Research Brief | Altria Study Finds Limited Impact of Massachusetts Flavor Ban on Adult Smoking Rates

The 2025 AJPM Focus paper, “The Behavioral Impact of the Massachusetts Flavored Tobacco Products Ban on Cigarette Smoking Among Adults Aged ≥21 Years,” assessed the ban’s impact using 2017–2022 BRFSS data and a difference-in-differences (DiD) design. Massachusetts (ban in June 2020) served as the treatment group, and U.S. states without flavor bans served as controls. The analysis compared pre- vs post-ban changes in adult smoking rates.

Key Findings

Overall trend:

• Massachusetts adult smoking: 14.1% (2017) → 10.7% (2022)
• Comparison states: 18.5% (2017) → 14.8% (2022)
• Annual decline rates shifted: in Massachusetts, about 6%/year pre-ban slowed to 2%/year post-ban; in comparison states, about 3%/year pre-ban accelerated to 5%/year post-ban.

Primary DiD results (adjusted for demographics and year fixed effects):

• Time effect AOR = 1.05 (95% CI: 1.00–1.11, p = 0.0428)
• Treatment effect AOR = 0.89 (0.84–0.95, p = 0.0002)
• DiD estimate = 0.94 (0.85–1.03, p = 0.1621) → not significant
• Multiple sensitivity checks were also not significant (e.g., ≥25 years only: AOR = 0.91, p = 0.0599).
• Scenario consideration: If roughly one-third of menthol smokers had quit due to the ban, Massachusetts smoking prevalence might have dropped to ≈7% by 2022; such a step-change did not occur.

Conclusions

With an extended observation window through 2022 and a focus on legal-age adults (≥21), the study did not find evidence that Massachusetts’ flavor ban produced a relative additional decline in adult smoking compared with non-ban states. The authors suggest continued evaluation of initiation, cessation/substitution, DIY flavoring, and illicit supply as potential behavioral and market dynamics that may offset nominal policy effects.

Limitations (as stated by the authors)

Self-report bias; unobserved, time-varying factors (e.g., state-level COVID-19 responses; Massachusetts’ concurrent tobacco/vaping policies such as temporary EVALI-era sales suspensions, a 75% e-cigarette tax, smoke-free air laws, and funding) may have influenced smoking rates.

Article Information

Title: The Behavioral Impact of the Massachusetts Flavored Tobacco Products Ban on Cigarette Smoking Among Adults Aged ≥21 Years

Journal: AJPM Focus, 2025, 4(5):100364

Study type: Replication study; Open Access (CC BY-NC-ND)

Authors: Evan A. Winiger, Pavel N. Lizhnyak, Scott W. Drenkard, Andrea R. Vansickel (all with Altria Client Services LLC)

Disclaimer

This summary by 2Firsts is based on a publicly available academic paper and is intended to help non-research readers—especially industry practitioners, policymakers, and media—understand the findings and foster dialogue among science, policy, and industry.

Unless otherwise indicated, the methods, data, and conclusions presented reflect the original authors’ views. 2Firsts does not endorse those positions and serves only as an information channel.

Given possible limitations in our summarization, inaccuracies may exist. Readers are encouraged to consult the original paper for comprehensive details.

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