Strong, but not weak, bans on the sale of flavored tobacco reduce availability of these products

The evidence that flavor bans substantially lower sales of menthol and other flavored tobacco products work continues to accumulate. Ralph Welwean and colleagues just published “Evaluating the Impact of Strong and Weak California Flavored Tobacco Sales Restriction Policies on the Tobacco Retail Environment” that, as the title indicates, evaluated the effectiveness of local laws prohibiting or restricting the sale of menthol and other flavored tobacco products in California.

They divided laws into weak and strong policies, with the strong policies including menthol and all flavors and had clear enforcement provisions. Weak laws excluded menthol, some kinds of retailers, or had weak enforcement provisions. (The paper describes these definitions in detail.) In addition to assessing hundreds of laws, they included matched control communities that had not passed any restrictions on the sale of flavored tobacco products. They included everywhere that flavored tobacco products could be sold, including vape shops.

Between the 2013 and 2019, in localities with strong laws ending sales of menthol cigarettes the fraction of stores selling menthol dropped by more than half, from 87.9% to 35.4%. During the same period, stores selling menthol increased in localities with no restrictions, from 78.0% to 91.3%. Stores selling menthol cigarettes in localities did not change, remaining around 82%.

Likewise, during the same time, sales of flavored non-cigarette tobacco products dropped by nearly half in localities with strong laws, from 63.8% to 37.0% stores selling non-cigarette tobacco products increased in localities without laws from 64.4% to 82.2%, as well as in places with weak laws, where the fraction of stores selling these products increased from 39.5% to 79.1%.

The bottom lines:

  • Strong flavor bans work
  • Weak laws don’t work

This study adds to the evidence base that flavor bans work when written well and enforced. The study also demonstrates that weak laws are not worth passing

Here is the abstract:

Purpose: Evaluate success of local flavored tobacco (FT) policies in reducing availability of FT products in California.

Design: Matched-jurisdiction cross-sectional design compared availability of FT at licensed tobacco retailers (LTR) in jurisdictions with and without such policies in 2013 and 2019. Flavor policy jurisdictions were split into strong and weak groups using Flavored Tobacco Policy Rating Rubric.

Setting: 32 local California jurisdictions.

Subjects: Final sample included 306 LTR in 2013 and 1441 LTR in 2019. LTR were classified as convenience store, liquor store, pharmacy, small market, supermarket, gas station booth, tobacco/vape product store, or other.

Measures: Retail availability of menthol cigarettes and flavored non-cigarette tobacco.

Analysis: Logistic regression analysis including covariate (store type) determined whether differences existed in availability of FT in jurisdictions with and without FT policies. Percentage change assessed difference in proportion of retailers that sold FT in 2013 (i.e. before-policies-passed) and in 2019 (i.e. after-policies-became-effective).

Results: Strong flavor-policy jurisdictions significantly differed from matched no-policy jurisdictions in availability of menthol cigarettes (OR = .04, 95% CI: .02-.08) and flavored non-cigarette tobacco (OR = .07, 95% CI: .05-.11). From 2013 to 2019, these jurisdictions experienced significant declines in menthol cigarettes (87.9% to 35.4%) and flavored non-cigarette tobacco sales (63.8% to 37.0%).

Conclusion: Strong FT sales restriction policies appear to be effective in reducing availability of FT, thereby creating a healthier retail environment in California.

The full citation is: Welwean RA, Andersen-Rodgers E, Akintunde A, Zhang X. Evaluating the Impact of Strong and Weak California Flavored Tobacco Sales Restriction Policies on the Tobacco Retail Environment. Am J Health Promot. 2022 Feb 1:8901171211068469. doi: 10.1177/08901171211068469. Epub ahead of print. PMID: 35105227. 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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