A systematic review investigating policy design and implementation of US state and local policy to restrict the sale of flavored tobacco products
Year: 2026
Type: review
Study design: Systematic Review
Abstract: INTRODUCTION: State and local jurisdictions in the United States are increasingly adopting flavored tobacco sales restrictions (FTSRs) to mitigate tobacco initiation and use. Policy implementation is highly understudied yet can impact policy effectiveness. This review examines existing literature on state and local FTSR policy design and implementation in the United States. METHODS: We systematically searched for PubMed articles published by December 31, 2024 which were: original research articles in English focused on a US state or local FTSR that reported at least one policy implementation outcome measure. We excluded articles that were systematic reviews or reported on federal or non-FTSR policy. Guided by policy and implementation science frameworks, we developed a data extraction template to report: policy design elements, study characteristics, and implementation measures (ie, inputs, activities, outcomes). RESULTS: Of 1595 articles identified, 30 were retained for review. Most evaluated local FTSRs, and eight evaluated a statewide policy. Pre-post test and cross-sectional study designs were the most common. Frequently reported implementation outcomes were acceptability, appropriateness, feasibility, and fidelity/compliance. Studies with pre-post test designs and comparison groups showed significantly increased fidelity/compliance (ie, reduced availability of restricted products) in FTSR jurisdictions. A majority (56.7%) detailed an implementation input for infrastructure (eg, resources) or activity (eg, outreach). Few described enforcement-related mechanisms. CONCLUSIONS: Key gaps exist in policy implementation articles on state and local FTSRs in the United States, including infrequent reporting of enforcement agencies and penalties which may impact implementation. Additional mixed-methods research is needed to compare FTSR implementation across jurisdictions with varying policy designs. IMPLICATIONS: Results contribute to our understanding of FTSR policy design, evaluation, and areas needed for intervention to strengthen implementation. Strategies to support compliance include guidance and criteria to identify targeted products for retailers and enforcement agents. Research gaps include a lack of information on penalty structures and data from enforcement agents or on violations, which are missed opportunities to evaluate components that can impact implementation and effectiveness.
Source: Nicotine & Tobacco Research
DOI: 10.1093/ntr/ntag028
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,392
OpenAlex ID: W7128712440