Areas for improvement include support of flavored tobacco ban to drive down youth tobacco use
Last week, The American Lung Association released its 19th annual “State of Tobacco Control” report, which reviews state and federal policies that prevent and reduce tobacco use. ALA reviewed state tobacco control efforts in the following areas: (1) funding for state tobacco prevention programs; (2) strength of smokefree workplace laws; (3) level of state tobacco taxes; (4) coverage and access to services to quit tobacco; (5) ending the sale of all flavored tobacco products. Ohio received only one “A” grade for smoke-free workplace laws; Ohio’s Smoke Free Workplace Act has been in effect since 2006. The report concluded that Ohio has several opportunities to encourage elected officials to enact evidence-based tobacco control policy. Ohio received three “F” grades for funding state tobacco prevention programs, level of state taxes, and ending the sale of all flavored tobacco products.
Examination of federal efforts yielded only slightly better evaluations; a single “F” for federal tobacco taxes, a “D” for federal government regulation of tobacco products, and two “A” grades for mass media campaigns and increasing the federal minimum age of sale for tobacco products to 21 (T21). While many local and state governments began implementing T21 policies over the past several years, former President Trump signed legislation in December 2019 amending the Federal Food, Drug, and Cosmetic Act, and raising the federal minimum age of sale of tobacco products from 18 to 21 years. It is now illegal for a retailer to sell any tobacco product—including cigarettes, cigars and e-cigarettes—to anyone under 21. The City of Cleveland implemented its T21 policy in 2016, and since that time, our research has shown that rates of past 30-day combustible tobacco use (cigarettes and cigar products) dropped from 26% in 2015 to 11.9% in 2019; rates of past 30-day e-cigarette use dropped from 15.5% in 2015 to 7.2% in 2019. Importantly, these declines were strong and consistent across racial/ethnic groups and gender.
While the promise of the impact of T21 policy is regarded as a win among tobacco control advocates, flavored tobacco products are still seen as a substantial threat to entice young users as replacement smokers. Since banning flavored cigarettes (excluding menthol) in 2009 legislation, the US FDA’s Center for Tobacco Products’ (CTP) regulatory action on addressing flavored non-cigarette products has been limited to a January 2020 policy limiting flavored cartridge-based e-cigarettes, such as fruit-flavored JUUL. FDA CTP must rely on existing research to inform its tobacco control policy, and to that end, FDA CTP partnered with NIH to build out a substantial research portfolio in tobacco regulatory science beginning in 2010. There has been a substantial investment in research related to flavored non-cigarette tobacco products, and we are contributing to this body of work with an R01 (Trapl, PI) using biobehavioral methods to measure how flavors impact appeal, attention, abuse liability and substitutability of cigarillos and e-cigarettes among young adult cigarillo users.
Tobacco control policy has historically followed a trend of local policy adoption followed by state adoption, and in some instances, federal adoption, as with T21. Several cities across the US have adopted flavored tobacco bans; Massachusetts and California have passed state policies. Here in Ohio, at least three large cities are considering a comprehensive flavored tobacco ban. With the growing body of research on the harms of flavored tobacco products, along with local, state and national advocacy groups advancing this issue, elimination of flavored tobacco might further drive down youth rates and ultimately the number of adult smokers in the US.
Erika Trapl, PhD
Associate Director for Community Outreach and Engagement, Case Comprehensive Cancer Center