State and local governments have taken action to restrict flavored tobacco product sales. This article examines the potential impact of these policies on public health.

Studies assessing the effects of implemented menthol bans, hypothetical menthol bans, and tobacco flavor bans that exclude menthol are reviewed.

Reduced initiation of smoking

With the passage of state and local flavor restrictions and even e-cigarette restrictions, we are starting to understand these policies’ impacts on youth and consumer behavior. It is also known that, despite attempts by the tobacco industry to exploit loopholes in some of these bans, robust and comprehensive flavor restriction policies reduce flavored tobacco use.

Whether or not a person quits smoking, they typically switch to unflavored tobacco products when they decide to stop using flavored tobacco products. In a study of adults who were previously regular smokers of flavored cigarettes, those who switched to unflavored cigarettes showed the most reduced cigarette consumption.

However, if a person’s first experience with tobacco involves a flavored product, they are more likely to continue using that type of tobacco in the future. Because of this, preventing young people from attempting to use tobacco through flavored products will lead to significant public health benefits in terms of reduced initiation of all types of tobacco and tobacco-related diseases and deaths.

To prevent the industry from continuing to promote its flavored products to youth, policymakers should consider banning all flavors for all tobacco products and banning flavored tobacco accessories as well. It will give the industry fewer opportunities to exploit loopholes. In addition, introducing or promoting proven quit-smoking services when these policy changes are implemented could help reduce the number of people switching to other, more dangerous, flavored tobacco products.

Reduced cigarette consumption

Reducing cigarette consumption due to flavor restrictions can have substantial health benefits, including a decline in smoking-related biomarkers and respiratory symptoms and a likely increase in longevity. While there is limited research on other benefits, some studies have found that reducing smoking also leads to reduced occurrence of certain cancers and decreased cardiovascular disease risk factors.

A study of the impact of a flavored tobacco ban showed that banning flavored cigarettes was associated with a reduced probability that adolescents smoke. However, the effect was less pronounced than for those who smoked unflavored cigarettes. However, the study also found that adolescents were likelier to choose menthol in response to the flavored ban, suggesting substitution toward the one remaining legal flavored tobacco product. In addition, the flavored tobacco ban was associated with increased use of other flavored tobacco products, such as cigars and pipes.

The results of this study demonstrate that the 2009 flavored cigarette ban effectively reduced adolescent smoking. However, this and other studies indicate a total tobacco flavor ban is needed because even if adolescents reduce their smoking rates, they may continue to smoke other flavored tobacco products like hookah and e-cigarettes, which are not regulated under the NYTS.

Reduced use of other tobacco products

Many states and localities have enacted flavored tobacco bans with varying degrees of strength. These policies, combined with effective marketing restrictions and proven quit-smoking services, can substantially reduce adolescent tobacco use, which harms the developing brain by impairing attention, learning, mood, impulse control, and more. However, studies of these policies’ impact have been mixed, and retailers and the industry have taken advantage of loopholes that can undermine the effectiveness of such bans. A more comprehensive flavor restriction policy, limiting sales of flavored cigars, vapor devices, and accessories, could prevent some users from switching to non-cigarette tobacco products like menthol cigarettes or e-cigarettes that are still legal while reducing the number of smokers who continue to smoke even after a flavored tobacco ban is in place.

Research has shown that flavored tobacco bans are associated with a reduced likelihood of being a cigarette smoker and cigarette consumption among those who remain smokers, regardless of whether they switched to menthol cigarettes or other flavored products. As envisioned in the administration’s reignited Cancer Moonshot and recently proposed FDA product standards, a comprehensive policy will be crucial to achieving these results and eliminating tobacco-related disease and death in the United States. However, continued evaluation of the structure and implementation of flavored tobacco sales prohibitions, including assessing retailer compliance, is necessary to advance the field.

Reduced e-cigarette use

Flavored tobacco products significantly contribute to youth initiation of smoking and e-cigarette use. Ending the sale of flavored cigarettes and e-cigarettes would be essential to creating the first tobacco-free generation.

To explore the impact of a flavored tobacco ban on cigarette use, researchers examined data on cigarette consumption from the National Surveys on Drug Use and Health between 2002 and 2017. They looked at cigarette consumption by adolescents and young adults before and after a flavored tobacco ban. This analysis allowed them to identify the changes in cigarette use that could be attributed to the ban and control for other influences on smoking behaviors.

This study found that the flavored tobacco ban was associated with a reduction in the percentage of adolescents and young adults who reported consuming any flavored tobacco product. This decline was primarily due to decreased use of flavored e-cigarettes. After the ban took effect, there was also a reduction in the use of other tobacco products, such as cigars and pipes.

In addition, the ban was associated with an increased likelihood of quitting e-cigarette use and an increase in the number of adults who reported trying to quit e-cigarettes. The authors conclude that, if supported by other interventions to help people quit smoking and e-cigarettes, a flavored tobacco ban would lead to significant public health benefits in both the short term (by reducing youth initiation of tobacco) and long term (by promoting early cessation and reducing subsequent tobacco consumption). Future research should continue to evaluate different structures of e-cigarette sales restriction policies at the local and state levels for optimal health impacts.