Many flavored tobacco sales restrictions have been amended, resulting in more comprehensive policies that may increase impact.

Flavored tobacco products contribute significantly to youth tobacco initiation and tobacco use disparities. Over the past five years, there has been increased interest in restricting the sale of flavored tobacco products in the US, with nearly 400 jurisdictions adopting flavored tobacco product (FTP) sales restrictions and the FDA proposing rules to remove menthol cigarettes and flavored cigars from the market. Increased adoption of these laws is encouraging, as research indicates they are associated with reductions in youth tobacco use and tobacco use disparities. However, FTP sales restrictions are rarely comprehensive. Many restrictions exempt key tobacco products, some categories of retailers, and/or flavors. Such exemptions may limit the impact of these laws on youth tobacco use and on tobacco use disparities. Although several FTP sales restrictions have already been amended, little is known about how amendments have affected the comprehensiveness of these laws. In our recent manuscript, we investigated how amendments affect the comprehensiveness of flavor laws enacted as of March 31, 2022.

Read our article in JPHMP

To explore this question, we identified U.S. state and local FTP sales restrictions that had been amended at least once as of March 2022 using an internal policy database. We examined each policy pre- and post-amendment to determine the products, retailers, and flavors included in the original and most recent version of the policy. We additionally applied a six-level classification scheme – level six being most comprehensive – to describe how amendments affected the overall comprehensiveness of each law. Finally, we examined if amended laws were, on average, more comprehensive than laws that had never been amended.

What we found:

• As of March 2022, nearly 14% (n=50) of local-level FTP sales restrictions had been amended since first enacted, with amendments largely leading to increased policy comprehensiveness.
• More than half of laws (n = 28, 56.0%) went from least comprehensive (level one) to most comprehensive (level six). On average, amendments increased policy comprehensiveness by 2.32 levels on the six-level comprehensiveness scale.
• Amendments most often strengthened FTP sales restrictions by removing menthol exemptions for cigarettes, e-cigarettes, and smokeless tobacco (n ≥ 30, 60.0%) and removing adult-only retailer exemptions (n = 12, 24.0%).
• Policies that were less comprehensive were more likely to go on to be amended. The average amended policy became more comprehensive than not only its original version, but also more comprehensive than other, non-amended FTP sales restrictions.
• Many non-comprehensive policies have not been amended. Most notably, none of the seven state-level FTP sales restrictions – five of which are categorized as level six comprehensiveness as they only apply to e-cigarettes – have been amended.

Amendments have largely been used as a tool to increase the comprehensiveness of weaker flavored tobacco sales restrictions. Most amendments increased policy comprehensiveness by adding provisions to include menthol products and adult-only retailers. Research indicates that FTP sales restrictions that include menthol and adult-only retailers may have greater potential to reduce youth access, use, and health disparities than laws that exclude menthol and adult-only retailers. While amendments have been used to strengthen existing (and often less comprehensive) FTP sales restrictions, developing fully comprehensive FTP sales restrictions initially may have the greatest impact in reducing youth tobacco access, use, and health disparities.

Emily Donovan is a Research Manager at Truth Initiative. In her role, she conducts research studies to monitor and evaluate tobacco prevention laws. Her research interests focus on applying legal epidemiology methods to describe characteristics of laws, examine their population distribution, and measure their impacts on tobacco use and health disparities. Emily received her Master of Public Health degree in Health Behavior from the University of North Carolina at Chapel Hill.

Mona Azadi is a Research Associate at Truth Initiative in Washington, DC. She supports research projects analyzing federal, state, and local tobacco regulations to evaluate and inform tobacco control policies and tobacco prevention efforts. Her research interests focus on tobacco use disparities, industry interference tactics, and the environmental impacts of tobacco use. Mona received her Master of Public Health degree in Environmental Health Science and Policy from the George Washington University in Washington, DC.

Maham Akbar is a Director of Public Policy at Truth Initiative. She received a bachelor’s degree in government and global studies from the College of William & Mary in Williamsburg, Virginia and a master’s degree in public policy from American University in Washington, DC.