How health groups defeated Juul’s effort to rewrite San Francisco’s e-cigarette regulations

The tobacco companies have been turning to the initiative and referendum process to undo California tobacco control laws and regulations. (The most recent example is the industry’s successful forcing of a referendum on SB 793, the ban on flavored tobacco products the legislature passed last summer.) In 2019 Juul, makers of the wildly popular e-cigarette with kids, undertook an aggressive effort to rewrite San Francisco’s e-cigarette regulations and prohibit the City from enacting new rules without requiring that the new rules be taken to an expensive direct vote of the people.

Neil Sircar and I just published “Defeating Juul’s Effort to Rewrite San Francisco’s E-Cigarette Regulations” in American Journal of Public Health that describes how the health groups successfully crushed Juul’s effort (with 82% over voters opposing Juul). This campaign provides a playbook for how to oppose similar efforts elsewhere. It also highlights the important emergence of parents as an important new voice in the debate.

Here is the abstract from the paper:

In 2019, San Francisco, California, prohibited the sale of electronic cigarettes lacking US Food and Drug Administration authorization. Juul then promoted a ballot initiative (Proposition C) to replace San Francisco’s e-cigarette legislation with legislation Juul wrote that required future legislation to be approved by the voters. Juul promoted Proposition C as a way to reduce youth e-cigarette use while allowing adult choice.Health groups argued that Juul’s measure could nullify San Francisco’s prohibition on selling flavored tobacco products. Health groups benefitted from having an established campaign network that recently defended the flavor ban. They successfully framed Proposition C as a tobacco industry ploy to undo San Francisco’s e-cigarette regulations, particularly the prohibition on selling flavored tobacco products. Juul ended its campaign on September 30, 2019, and the measure failed on election day, with 82% voting against it.Lessons learned from the campaign include the importance of framing an industry initiative as a threat to local public health lawmaking and the potential for the e-cigarette issue to attract parents as new leaders and engage a powerful constituency to support tobacco control measures. (Am J Public Health. Published online ahead of print January 21, 2021: e1-e8. https://doi.org/10.2105/AJPH.2020.305993).

In addition to the summary of the campaign in the main paper, there is a detailed play-by-play of the campaign in an online appendix (click on “Supplements” on the paper abstract page) that can provide guidance to others dealing with similar challenges.

The full citation for the paper is: Sircar NR, Glantz SA. Defeating Juul’s Effort to Rewrite San Francisco’s E-Cigarette Regulations. Am J Public Health. 2021 Jan 21:e1-e8. doi: 10.2105/AJPH.2020.305993. Epub ahead of print. PMID: 33476232. It is available here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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