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Background According to the National Alcohol Beverage Control Association, twelve states in the United States (U.S.) have government retail monopolies on spirits/liquor sales. With a new federal minimum legal sales age for tobacco (raised from 18 to 21, the minimum legal sales age for alcohol), we examine possible unintended consequences of a hypothetical policy change restricting retail tobacco sales to state-run spirits/liquor stores in alcohol control states, which has been proposed as a tobacco endgame strategy. Methods We used cross-sectional survey data from 14,821 randomly-selected adults ages 21 and older who responded to the 2015 or 2020 U.S. National Alcohol Survey (51.8% female; 65.8% identified as non-Hispanic White, 12.4% as Black or African American, 14.2% as Hispanic or Latinx; 34.0% had a low level of education), including 2,274 respondents (18.9%) residing in one of the alcohol control states (representing 42.2 million (M) adults ages 21+). We estimated associations between tobacco measures (lifetime smoking status, lifetime daily smoking, past-year daily smoking) and alcohol measures (drinking status, beverage choices, lifetime alcohol use disorder (AUD) status, recovery status) overall and for specific subgroups. Results In control states, 55.1% of people who smoked daily in the past year also reported lifetime AUD, including an estimated 3.56 M adults ages 21 + who reported prior (but not current) AUD. The association of daily smoking with lifetime AUD was stronger among those with low education compared to those with higher education. Further, 58.8% of people in recovery from an alcohol and/or drug problem (1.49 M adults ages 21+) smoked daily, and this was more marked among women than men in control states. Conclusion There could be negative consequences of an endgame strategy to restructure tobacco retail sales, including increased risk for relapse to drinking among people who smoke daily, especially among women and people with low levels of education. Strategies to mitigate unintended harms would be needed if such a policy were implemented.

ObjectiveSan Francisco’s comprehensive restriction on flavoured tobacco sales applies to all flavours (including menthol), all products and all retailers (without exemptions). This study evaluates associations of policy implementation with changes in tobacco sales in San Francisco and in two California cities without any sales restriction.MethodsUsing weekly retail sales data (July 2015 through December 2019), we computed sales volume in equivalent units within product categories and the proportion of flavoured tobacco. An interrupted time series analysis estimated within-city changes associated with the policy’s effective and enforcement dates, separately by product category for San Francisco and comparison cities, San Jose and San Diego.ResultsPredicted average weekly flavoured tobacco sales decreased by 96% from before the policy to after enforcement (p<0.05), and to very low levels across all products, including cigars with concept-flavour names (eg, Jazz). Average weekly flavoured tobacco sales did not change in San Jose and decreased by 10% in San Diego (p<0.05). Total tobacco sales decreased by 25% in San Francisco, 8% in San Jose and 17% in San Diego (each, p<0.05).ConclusionsSan Francisco’s comprehensive restriction virtually eliminated flavoured tobacco sales and decreased total tobacco sales in mainstream retailers. Unlike other US flavoured tobacco policy evaluations, there was no evidence of substitution to concept–flavour named products. Results may be attributed to San Francisco Department of Health’s self-education and rigorous retailer education, as well as the law’s rebuttable presumption of a product as flavoured based on manufacturer communication.

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.

BackgroundIn 2018, Minneapolis and St. Paul, Minnesota, expanded existing local sales restrictions on flavoured (non-menthol/mint/wintergreen) tobacco products (‘flavour policies’) to include menthol/mint/wintergreen-flavoured tobacco products (‘menthol policies’). All policies included exemptions for certain store types.MethodsWe obtained weekly retail tobacco product sales for 2015 through 2019 from NielsenIQ for convenience stores and other outlets in the policy jurisdictions and two comparison areas (rest of the state of Minnesota and total USA). We standardised unit sales across product categories and used NielsenIQ-provided descriptors to classify products as menthol (including mint/wintergreen) or flavoured (non-menthol/non-tobacco). Using single group interrupted time series models, we analysed unit sales by product category and by flavour separately for each geography to assess associations between menthol policy implementation and trends in tobacco product unit sales.ResultsFollowing menthol policy implementation, unit sales of menthol cigarettes and menthol smokeless tobacco decreased in both cities, with smaller decreases in comparison areas. Flavoured cigar sales—which decreased following the flavour policies—further decreased after the menthol policies, while sales of menthol electronic nicotine delivery systems (ENDS) increased in both cities and sales of flavoured ENDS increased in St. Paul.ConclusionExpanding flavour policies to include menthol/mint/wintergreen was associated with significant decreases in unit sales of most menthol products and in total unit sales by tobacco product category. Increases in menthol and flavoured ENDS sales in these cities may be associated with legal sales by exempted retailers and/or illicit sales by non-compliant retailers, highlighting opportunities for retailer education and enforcement.

Objectives. To assess exposure to marijuana advertising in Oregon after the start of retail marijuana sales in October 2015. Methods. We conducted a repeated cross-sectional online survey of 4001 Oregon adults aged 18 years and older in November 2015 and April–May 2016. We assessed subgroup differences by using the Pearson χ 2 test. Results. More than half of adults (54.8%) statewide reported seeing marijuana advertising in the past month. These adults reported that they most frequently saw storefront (74.5%), streetside (66.5%), and billboard (55.8%) advertising. Exposure did not significantly differ by participant’s age or marijuana use but was higher among those living in counties with retail sales (56.5%) than in counties without (32.5%). Conclusions. Most adults reported exposure to marijuana advertising following the start of retail marijuana sales in Oregon. People who do not use marijuana and those aged 18 to 24 years were as exposed to advertising as other groups. Public Health Implications. Advertising restrictions may be needed to protect youths and young adults from pro-use messages. Commercial free speech afforded by the First Amendment makes advertising restrictions challenging, but public policy experts note that restrictions aimed at protecting youths may be allowed.

IntroductionCigar sales have increased in the USA in recent years. A growing proportion of cigar sales are of flavoured varieties, many bearing ambiguous or ‘concept’ flavour descriptions (eg, Jazz). This study assessed US cigar sales by flavour category (ie, concept flavoured, characterising flavoured and tobacco), at national, regional and state levels.MethodsSales of cigarillos, large cigars and little cigars from chain, franchise and convenience stores, mass merchandisers, supermarkets, drug, dollar and club stores, and military commissaries during 2012–2016 were acquired from the Nielsen Company. US national-level and state-level sales, including District of Columbia, were analysed by flavour category. Flavour descriptors were classified as ‘tobacco', ‘characterising’ or ‘concept', based on Universal Product Code (UPC)-linked characteristics and brand website and consumer review descriptions.ResultsCigar sales increased by 29% during 2012–2016, driven by a 78% increase in cigarillo sales. The proportion of concept-flavoured sales increased from 9% to 15%, while the proportion of sales decreased for tobacco (50% to 49%) and characterising flavours (eg, cherry) (41% to 36%). Cigarillos had the greatest increase in unique concept flavour descriptions (17 to 46 unique UPCs), with most sales occurring among Sweet, Jazz and Green Sweets concept flavours. By US region, total and concept-flavoured cigarillo sales were highest in the South.ConclusionsFlavoured cigars are increasingly labelled with concept flavours, including in areas with flavoured tobacco sales restrictions. Cigarillos are driving recent increases in US cigar and concept-flavoured cigar sales. It is important to consider concept flavours when addressing flavoured tobacco product sales and use.

ObjectivesComprehensive tobacco control policies with minimal exemptions can reduce tobacco use and sales. Many states and localities have adopted flavoured tobacco product (FTP) sales restrictions. This study describes the development and application of a schema to characterise the comprehensiveness of these FTP sales restrictions.DesignWe coded state and local FTP sales restrictions enacted June 2007–March 2021 for retailer, tobacco product, and flavour inclusions and exemptions. Guided by FTP literature, legal resources and meetings with FTP policy experts, we developed a six-level classification scheme to characterise coded FTP policies from least to most comprehensive. We present descriptive statistics of FTP policy features and comprehensiveness.ResultsAs of 31 March 2021, 7 state-level and 327 local-level FTP sales restrictions were enacted in the USA. Most state-level policies (71.4%) were categorised in the second lowest comprehensiveness category; local policies most commonly fell within the lowest (48.9%) or highest (26.0%) comprehensiveness categories. Across jurisdictions, adult-only retailers were most frequently exempted from the FTP sales restrictions (state: n=1, 14.3%; local: n=184, 56.3%); and most jurisdictions included electronic cigarettes (e-cigarettes) as a banned product (state: n=6, 87.5%; local: n=327, 100%). While just over half of state (n=4, 57.1%) and local (n=169, 51.7%) sales restrictions included menthol e-cigarettes, most excluded menthol cigarettes and/or menthol smokeless tobacco.ConclusionsComprehensiveness of FTP sales restrictions in the USA varies widely. Current and future FTP policies would be strengthened by including all flavours and all tobacco products—particularly menthol cigarettes—and by avoiding exemptions for certain retailers, particularly adult-only retailers.

BackgroundIn December 2022, California became the second US state to put into effect a sales restriction on most flavoured tobacco products, including menthol cigarettes and flavoured e-cigarettes. This study explored tobacco retailers’ experiences with the statewide sales restriction across four Northern California jurisdictions with large Black communities.MethodsWe conducted structured interviews with 25 store owners and managers at tobacco retailers from July to September 2023. These occurred in four Northern California jurisdictions, three without an existing local flavoured tobacco sales restriction (Elk Grove, Stockton, Modesto) and one with (San Jose). Interviews were digitally recorded, transcribed and analysed using a thematic content analysis approach.ResultsMost (n=23) individuals owned or managed a tobacco specialty shop. We identified three main themes about retailers’ experiences: (1) challenges understanding how to comply with the sales restriction, due to a lack of concrete and consistent government information; (2) the restriction’s impact on business and customers, including selling new products (eg, anime plushies and glassware) and concerns that customers would purchase flavoured products elsewhere (eg, online or in another state) and (3) willingness to comply—most retailers reported attempting to comply with the restrictions, despite a lack of enforcement.ConclusionsRetailers reported that the sales restrictions had reduced overall flavoured tobacco product sales, which distressed businesses and customers. Retailers sought clearer guidance on products they could sell and requested assistance with transitioning away from selling flavoured tobacco.

In June 2020, Massachusetts implemented a first in the nation statewide law that restricts sales of menthol and other flavored tobacco. Since implementation, sales data indicate high retailer compliance. Drastic decreases were seen in sales of all flavored tobacco. Most neighboring states did not see increases in overall tobacco sales, although New Hampshire saw an initial increase in menthol sales, which was not sustained. We found that menthol restrictions are effective and that federal-level legislation is important, as some cross-border sales highlight. (Am J Public Health. 2022;112(8):1147–1150. https://doi.org/10.2105/AJPH.2022.306879 )

PurposeThis study compares access to flavoured JUUL and other e-cigarettes from retail, online and social sources among underage and young adult e-cigarette users who live in California jurisdictions that restrict sales of flavoured tobacco with the rest of the state.MethodsAn online survey used social media advertisements to recruit participants (n=3075, ages 15–29) who lived in one of nine jurisdictions that restrict sales (n=1539) or in the rest of state, and oversampled flavoured tobacco users. Focusing on past-month e-cigarette users (n=908), multilevel models tested whether access to flavoured JUUL and other e-cigarettes from retail, online and social sources differed by local law (yes/no) and age group (15–20 or older), controlling for other individual characteristics.ResultsThe percent of underage users who obtained flavoured JUUL and other e-cigarettes in the past month was 33.6% and 31.2% from retail, 11.6% and 12.7% online, and 76.0% and 70.9% from social sources, respectively. Compared with underage and young adult users in the rest of California, those in localities that restrict the sales of flavoured tobacco were less likely to obtain flavoured JUUL from retail sources (Adjusted OR=0.54, 95% CI 0.36 to 0.80), but more likely to obtain it from social sources (Adjusted OR=1.55, 95% CI 1.02 to 2.35). The same pattern was observed for other brands of flavoured e-cigarettes.ConclusionAlthough local laws may reduce access to flavoured e-cigarettes from retail sources, more comprehensive state or federal restrictions are recommended to close the loopholes for online sources. Dedicated efforts to curtail access from social sources are needed.