Restricting Sales of Menthol Tobacco Products: Lessons Learned from Policy Passage and Implementation in Minneapolis, St. Paul, and Duluth, Minnesota

Abstract

Purpose: Commercial tobacco products have historically been target marketed to African American, Latinx, Asian American Pacific Islander, Indigenous, and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) communities, as well as to youth. Menthol cigarettes increase smoking initiation and decrease smoking cessation, particularly among African Americans who smoke menthol cigarettes at higher rates than their white peers. Due to disproportionate tobacco-related health consequences for members of these communities, effective tobacco control policies that restrict availability of menthol products by focusing on retail sales are an important element of addressing health disparities, and require policy efforts informed by leadership and the voice of communities most impacted. This study examines the organizing efforts of three successful policy initiatives in 2017-2018 in Minneapolis, St. Paul, and Duluth, Minnesota, and identifies facilitators and barriers of these campaigns. Methods: We conducted 50 key informant interviews with city council/staff, advocates, and community members and analyzed them for emerging themes. The analysis employed a process-oriented qualitative matrix process to identify emerging themes and divergent perspectives. Results: Following policy implementation, outlets selling commercial menthol tobacco products substantially decreased. Facilitators included strong city council support, leadership from impacted communities, community awareness-building campaigns, and understanding tobacco industry counter-tactics. Challenges included the need to counter tobacco industry misinformation and retailer attempts to circumvent the intent of restrictions. Conclusion: Well-planned advocacy campaigns led by community members most impacted by commercial tobacco can overcome opposition and challenges to restrict sales of menthol tobacco products and successfully reduce availability of these products in their communities.

A Comprehensive Qualitative Review of Studies Evaluating the Impact of Local US Laws Restricting the Sale of Flavored and Menthol Tobacco Products

“…Our review highlights the need for a comprehensive study of the association between policy mechanisms (e.g., policy provisions, exemptions, implementation actions, and challenges) and outcomes, which could provide evidence-based guidance for improving policy development and implementation, 51 , 52 especially to address endemic health inequities associated with target marketing of flavored and menthol tobacco products. 8 , 53 , 54 Indeed, few studies have specifically assessed the health equity impacts of sales restrictions among population groups who disproportionately suffer from tobacco-related disease and death, such as Black Americans. 55 Recent studies that have investigated health equity impacts of flavored and menthol sales restrictions reveal, for example, that: (a) the rationale for menthol tobacco sales restrictions was not well-understood or universally supported by African American smokers in Minneapolis and St. Paul, MN 56 ; (b) compared to White, non-Hispanic youth, Black, Hispanic, Asian, and LGBTQ youth in various California localities with flavor policies reported greater difficulty in accessing policy-restricted flavored tobacco products 57 ; and (c) Black young adults in San Francisco were more likely than other young adults to continue using flavored cigars after implementation of the flavored and menthol sales restriction in that city.…”

The commercial determinants of Indigenous health and well-being: a systematic scoping review

“…37 48 Tobacco industry Fifteen articles focused on the tobacco industry. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] These predominately covered marketing, including direct-to-consumer marketing targeting Indigenous populations and/or the use of traditional Native American imagery in tobacco advertisements. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] For example, 'Red Man', a racist slur, is a popular chewing tobacco in the USA and 'Native American Spirit' cigarette company use American Indian imagery on its packaging.…”

Expanding local sales restrictions on flavoured tobacco products to include menthol: retail sales changes in two Minnesota cities

“…Although unit sales of flavoured and menthol tobacco products following both the flavour and menthol policies decreased significantly, sales did not go to zero. This may reflect a combination of flavoured and menthol products sold legally by retailers exempted from the policy and illicitly by non-exempt retailers 31. Sales of certain restricted products increased after the implementations of menthol policies—specifically, flavoured and menthol ENDS (eg, blackberry prefilled cartridges, cool menthol disposable ENDS, strawberry e-liquid, glacier mint prefilled cartridges).…”