 through December 2019), we computed sales volume in equivalent units within product categories and the proportion of flavoured tobacco. An interrupted time series analysis estimated within-city changes associated with the policy's effective and enforcement dates, separately by product category for San Francisco and comparison cities, San Jose and San Diego.

RESULTS

Predicted average weekly flavoured tobacco sales decreased by 96% from before the policy to after enforcement (p<0.05), and to very low levels across all products, including cigars with concept-flavour names (eg, Jazz). Average weekly flavoured tobacco sales did not change in San Jose and decreased by 10% in San Diego (p<0.05). Total tobacco sales decreased by 25% in San Francisco, 8% in San Jose and 17% in San Diego (each, p<0.05).

CONCLUSIONS

San Francisco's comprehensive restriction virtually eliminated flavoured tobacco sales and decreased total tobacco sales in mainstream retailers. Unlike other US flavoured tobacco policy evaluations, there was no evidence of substitution to concept-flavour named products. Results may be attributed to San Francisco Department of Health's self-education and rigorous retailer education, as well as the law's rebuttable presumption of a product as flavoured based on manufacturer communication.

Effects of a minimum floor Price law on cigarette use in Oakland, California: A static microsimulation model

Tobacco minimum floor price laws (MFPLs) are a non-tax price policy that set a price below which tobacco products cannot be sold, thereby raising prices. Despite their growing interest among policy makers, little is known about the effects of local MFPLs on smoking prevalence or smoking intensity. We aimed to project the impact of a local tobacco MFPL on cigarette smoking prevalence and cigarette smoking intensity in Oakland, California, including detailed analysis of several important subpopulations. We used data collected between April 2017 and December 2019 from the California Behavioral Risk Factor Surveillance System and the National Youth Tobacco Survey to construct a static microsimulation model representative of Oakland. We projected the impact of MFPLs ranging from $8.00 to $13.00 per pack. All analyses were conducted between 2019 and 2020. With the introduction of an MFPL and assuming 15% policy evasion, mean price paid per pack was projected to increase by $1.05 to $4.69, cigarette smoking prevalence was projected to drop by 0.3% to 0.8%, and smoking intensity was projected to drop by 0.7% to 2.0% among continuing smokers. Total number of cigarettes smoked per month was projected to drop by 246,000 to 734,000 cigarettes, a 3.0% to 9.0% reduction from the current level (8.2 million cigarettes). The greatest reductions in cigarette smoking prevalence were among those aged 12 to 24-years-old, of non-Hispanic black or other race/ethnicity, and living below the federal poverty level. An MFPL in Oakland may substantially reduce cigarette use and target several important subpopulations.