Characteristics and Reach Equity of Policies Restricting Flavored Tobacco Product Sales in the United States

Abstract

In 2009, flavored cigarettes (except menthol) were banned in the United States, but other flavored tobacco products (FTPs) were allowed. Women, populations of color, youth, sexual minority, and low-socioeconomic status populations disproportionately use FTPs. Localities have passed sales restrictions on FTPs that may reduce disparities if vulnerable populations are reached. This study assessed the extent to which FTP restrictions reached these subgroups ("reach equity"). We identified 189 U.S. jurisdictions with FTP policies as of December 31, 2018. We linked jurisdictions with demographics of race/ethnicity, gender, age, partnered same-sex households and household poverty, and stratified by policy strength. We calculated Reach Ratios (ReRas) to assess reach equity among subgroups covered by FTP policies relative to their U.S. population representation. Flavor policies covered 6.3% of the U.S. population (20 million individuals) across seven states; 0.9% were covered by strong policies (12.7% of policies). ReRas indicated favorable reach equity to young adults, women, Hispanics, African Americans, Asians, partnered same-sex households, and those living below poverty. Youth, American Indians/Alaska Natives 879928H PPXXX10.1177/1524839919879928Health Promotion PracticeRose et al. / SHORT TITLE research-article2019 Rose et al. / REACH EQUITY OF LOCAL FLAVOR POLICIES 45S(AIAN) and Native Hawaiians/Pacific Islanders (NHPI) were underrepresented. Strong policies had favorable reach equity to young adults, those living below poverty, Asians, NHPIs, individuals of 2+ races, and partnered same-sex households, but unfavorable reach equity to women, youth, Hispanic, AIAN, and African American populations. U.S. flavor policies have greater reach to many, but not all, subgroups at risk of FTP use. Increased enactment of strong policies to populations not covered by flavor policies is warranted to ensure at-risk subgroups sufficiently benefit.

National Support for a Menthol Cigarette Sales Ban

“…This additional insight is particularly relevant for regions such as the South and Midwest, where rates of smoking and using menthol cigarettes are higher than in regions such as the West, 1,37 and an opportunity exists to advance tobacco control initiatives, including restrictions on menthol cigarettes sales. 38,39 Findings from this research can provide updated evidence to federal and local policy makers and advocates seeking to reduce tobacco use.…”

Perceptions of Use Patterns and Health Consequences Associated With Mentholated Cigarettes Among U.S. Adults

“…According to the Risk Perception Attitude framework, behavior change cannot occur unless risk perceptions are corrected and efficacy is increased, so messaging should also use evidence-based strategies to increase efficacy in order to avoid menthol cigarettes (Rimal & Real, 2003). In addition, recent efforts by localities in the United States to ban the sales of menthol cigarettes in their jurisdiction can help to reduce tobacco use among these vulnerable groups who are most at risk of menthol use (Innocent, 2018; Rose et al, 2020). Modeling studies indicate that banning menthol in 2011 would have saved over half a million lives by 2050, with 37% of those among Blacks (Levy et al, 2011).…”

Modelling retailer-based exemptions in flavoured tobacco sales restrictions: national estimates on the impact of product availability

“…Therefore, our findings highlight the potential equity effect of passing any flavour policy, regardless of retailer-based exemption and informs other studies investigating flavour policies within marginalised communities disproportionately impacted by FTP use. 27 28 Stakeholders and policy-makers should incorporate an equity lens when considering a retailer-based exemption policy to ensure that FTP availability decreases equally in low-income populations and communities of colour.…”

“…Studies found that FTP policies equitably reach most racial/ethnic minority populations and individuals with lower socioeconomic status. 27 28 As recent federal policy and continued action at the state and local-level unfolds, there is a need to estimate the magnitude of effect that comprehensive bans could have on reducing access to FTPs nationwide. In addition, it is important to understand the extent to which the impact may be lessened by including retailer exemptions and the extent to which such exemptions may disproportionately impact vulnerable populations.…”