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In June 2019, Beverly Hills, California, became the first American city in the 21st century to pass an ordinance ending the sale of most tobacco products, including cigarettes, and it is unlikely to be the last. Knowledge of previous efforts to ban tobacco sales in the US, both successful and unsuccessful, may help inform tobacco control advocates' approach to future efforts. We retrieved and analyzed archival tobacco industry documents. We confirmed and supplemented information from the documents with news media coverage and publicly available state and local government materials, such as meeting minutes and staff reports, related to proposed bans. We found 22 proposals to end the sale of cigarettes or tobacco products from 1969-2020 in the US. Proposals came from five states, twelve cities or towns, and one county. Most came from elected officials or boards of health, and were justified on public health grounds. In opposing tobacco sales bans, the tobacco industry employed no tactics or arguments that it did not also employ in campaigns against other tobacco control measures. Public health groups typically opposed sales ban proposals on the grounds that they were not evidence-based. This changed with Beverly Hills' 2019 proposal, with public health organizations supporting this and other California city proposals because of their likely positive health impacts. This support did not always translate into passage of local ordinances, as some city council members expressed reservations about the impact on small businesses. Tobacco control advocates are likely to encounter familiar tobacco industry tactics and arguments against tobacco sales ban proposals, and can rely on past experience and the results of a growing body of retail-related research to counter them. Considering how to overcome concerns about harming retailers will likely be vital if other jurisdictions are to succeed in ending tobacco sales.

Early contributions to this literature, many of which were first published in this journal, included Borland's regulated market model 1 ; Callard, Thompson and Collishaw's work on restructuring the industry so that it was incentivised to reduce consumption 2 ; and calls for phasing out smoked tobacco products through various approaches. 3-5 Others in this broad genre of work include Chapman's 6 call for licensing smokers, work on nicotine and other types of ingredient regulation to render cigarettes less or non-addictive, 7 8 and other 'big picture' ideas. 9 Increasingly, the idea that tobacco control is fundamentally a systems problem is becoming a part of global discussions. 10 Major tobacco control programme successes also suggest that changing what tobacco use (and the tobacco industry) means is foundational to ending the global pandemic. 11 12 In this issue, Gilmore and colleagues 13 argue that regulating prices of tobacco through capping of manufacturers' prices could reduce tobacco industry market power by eliminating manufacturers' ability to disguise price increases and achieve higher profits. Studies suggest there may be fairly strong support for ending tobacco sales. 18-20 Earlier work drawing on tobacco industry documents showed that the industry's own survey data from the early 2000s in the US suggested that a majority wished 'there were some way to eliminate cigarettes', supported banning cigarette advertising and felt that 'the right and responsible thing for cigarette companies to do would be to phase out of the cigarette business.'

This malign industry must not be allowed to influence clinicians’ learning

Tobacco retailers are key players in the ongoing tobacco epidemic. Tobacco outlet density is linked to a greater likelihood of youth and adult smoking and greater difficulty quitting. While public policy efforts to address the tobacco problem at the retail level have been limited, some retailers have voluntarily ended tobacco sales. A previous pilot study examined this phenomenon in California, a state with a strong tobacco program focused on denormalizing smoking and the tobacco industry. We sought to learn what motivated retailers in other states to end tobacco sales and how the public and media responded. We conducted interviews with owners, managers, or representatives of six grocery stores in New York and Ohio that had voluntarily ended tobacco sales since 2007. We also conducted unobtrusive observations at stores and analyzed media coverage of each retailer's decision. Grocery store owners ended tobacco sales for two reasons, alone or in combination: health or ethics-related, including a desire to send a consistent health message to employees and customers, and business-related, including declining tobacco sales or poor fit with the store's image. The decision to end sales often appeared to resolve troubling contradictions between retailers' values and selling deadly products. New York retailers attributed declining sales to high state tobacco taxes. All reported largely positive customer reactions and most received media coverage. Forty-one percent of news items were letters to the editor or editorials; most (69%) supported the decision. Voluntary decisions by retailers to abandon tobacco sales may lay the groundwork for mandatory policies and further denormalize tobacco. Our study also suggests that high tobacco taxes may have both direct and indirect effects on tobacco use. Highlighting the contradictions between being a responsible business and selling deadly products may support voluntary decisions by retailers to end tobacco sales.

Endgame thinking means transitioning from merely trying to ‘control’ the tobacco epidemic to developing plans and measures to bring it to an end within a specific time, by changing the underlying dynamics that have created and perpetuated it for more than a century. Among the innovative policies characterised as ‘endgame’ policies are so-called ‘tobacco-free generation’ or ‘smoke-free generation’ policies, which prohibit sales of some or all tobacco products to individuals born on or after a particular date. Such birthdate-based sales restrictions (BSR) have intuitive appeal, largely because they do not appreciably disrupt the status quo of retail sales, which continue unchanged for all those born before the designated cut-off date. They also hold the potential for further denormalising tobacco use and sales by anticipating the long-term end of tobacco sales. In this Special Communication, we analyse BSR policies through an endgame lens and propose questions that should be discussed in jurisdictions considering them. We suggest that this policy has potential underexamined pitfalls, particularly related to equity, and that if enacted, it should include policy guardrails and be part of a package of endgame measures.

Titus et al 1 conducted a study using census data to explore disparities in smoking rates and exposure to tobacco control policies (smoke-free laws and televised anti-tobacco campaigns) among sexual minority adults. [...]a Canadian study examining changes in secondhand smoke exposure before, during and after a 2015 population tobacco control measure that extended smoke-free laws found that among groups of different income and education levels, exposures among all groups decreased across time periods but the magnitude of inequalities in exposure did not change.5 Given these persistent disparities, it is important to consider prioritising public health interventions that not only reduce smoking overall, but also contribute to reducing the disparities themselves. The well-known ‘Tobacco Control Vaccine’ model (comprising price increases, smoke-free policies, hard-hitting media campaigns and cessation resources) is extended with a ‘booster’ in an analysis by Kong and King9 which highlights the retail environment, the topic of another set of interesting papers in this issue that further extends the growing literature on the role of tobacco retailers in tobacco disparities. [...]Mills et al 13 offer practical lessons in why it is crucial to invest time in building trusting relationships across communities affected by social, economic and racial inequities before asking them to support policy change.

Musing on Twitter about the ongoing struggles within the tobacco control community over the role and regulation of newer tobacco and nicotine products, I observed recently that it would be so much easier to find consensus on those issues if the tobacco industry would just stay out of it. What if those working in public health could agree among ourselves that the number one goal—the very top priority—should be addressing the structural, political and social dynamics that sustain the tobacco epidemic, all of which have industry disease-promoting activities at their root? Then we might find some unanimity in eradicating the industry’s influence and reducing the harm caused by its products while doing more to eliminate the most well-researched, most marketed and most deadly commercial tobacco products rather than arguing endlessly over the science and public health regulatory implications of multiple types of e-cigarettes, heated tobacco products and various new nicotine products.

In the late 1990s, American tobacco companies began offering limited cessation assistance to smokers by posting links on their company websites to government-sponsored smoking cessation resources. Philip Morris USA (PM) went further, funding youth cessation programs and creating its own online cessation program, QuitAssist. We explore why PM entered the cessation arena, and describe the variety of options considered and how PM-supported cessation programs were evaluated and promoted. We retrieved and analyzed archival PM documents from 1998-2005. We supplemented information from the documents with scholarly articles assessing QuitAssist and archived versions of the PM and QuitAssist websites. PM's Youth Smoking Prevention department began funding youth cessation projects and programs soon after its creation in 1998, motivated by the same issue that drove its interest in youth smoking prevention: regulatory threats posed by public and policymaker concern about youth smoking. The department took a similar approach to youth smoking cessation as it did with prevention, rejecting curricula with \"anti-industry\" themes. In 2002, a \"cessation exploration team\" examined a variety of rationales for and approaches to company support for adult smoking cessation. Ultimately, PM chose QuitAssist, a limited and less expensive option that nonetheless provided opportunities for engagement with a variety of public health and government officials. Independent research indicates that QuitAssist is not an effective cessation tool. While the transformation of ambitious plans into a mundane final product is a recurring theme with PM's corporate responsibility efforts, it would be inappropriate to dismiss PM's smoking cessation endeavors as half-hearted attempts to appear responsible. Such endeavors have the potential to inflict real harm by competing with more effective programs and by helping to maintain a tobacco-favorable policy environment. If PM truly wanted to support cessation, it could drop legal and other challenges to public policies that discourage smoking.