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.
