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Comment & Response
September 13, 2021

Further Considerations on the Association Between Flavored Tobacco Legislation and High School Student Smoking Rates—Reply

Author Affiliations
  • 1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
JAMA Pediatr. Published online September 13, 2021. doi:10.1001/jamapediatrics.2021.3293

In Reply: I thank my colleagues for their comments on my recent Research Letter.1 Given space constraints, I will focus on their 3 main critiques.

The critique that findings were premature as they relied on a single data point was noted by Maa and Gardiner as well as Leas but has a false premise. Regressions used data on 95 843 high school students (2097 from San Francisco, California, in 2019) to estimate a difference-in-differences research design assessing whether smoking trends among San Francisco minors enrolled in high school diverged from students in comparison districts after the flavor ban. Covariates adjusted for respondent demographics, other tobacco policies, time-invariant differences between districts, and common time trends (eg, accounting for changes in electronic nicotine delivery system technology). While this provides a short-run estimate, it is by no means based on a single data point.

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