With the exception of menthol, federal law banned flavored cigarettes in 2009. Flavored products are a major target for youth tobacco cessation efforts because eight in 10 youth initiate tobacco use with flavored products, and nearly 90% of youth who use vapes use flavored products. Additionally, the tobacco industry has long targeted youth in its marketing of flavored products.

Then, in 2019, Massachusetts became the first state to ban the sale of all flavored tobacco products, including menthol. Early evidence found that, after the ban was implemented, sales of e-cigarettes fell by 89.4%. It remains the most comprehensive statewide flavor ban.

The Massachusetts law prompted six other states to enact their own restrictions to cover menthol cigarettes and other flavored tobacco products, including e-cigarettes, or vapes.

LDI Senior Fellow Andy Tan, an expert in youth tobacco use prevention policy, sought to measure the longer-term impact of Massachusetts’ ban on youth tobacco use. He and his research team compared past 30-day use among youth in Massachusetts with use among youth in neighboring states without flavor bans. They found no difference in tobacco use between the youth in Massachusetts and those in neighboring states and did not observe a meaningful increase in use of other products, such as cigarettes.

We asked Tan about his study, the broader issue of flavored tobacco product bans, and their implications for youth uptake and use.

What are some current policy issues around flavor bans?

Tan: Some of the key policy questions currently include:

• Do flavor bans work in limiting access to youth and reducing uptake of tobacco products?
• Do flavor bans lead to unintended consequences, e.g. substitution with non-flavored products like cigarettes?
• Are there health disparities or equity concerns of uneven enforcement in different populations?

Previous research from our team focused on the educational, organizational, and enforcement challenges faced by Massachusetts when implementing its ban, and colleagues similarly published one in the context of California’s communities. Regarding equity, we assessed key stakeholders’ perceived equity and racial justice concerns from implementation of the ban in MA.

Ultimately, lasting effectiveness may require combining sales restrictions with enhanced cessation support and youth prevention programs.

Since Massachusetts’s ban started, six more states have introduced bans. What does the literature say so far about state-level flavor bans and youth tobacco use?

Tan: Early research on local and statewide bans showed initial reductions in youth tobacco use and product availability. More recent studies found mixed findings on the effectiveness of flavor bans on reducing youth and young adult vaping and may have unintended effects of increased cigarette smoking over the short term.

What is your most important study finding, and why?

Tan: We identified no significant difference in tobacco use trends between Massachusetts and neighboring states a year after implementation. While some literature suggests bans might unintentionally increase youth cigarette use, we observed no such trend in MA. This is critical because it suggests that while restrictions on flavored tobacco sales are a vital first step, they may not be sufficient for sustained effectiveness.

What limitations should readers be aware of?

Tan: Readers should be aware of four limitations. First, the study used convenience samples that are not representative of the entire youth population in these states. Second, data collection occurred during the pandemic, which may have independently disrupted tobacco use behaviors or interacted with the policy’s implementation. Third, federal changes, such as the national Tobacco 21 law and the FDA’s partial ban on flavored cartridge-based e-cigarettes, occurred around the same time and may have influenced trends across all surveyed states. Finally, we measured past 30-day use to gauge prevalence, but did not capture changes in the frequency or intensity of use. 

What recommendations do you have for policymakers, both state and federal?

Tan: Policymakers should integrate flavor restrictions into a comprehensive strategy including enhanced enforcement, price increases, and youth prevention programs. Additionally, restrictions must be paired with robust cessation support to make evidence-based treatments more easily accessible, specifically mandating insurance coverage for treatments without cost-sharing. Federal regulators should also incorporate long-term evaluation plans rather than expecting immediate shifts in prevalence. Finally, all bans must include menthol to reduce youth initiation, protect communities historically targeted by the tobacco industry, and advance overall health equity.

Where are you going next with the research?

Tan: We are conducting long-term studies to assess the policy’s sustained impact on social norms and tobacco initiation rates among youth. In future research, we hope to move beyond measuring 30-day prevalence to examine more granular changes in the intensity and frequency of use. Finally, we hope to compare effects across the six states that have implemented flavor bans, given that each has a different set of exemptions, inclusions, and enforcement, and assess whether the policies have positive or adverse effects on health equity and justice-impacted populations.

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The study, “Trends of Past 30-Day Use of Commercial Tobacco Products Among Youth and Adults in Massachusetts Compared to Four Neighboring States After the 2019 Statewide Flavored Tobacco Sales Restriction,” was published in Nicotine & Tobacco Research on June 1, 2026. Authors include Jessica Liu, Jonathan P. Winickoff, Elaine P. Hanby, Matthew J. Reynolds, Karen M. Emmons, and Andy S.L. Tan.

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