staff State and local governments’ passage of flavored tobacco bans is essential to public health. However, these policies are limited in their impact, and flavored products remain widely available.
We reviewed 12 eligibles, currently active or pending flavor policies (11 national policies and the EU TPD) about flavors of tobacco products, including cigarettes.
Tobacco Taxes
Flavored tobacco bans have been successful in cities and counties across the country. The success has been attributed to tobacco taxes, regulations, and enforcement.
Tobacco tax increases have been shown to reduce smoking prevalence, reducing the public health burden and the costs associated with smoking. However, this effect is negligible if tax avoidance and evasion are present.
A recent study compared the effectiveness of a ban on flavored tobacco with no limits to the effects of a menthol cigarette ban in Massachusetts, which states have banned flavored tobacco. It was discovered that the prohibition averted a significant rise in adult smokers and resulted in a 9 percent decrease in young people who smoked cigarettes.
These results have been backed up by other research, including a large study conducted in Australia. A total ban on flavored tobacco reduced the number of young people who smoked by 4% in the short term and 6% in the long term.
Many states have total bans on flavored tobacco products in the United States. While this has a positive impact on preventing children from starting to use these products, it has also been criticized by the tobacco industry and many public health advocates as an unwise move.
While tobacco companies and public health groups have fought against the bans, they failed to succeed. Even in cities that banned the sale of flavored tobacco products, stores have reportedly continued to sell them. Since Sacramento’s flavored tobacco ban took effect in 2020, six to 12 businesses have been cited by the city’s code enforcement team for selling prohibited products yearly.
Sales Taxes
Many cities and counties nationwide have banned the sale of flavored tobacco products, including menthol cigarettes. Some, like San Francisco and Richmond, CA, have prohibited the sale of flavored tobacco entirely; others, such as Jersey City, NY, and Yonkers, NY, have restricted the sale of flavored tobacco to adult-only tobacco specialty stores.
Research has shown that reducing the availability of flavored tobacco products can decrease smoking among adolescents and young adults. It is primarily due to reduced consumption of flavored products and increased usage of tobacco cessation aids, such as nicotine patches or gum.
The ban on flavored tobacco is a significant component of the overall strategy to reduce teen smoking. It will also help prevent youth vaping, a growing problem that health experts say has become a considerable threat to the public health of American teens.
As of August 2019, 12 countries and the European Union (EU) have enacted legal restrictions on flavors in tobacco products. These policies typically prohibit the sale of flavored tobacco across a wide range of products; they are often accompanied by restrictions on flavor descriptors on product packaging.
A ban on flavored tobacco may reduce sales and increase demand for lower-cost, lower-salt, and other less-flavored smoking versions. It may also lead to a reduction in the consumption of regular cigarettes. However, the effects of the policy are likely to be limited by other factors such as smuggling, price inflation, or weak compliance with the law.
Regulations
Despite the general decline in tobacco use since the 1950s, tobacco use remains a high prevalence and a significant threat to public health. As such, preventing smoking initiation is essential to reducing long-term harm and improving public health.
Tobacco use among adolescents is a grave concern. Previous research has shown that flavored cigarettes appeal to and are disproportionately used by underage smokers. Nearly 90% of smokers start smoking by age 18; therefore, preventing smoking initiation is a critical objective for tobacco control.
We investigated the success of flavored bans across the country by analyzing data from various national and subnational jurisdictions. We evaluated policy restrictions on selling and marketing a range of flavored tobacco products, including menthol-flavored cigarettes and flavors of a non-tobacco leaf.
Our findings show comprehensive policy restrictions on selling and marketing flavored tobacco products can significantly reduce adolescent nicotine consumption. It is because they decrease the probability of teenage smokers consuming flavored cigarettes and other tobacco products besides cigarettes (including cigars, pipes, and smokeless tobacco).
We also find that some of these policies have gaps that tobacco companies may exploit to entice new users or minimize perceptions of product harm. However, we found that most national-level flavor policy restrictions are genuinely intended to reduce damage from tobacco use and were implemented with an emphasis on the public health objectives of protecting youth from exposure to tobacco products and minimizing adverse effects on health.
Enforcement
Despite industry-led efforts to sabotage local flavor restrictions, recent research by Tobacco Control finds that high school youth vaping and smoking declined after implementing a flavored tobacco sales ban in Oakland, California. The new study also refutes an industry-touted study that linked San Francisco’s flavored tobacco ban to higher smoking rates in high school students.
The study aimed to evaluate the success of flavored tobacco bans nationwide through interviews with 17 experts across the USA and Canada. These experts included health department staff, researchers, legal professionals, and local government officials with expertise in flavored tobacco product policies.
Interviews were conducted using a standardized semistructured interview guide that asked respondents about an ideal timeline for adopting, implementing, and enforcing flavored tobacco bans or restrictions in their jurisdiction. Participants were also asked about the efficacy of implementation in their authority, evaluation considerations, lessons learned, menthol-specific challenges, economic impacts, and unforeseen consequences (see online supplemental file for complete interview guide).
Most participants consistently reported that flavor bans or restrictions had been successfully implemented. Typically, this was evidenced by retailer compliance with purchase and inspection data. They also praised the effectiveness of comprehensive language, robust engagement, strong non-compliance measures, clear enforcement procedures and authority, and early consideration of evaluation measures. However, identifying concept flavors and ensuring consistent enforcement were recognized as critical challenges. In addition, past and pending litigation and the potential for legislative pre-emption were perceived as constant threats across jurisdictions large and small.
