Flavored tobacco use among youth and young adults
Flavors play a significant role in drawing youth and young adults to tobacco products.
Federal law bans flavors in cigarettes — excluding menthol — but not in other tobacco products, such as smokeless tobacco, cigars, hookah and e-cigarettes. These products come in an array of candy, fruit, dessert and cocktail flavors, such as sour apple, cherry, grape, chocolate, strawberry margarita, appletini, piña colada, cotton candy and cinnamon roll. Flavored tobacco products also typically have bright, colorful packages and are often sold individually and cheaply, making them even more appealing to youth and young adults.
Research on national use patterns, perceptions, marketing and existing policies makes clear that the United States needs a ban on flavored tobacco products to protect public health.
Flavored Tobacco Product Use
Youth and young adults use flavored tobacco products more than other age groups. Additionally, flavored products are often the first tobacco products youth and young adults ever use.
- In 2014, an estimated 3.26 million middle and high school students in the U.S. used a flavored tobacco product in the past 30 days.
- Among students who reported they were currently using a tobacco product, 73 percent of high school students and 57 percent of middle school students reported using flavored products.
- Nearly 81 percent of youth ages 12 to 17 who had ever used a tobacco product reported that the first product they used was flavored.
- Four out of five youth who were current tobacco product users reported they used a flavored tobacco product.
- More than four out of five young adults ages 18 to 24 who have ever used tobacco reported that their first product was flavored.
- Flavored tobacco product use is higher in younger adults than in older adults.Nearly three-quarters — 72.7 percent — of young adult current tobacco users report flavored tobacco use, compared to just 28.6 percent of adults over 65.
- Among young adult non-cigarette tobacco users, 83.5 percent report that they use a flavored product. Hookah users reported the most flavored product use — with nearly 86 percent — followed closely by e-cigarette users with 85.2 percent.
Youth and Young Adult Perceptions of Flavored Products
Research shows that youth highly prefer sweet tastes and sweet odors, which may explain the appeal of flavored products, especially the most preferred flavor categories of fruit and candy. Youth and young adults perceive flavored tobacco products as more appealing, better tasting and less harmful than non-flavored tobacco products.
Flavors, especially sweet and fruit flavors, play a role in influencing tobacco use or experimentation in youth and young adults. For example, a 2016 study using a national sample of youth 13 to17 years old found that they were more likely to try menthol-, candy- or fruit-flavored e-cigarettes if a friend offered, compared to tobacco- and alcohol-flavored e-cigarettes. Youth also perceived fruit-flavored and menthol-flavored e-cigarettes as less harmful than tobacco-flavored e-cigarettes.
All e-cigarettes have a characterizing flavor, such as tobacco, menthol, fruit or candy. A 2014 study found nearly 8,000 e-cigarette flavors on the market. Additional evidence indicates that people view flavors as an attractive characteristic of e-cigarettes, and youth and adults cite flavors as a reason for e-cigarette use.
Youth who regularly use tobacco also report that flavoring is a leading reason for using a range of tobacco products. Among youth, non-cigarette users who had used a product in the last 30 days, a large majority cited flavoring as a primary reason they used the products.
Many hookah companies offer multiple flavors in their product lineup, which may entice hookah use among young people. A focus group of young adult hookah smokers showed that participants found the wide variety of hookah flavors appealing and liked that they could personalize their smoking experience by mixing and customizing flavors. Additionally, young adults perceive hookah as less harmful and less addictive than cigarettes.
Youth also may perceive cigars more favorably than cigarettes and consider cigars more natural, less harmful, cheaper and better smelling. The use of flavors in cigar products, including little cigars and cigarillos, may play a role in leading youth and young adults to believe that they are less harmful than cigarettes.
Marketing of Flavored Tobacco Products
Tobacco product manufacturers aggressively market flavored products in several ways, including emphasizing flavors in advertisements, paying to place them on store countertops, using colorful imagery on packaging and introducing new and limited-edition flavors.
The packaging and other marketing of flavored products, little cigars, cigarillos and e-cigarettes often emphasize their flavors with bright colors and descriptors such as “bold wintergreen,” “crisp apple” or “refreshing citrus.” Companies also release new, seasonal or limited-edition flavors, such as “harvest blend,” “summer fusion,” “sticky sweets” and “spiced rum.”
These flavored products are often found on counter tops, or next to candy displays, where they are visible and easily accessible to youth. While the 2009 Family Smoking Prevention and Tobacco Control Act requires that cigarettes and smokeless tobacco products be located behind the counter, the restriction does not apply to other tobacco products.
Companies have also increased their flavor offerings to attract new users. For example, a study of internal tobacco industry documents found that smokeless tobacco product manufacturers added flavors to their products to attract new users, especially young males. The proportion of magazines that included advertising for flavored smokeless products has also increased — it rose from 17 percent of magazines in 1998 to 71 percent in 2005.
Cigar manufacturers have also relied on flavors to increase the appeal of their products. After the release of the 1964 Surgeon General’s report focusing on the health effects of cigarette smoking, major cigar manufacturers aimed to increase the appeal of little cigars and cigarillos to cigarette smokers. They added flavors to these products to mask the harsh and heavy taste of cigar tobacco, reduce throat irritation and make the smoke easier to inhale. They also used flavors to make little cigars and cigarillos more appealing to new and younger smokers and to recruit women and minorities to become users of these products. In addition, manufacturers have made little cigars visually almost identical to cigarettes, including packaging them in the traditional 20-cigarette soft pack.
Truth Initiative® conducted several studies about the availability and marketing of cigars. One found that more than 80 percent of stores selling tobacco in Washington, D.C., sold little cigars and cigarillos, and of those stores that sold little cigars and cigarillos, 95 percent sold them in flavors such as fruit, candy and wine. A separate study of YouTube videos promoting little cigars and cigarillos found that they often advertised their candy flavors. A third Truth Initiative study of direct-to-consumer marketing of cigar products found that many of the advertisements featured flavored cigar products.
The Tobacco Control Act required the FDA Tobacco Products Scientific Advisory Committee (TPSAC) to conduct a review of menthol cigarettes’ effect on youth and other vulnerable populations. TPSAC published its report in March 2011, concluding that “the removal of menthol cigarettes from the marketplace would benefit public health in the United States.” In July 2013, the FDA published its own report, which came to a similar conclusion. At the same time, FDA requested public comment seeking additional information to help the agency make informed decisions about menthol in cigarettes. Four years later, in July 2017, the FDA announced that it would again request public comment on the role that menthol in tobacco products plays in attracting youth, as well as the role it may play in helping some smokers switch to potentially less harmful forms of nicotine delivery. This measure suggests that the FDA will not act on menthol for many months, and more likely, years to come.
Policy in the U.S.
The Tobacco Control Act gave the U.S. Food and Drug Administration the authority to regulate tobacco products. The law also prohibits the use of characterizing flavorings in cigarettes, except for menthol. Although the law gave the FDA the right to regulate all tobacco products, it did not specifically include non-cigarette tobacco products, such as cigars, little cigars, cigarillos, hookah and e-cigarettes, in the ban on characterizing flavors. Therefore, under current federal law, flavored smokeless tobacco, cigars, hookah and e-cigarette products are allowed on the market.
In 2016, the FDA indicated that it intends to extend the ban on flavored cigarettes (excluding menthol) to cigars, but to date the agency has taken no action. In July 2017, the FDA announced that it would request public comment to better understand the role that flavors in tobacco products play in attracting youth, as well as the role they may play in helping some smokers switch to potentially less harmful forms of nicotine delivery. However, no request for comment has been opened yet, and such a request for comment is not a guarantee of agency action.
STATE AND LOCAL POLICIES
Several states and localities have enacted laws to restrict the sale of flavored tobacco products.
In 2012, Providence, Rhode Island, became the first city to prohibit the sale of tobacco products with a characterizing flavor, including, but not limited to, the tastes or aroma relating to any fruit, chocolate, vanilla, honey, candy, cocoa, herb, spice, dessert or alcoholic beverage. The law exempts menthol, mint and wintergreen flavors. The tobacco industry sued to prevent this law from taking effect, and after a lengthy legal battle, a federal appeals court upheld the ordinance as a lawful exercise of local authority to regulate the sale of tobacco products.
In 2013, New York City prohibited the sale of tobacco products with a characterizing flavor. The law does not apply to e-cigarettes and does not include the flavors tobacco, menthol, mint or wintergreen. Using data on retail tobacco sales, a study found that sales of flavored tobacco products in New York City, excluding menthol tobacco products, decreased by 87 percent after the law went into effect. The research also found that in 2013, New York City youth aged 13 to 17 had 37 percent lower odds of ever trying flavored tobacco products than they did in 2010. Teenagers in New York Cityin 2013 also had 28 percent lower odds of ever using any type of tobacco product compared to teenagers in 2010.
Other states and localities have passed laws restricting the sale of flavored tobacco products, including communities in Massachusetts, California, Minnesota, Illinois and Maine.
- Ninety-seven municipalities in Massachusetts, including Boston, have restricted flavored tobacco products (other than menthol) to adult-only retail tobacco stores and smoking bars.
- Localities in California and Minnesota have restricted the sale of flavored tobacco products, excluding menthol, mint and wintergreen, including Hayward, Manhattan Beach, San Leandro and Sonoma in California; and Robbinsdale, Shoreview and St. Louis Park in Minnesota.
- El Cerrito, Yolo County, Santa Clara and Oakland, California, have prohibited the sale of flavored tobacco products, including menthol. Minneapolis and St. Paul, Minnesota, have prohibited the sale of flavored tobacco products except in adult- only tobacco stores and prohibited the sale of menthol, mint, wintergreen flavored products except in adult-only tobacco stores and liquor stores.
- Chicago has prohibited the sale of flavored tobacco products, including menthol, within 500 feet of city high schools. Berkeley, California, has prohibited the sale of flavored tobacco products, including menthol, within 600 feet of schools. Contra Costa County, California, has prohibited the sale of flavored tobacco products, including menthol, within 1,000 feet of a “youth-sensitive place,” including public and private schools, playgrounds, parks and libraries.
- Maine has banned the sale of cigars with candy, chocolate, vanilla, fruit, berry, nut, herb, spice, honey and alcoholic drink flavors. Premium cigars are exempt from the flavor ban.
Restricting the marketing of flavors, including menthol, that appeal to youth and young adults would have significant public health benefit. Given their well-documented appeal to youth, all flavors, including menthol, should be eliminated from all tobacco products, with the limited exception described below.
- The FDA must issue product standards eliminating flavors from all tobacco products. A narrow exception may apply to proven harm-minimized products where a manufacturer can demonstrate that the flavored product helps smokers completely switch from combustible tobacco to the harm- minimized product and show that it does not appeal to or attract youth (verified with careful post- market surveillance of actual usage patterns).
- Until a federal ban takes effect, state and local entities should enact policies prohibiting all flavors, including menthol, mint and wintergreen flavors, from tobacco products.
- The marketing of all flavored tobacco products should be restricted so that it does not target youth.