A uniquely timed study that explored youth perceptions of menthol and other flavored tobacco product bans and begins to address important equity and policy gaps in tobacco control research.
The goal of this 18-month study (2019-2021), funded by the Robert Wood Johnson Foundation, was to understand how support for and barriers to passing and implementing comprehensive bans on the sale of menthol tobacco and flavored electronic nicotine delivery system (ENDS) products affects communities of color. Another goal was to understand the impact of proposed and implemented flavor bans on risk perceptions and tobacco use among youth and young adults of color. These issues have taken on even greater significance in the context of the COVID-19 pandemic, a respiratory illness that disproportionately affects communities of color, as well as the growing prominence of the social justice movements in the U.S. and related concerns around racism and policing.
At the start of our study, the U.S. Food and Drug Administration had recently provided guidance to only ban flavored cartridge or “pod”- based vape products, while not restricting other products containing menthol. Also, local government and community-level initiatives to ban flavored cartridge-based products were on the rise, believing that flavored products are marketed to and appeal to youth. All-in-all, these regulations did not restrict sales of menthol-flavored products (e.g., menthol cigarettes), which raised two broad concerns that warranted our research:
- African American and Latinx youth and young adults disproportionately use combustible tobacco products, mostly menthol cigarettes and flavored little cigars and cigarillos (LCCs), which was likely influenced by the historical and disproportionate marketing of menthol-flavored products to racial/ethnic minority populations. Thus, without comprehensive flavor bans that include menthol and other flavored combustible tobacco products, flavor ban policies may exacerbate disparities in tobacco use and tobacco related disease. This becomes even more salient in light of COVID-19, which, as a respiratory disease pandemic also disproportionately affects African American and Latinx communities.
- Flavor bans may result in reductions in vaping. However, given that partial flavor bans have typically excluded menthol, this may encourage the use of menthol ENDS products. In addition, in cases where there are full flavor bans that include menthol, this may encourage switching to non-menthol combustible products.
This study was participatory, mixed methods, and multi-modal. Our research included interviews with prominent tobacco control researchers and policy experts to assess and understand policy priorities, barriers, potential resources and pressing issues which were not currently assessed in national tobacco surveillance surveys. It also included surveys and focus groups with youth and young adults, aiming to ask questions that position us to make unique and timely contributions to understanding the impacts of flavored tobacco bans. Finally, our study conducted a social media analysis to measure broader messages on tobacco promotion, support, and opposition for menthol and flavor bans.
This research identified and began to address important equity and policy gaps in tobacco control research. The findings suggest several opportunities for supporting advocacy and developing communication strategies to bolster support for the FDA menthol ban, and ongoing efforts across the U.S. to enact comprehensive state and local flavored tobacco bans. Given the unfolding evidence that the tobacco industry will again position the menthol ban as discriminatory, it is significant that we found broad support for bans on flavored tobacco products, including menthol cigarettes by all races/ethnicities among young people.