US state implementation of policies restricting sales of flavoured E-cigarettes: a qualitative analysis

E-cigarettes are the most popular nicotine product among youth in the USA and the majority of young people use products with flavours such as mint, menthol, fruit and candy. Between December 2019 and December 2022, seven US states and the District of Columbia put in place restrictions on the sale of flavoured e-cigarettes. Studies of e-cigarette flavour restrictions have found varied policy effects across different populations. While some qualitative research has investigated policy implementation details, no studies to date have systematically examined how flavour restrictions are implemented.

From April to December 2023, we conducted key informant interviews guided by Bullock's policy implementation process model and determinants framework to investigate how states are implementing flavour restriction policies.

Key themes in implementation included the roles of clear product definitions and enforcement processes, coordination across state and local governments, adequate resources and communication with retailers. We found between-state heterogeneity in these factors, with key informants reporting challenges with one or more of these components.

Implementing policies restricting the sale of flavoured e-cigarettes is complex and variable from state to state. Future implementation efforts and policy evaluations should take this variability into account.