San Francisco Bans Flavored Tobacco
On June 5th 2018, Proposition E, the ban on the sale of flavored tobacco, was affirmed with support from over 68% of San Francisco voters. This public health legislation had been unanimously adopted by the Board of Supervisors one year ago and enthusiastically signed by the late Mayor Ed Lee. The new law bans the local sale of flavored tobacco products including e-cigarette liquids, flavored little cigars, and menthol cigarettes. The law only affects retailers and does not criminalize the use of these products by individuals. Since the tobacco industry has historically targeted sales of flavored products to youth and communities of color, the law represents an important step in reducing health disparities and smoking incidence rates in San Francisco. Education and enforcement of the new law will be a collaborative effort, developed over the coming months, from programs under the Population Health Division of SFDPH including Environmental Health and the Tobacco Free Project. These efforts will include working with local retailers and community based organizations to support the transition. A planned educational campaign will focus on bringing awareness to the new law, the harms of flavored tobacco, and expanded resources for cutting back and quitting smoking.
Flavored Tobacco Products are Designed to Attract Youth
In 2009, the Family Smoking Prevention and Tobacco Control Act (FSPTCA) prohibited flavored cigarettes (for example, cherry cigarettes) on the case that it attracts youth, but did not ban flavoring in other tobacco products like cigarillos, electronic cigarettes, blunt wraps and chew (1-5). Now, these tobacco products come in over a variety of flavors like Cotton Candy, Banana Mash, Dragon’s Blood, and more, masking the harsh taste of tobacco products and making it appealing to young people.
In fact, there are over 15,000 e-liquid flavors for electronic cigarettes, ranging from candy to cereal to alcohol flavors , and flavored little cigars make up 80% of the cigar market share . Many of these flavors share the same packaging, logo and names as popular brands of candy, drinks, and other snacks.
The Tobacco companies package these products in bright colors and place them near candy, often at children’s eye-level, making it attractive to youth . These products are priced cheaper than cigarettes and come in small packages, making them low cost alternatives and affordable for young people . Little cigars or cigarrillos are packaged as singles at as low as 69 cents, doubles at 99 cents, and other other small packs for low price points . Flavored tobacco products are also sold at most tobacco retail stores– in San Francisco, 70% of tobacco retail stores near schools sell flavored tobacco products! 
What is being done to protect youth
In 2009, New York City passed a law prohibiting the sale of flavored tobacco in 2009, and a recent evaluation of their policy shows that there was a 20% decline in youth reported use of flavored tobacco products, a 37% decrease chance of youth ever trying a flavored tobacco product, and 28% decrease chance of youth using tobacco product. 
Several cities and counties in around the country, most notably in California, have since enacted laws to limit the sale of flavored tobacco products. These include:
Yolo County– complete prohibition of flavored tobacco products, including menthol cigarettes in unincorporated areas
City of Hayward- prohibit flavored tobacco products, include menthol cigarettes; applies only to new tobacco retailers within 500 feet from schools
Berkeley– prohibit flavored Tobacco, including menthol cigarettes; applies only to buffer zone 600 feet from private and public schools
Santa Clara County- prohibits flavored tobacco, including menthol cigarettes; exempts tobacco-only (adult only shops); applies only to unincorporated areas
Los Gatos City- Same as Santa Clara County
- City of Oakland – ban on the sale of all flavored products except in ‘tobacco stores’ where over 60% of their sales are from tobacco
- San Mateo County – unincorporated areas of the county have banned the sale of flavored tobacco products
- San Francisco – ban on the sale of all flavored tobacco products
Youth Use of Flavored Tobacco Products
80% of youth who use tobacco started with a flavored tobacco product.  Youth may mistakenly believe that cigars are less addictive and harmful than cigarettes, especially since flavors mask the harsh taste of tobacco and make it taste good and sweet [12, 13]. Young people are much more likely to use candy-and fruit-flavored tobacco products, like cigars, cigarillos and hookah, than adults . In fact, the US Surgeon General and the FDA have stated that flavored tobacco products are “starter” products for young people, establishing a long-term addiction to nicotine [5, 14]
In 2015, Breathe California’s Project E-nuff conducted a survey of high school students in San Francisco about their use and preference of tobacco products. Their survey shows that high school students use e-cigarettes, blunts/cigarillos, and hookah tobacco products over cigarettes; like flavored tobacco products because they taste good; and preferred flavored tobacco products. In fact, two-thirds of high school students who use blunts/cigarillos prefer flavored products and over half preferred flavored e-cigarette products. Check out their infographic (Chinese & Spanish) and website here.
Similarly, California Health Kids 2015-16 survey also show that among San Francisco 11th graders almost one-fourth (23%) have ever tried an electronic cigarette or vaping device while only 11% have ever tried a cigarette. E-cigarette use among youth is on the rise– in the 2013-14 survey, among San Francisco 11th graders only 16% have ever tried an electronic cigarette or vaping device while cigarette use stayed the same.
(Updated June 2018)
 21 U.S.C. § 387g.
 Carpenter CM, Wayne GF, Pauly JL, et al. 2005. “New Cigarette Brands with Flavors that Appeal to Youth: Tobacco Marketing Strategies.” Health Affairs. 24(6): 1601–1610
 Lewis M and Wackowski O. 2006. “Dealing with an Innovative Industry: A Look at Flavored Cigarettes Promoted by Mainstream Brands.” American Journal of Public Health. 96(2): 244–251
 Connolly GN. 2004. “Sweet and Spicy Flavours: New Brands for Minorities and Youth.” Tobacco Control. 13(3): 211–212;
 U.S. Department of Health and Human Services. 2012. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, p. 537, www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf.
Zhu, S.-H., et al., Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tobacco control, 2014. 23(suppl 3): p. iii3-iii9.
Federal Trade Commission (FTC). 1999. Federal Trade Commission Report to Congress on Cigar Sales and Advertising and Promotional Expenditures for Calendar Years 1996 and 1997. Washington, DC: Federal Trade Commission, www.ftc.gov/os/1999/07/cigarreport1999.htm.
Oregon Public Health Division, Flavored Tobacco: Sweet, Cheap, and Within Kids’ Reach, in CD Summary. 2014, Oregon Health Authority: Oregon.
 Delnevo, C.D. and M. Hrywna, “A whole ’nother smoke” or a cigarette in disguise: How RJ Reynolds reframed the image of little cigars. American Journal of Public Health, 2007. 97(8): p. 1368.
 San Francisco County, Healthy Stores for Healthy Community, 2017
Ambrose, B.K., et al., Flavored Tobacco Product Use Among US Youth Aged 12-17 Years, 2013-2014. JAMA, 2015: p. 1-3.
 Cullen, J., et al., Seven-year patterns in US cigar use epidemiology among young adults aged 18–25 years: a focus on race/ethnicity and brand. American Journal of Public Health, 2011. 101(10): p. 1955-1962.
 King, B.A., S.R. Dube, and M.A. Tynan, Flavored cigar smoking among US adults: findings from the 2009–2010 National Adult Tobacco Survey. Nicotine & Tobacco Research, 2013. 15(2): p. 608-614.
Food and Drug Administration, Fact Sheet: Flavored Tobacco Products. 2011.
Farley, S. M., & Johns, M. (2016). New York City flavoured tobacco product sales ban evaluation. Tobacco control, tobaccocontrol-2015.