Flavored tobacco products have long played an important role in youth starting to use tobacco products and in the case of menthol keeping people, particularly Black Americans, addicted. According to CDC’s 2020 National Youth Tobacco Survey, over 80% of high school students and over 70% of middle school students who use e-cigarettes use a flavored product.1 And while 2020 data is not out yet, the 2019 National Youth Tobacco Survey found that close to 70% of youth tobacco users used a flavored product.2
Menthol cigarettes play a key role in addicting youth smokers and keeping people hooked. About half of youth smokers ages 12-17 smoke menthol cigarettes. Black Americans are disproportionately impacted with over 80% of Black persons who smoke using menthol cigarettes.3 Menthol cigarette use is also elevated among LGBTQ+ Americans, pregnant women and persons with lower incomes. A recent study showed that while overall cigarette use declined by 26% over the past decade, 91% of that decline was due to non-menthol cigarettes.4
Given the key role that flavors play in getting and keeping people addicted to tobacco products, and the lack of action by the federal government on the topic, a new grade was added to “State of Tobacco Control 2021” evaluating states on whether they have prohibited the sale of all flavored tobacco products. This new grade replaces the Minimum Age grade from “State of Tobacco Control” 2020 and earlier years. Grades are based on the strength of a state’s restrictions on flavored tobacco products with exemptions for certain products or in certain locations decreasing the grade.
Grades break down as follows:
the sale of all flavored tobacco products is prohibited;
the sale of most flavored tobacco products, including menthol cigarettes, is prohibited with some narrow exemptions;
the sale of all flavored tobacco products, including menthol cigarettes, is limited to over age 21 stores/locations;
the sale of one type of flavored tobacco product is completely prohibited (i.e. flavored e-cigarettes or flavored tobacco product restrictions that completely exempt menthol cigarettes);
No state law on flavored tobacco products or the sale of one type of flavored tobacco product restriction that exempts menthol.
There is one situation that creates an exception to the grading system:
- Local Ordinances: States without a statewide law or weaker statewide restrictions on flavored tobacco products may be graded based on local ordinances. Local ordinances that prohibit the sale of all flavored tobacco are considered according to the percentage of population covered in the state. States with over 95% of their population covered by local flavored tobacco product ordinances will receive an “A,” over 80% a “B,” over 65% a “C” and over 50% a “D.” Local ordinances that cover less than 50% of the population will not be considered for evaluation under this exception.
Wang TW, Neff LJ, Park-Lee E, Ren C, Cullen KA, King BA. E-cigarette Use Among Middle and High School Students — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1310–1312.
Wang TW, Gentzke AS, Creamer MR, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students —United States, 2019. MMWR Surveill Summ 2019;68(No. SS-12):1–22.
Substance Abuse and Mental Health Services Administration's public online data analysis system (PDAS). National Survey on Drug Use and Health, 2017.
Delnevo CD, Ganz O, Goodwin RD, Banning Menthol Cigarettes: A Social Justice Issue Long Overdue. Nicotine Tob Res, 2020 Oct 8;22(10):1673-1675. https://doi.org/10.1093/ntr/ntaa152
Page last updated: January 27, 2021