Menthol Tobacco Sales Restrictions at the Local Level: Community Perceptions, Lessons Learned, and Policy Evaluation

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2019

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Abstract

Menthol cigarettes are a significant public health concern. While sales of regular cigarettes have declined in recent years, menthol cigarette sales are increasing. Known for their minty taste and cooling effects, menthol cigarettes are a starter product for youth. The tobacco industry has a long history of predatory marketing to African Americans, who are more likely to smoke menthol cigarettes, have lower quit rates, and experience higher tobacco-related mortality than white smokers. Because flavored cigarettes are appealing to youth, the 2009 Tobacco Control Act banned the sale of flavored cigarettes; however, menthol was exempted. Due to federal inaction on menthol, localities are enacting restrictions to address this social justice issue.

 In 2017, Minneapolis, Minnesota was among the first U.S. jurisdictions to restrict menthol sales to tobacco shops and liquor stores. Grounded in the Social Ecological Model, this dissertation utilized multiple methods to increase our understanding of the experience and impact of the Minneapolis menthol policy.

 Study 1 examined African American adult smoker perceptions and found that many menthol smokers perceived menthol to be as harmful or more harmful than non-menthol cigarettes and emphasized the role of tobacco industry targeting to African American communities and youth. Participants also indicated mixed support for menthol policy restrictions. 

 Study 2 identified key factors that led to policy passage and included an in-depth assessment of critical steps in policy-making from policy formulation through adoption. The active engagement of youth and support of members of communities most impacted by menthol tobacco-related disparities were identified as critical to the policy’s successful adoption.  

 Study 3 evaluated the impact of the menthol policy on the retail environment and found reduced menthol availability and decreased menthol marketing at the point-of-sale two months following policy implementation. Unintended consequences of the policy were also observed; two tobacco shops were added to convenience stores and continued to sell menthol tobacco. 

 Results from these studies provide critical insights from several phases of the policy process. Findings can inform other jurisdictions around the country interested in pursuing menthol restrictions to reduce the burden of tobacco use and advance health equity for priority populations.

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