A new study recently published in the journal Tobacco Control found that menthol sales restrictions in four Minnesota cities resulted in significantly reduced availability and reduced interior menthol marketing at the point of sale. The study compared the availability of menthol-flavored commercial tobacco products and menthol marketing materials in multiple stores approximately two months before and after policy implementation in Minneapolis, St. Paul, Duluth and Falcon Heights.
In 2017 and 2018, four Minnesota cities were among the first in the country to restrict the sale of menthol tobacco to adult-only stores. Minneapolis, St. Paul, Duluth and Falcon Heights passed ordinances restricting the sale of menthol, mint, and wintergreen tobacco – including e-cigarettes – to adult-only tobacco shops and, in Minneapolis and St. Paul, liquor stores. These policies were intended to reduce youth access and address tobacco-related health disparities by limiting menthol sales to fewer retail outlets.
“We know that the tobacco industry has a long history of targeting youth, African American and LGBTQ communities with menthol tobacco. Policies that restrict menthol tobacco products can help address these tobacco-related disparities and protect youth from nicotine addiction,” said Joanne D’Silva, Ph.D., ClearWay Minnesota’s Director of Health Equity Research and lead author of the study.
Funded by ClearWay Minnesota and the Center for Prevention at Blue Cross and Blue Shield of Minnesota, the study utilized a data collection platform called Streetwyze to examine the availability and marketing of menthol tobacco in the four Minnesota cities. Researchers also assessed tobacco retailer compliance with the policy. After the policies went into effect, data collectors found all the stores visited in St. Paul and Falcon Heights had stopped selling menthol tobacco. Compliance was not universal, however, as researchers found one Duluth store and seven Minneapolis stores were still selling menthol tobacco. The study authors hope that their findings can inform other jurisdictions pursuing flavored tobacco policy, as well as the U.S. Food and Drug Administration regulatory action on menthol tobacco to reduce the burden of commercial tobacco use.
While compliance of the menthol restrictions among retailers was high in all four cities, challenges remain. Data collectors noted some stores attempted to circumvent the menthol restrictions by creating separate tobacco shops within a convenience store. In addition, a separate density study noted the number of tobacco shops in Minneapolis doubled after the menthol ordinance went into effect.
“Commercial tobacco use continues to be the leading cause of preventable disease and death in Minnesota. Ending the sale of menthol commercial tobacco is an important step in advancing health equity in all Minnesota communities,“ said Dr. Mark Steffen, Vice President and Chief Medical Officer at Blue Cross and Blue Shield of Minnesota.
Despite progress to reduce commercial tobacco’s harm, the state continues to face major tobacco-related challenges that affect the health and pocketbooks of all Minnesotans, including the youth e-cigarette epidemic and ongoing tobacco-related health disparities. While adult and youth cigarette smoking is at historic lows, the 2019 National Youth Tobacco Survey found that 57 percent of high school e-cigarette users use menthol or mint flavors.
The burden of commercial tobacco addiction and disease also remains unconscionably high in some communities, in large part because menthol tobacco products have been heavily marketed toward African Americans, LGBTQ, youth and other populations. Among African American smokers – who have been targeted by aggressive advertising in Black magazines and neighborhoods and other tactics – 88 percent smoke menthol, compared to 22 percent of white smokers. The exclusion of menthol tobacco in a federal 2009 ban on flavored cigarettes has institutionalized these disparities and cost precious lives. According to a separate research study, if menthol had been banned when all other cigarette flavors were disallowed, by 2050 there would be an estimated 10 percent reduction in overall smoking prevalence and up to 633,252 lives would be saved, a third of whom would be African Americans.
“Bold policies in commercial tobacco control have driven down smoking rates, saved thousands of lives and billions of dollars in medical costs and productivity, but we still have much work to do especially among communities disproportionately harmed by commercial tobacco,” said David Willoughby, ClearWay Minnesota’s Chief Executive Officer. “We hope that Minnesota’s experience and research will inform and inspire other communities to take action on menthol tobacco. We urge lawmakers at all levels to end the sale of all flavored tobacco products – especially menthol – to improve the health of Black communities and protect youth.”
ClearWay Minnesota presented five webinars in 2020. The webinars highlighted our work over the past 20 years with the goal of sharing lessons learned that others could apply to their efforts to reduce commercial tobacco use. Recordings and slides from presentations in the series are posted below.
Marketing Evolution in Tobacco Control
Mike Sheldon, Director of Marketing
Presented September 23, 2020
Over the last 20 years, ClearWay Minnesota and our marketing partners produced numerous award-winning media campaigns. The outreach and message changed significantly over the years, but the ultimate goal of each campaign remained the same – change attitudes and motivate behaviors. This webinar will provide highlights of ClearWay Minnesota’s advertising campaigns, plus insight into the evaluation process that informed changes to future campaigns.
Learnings from 10+ Years of Funding Local Policy Grants
Alexis Bylander, M.S., Senior Public Affairs Manager
Presented September 17, 2020
ClearWay Minnesota is a statewide life-limited nonprofit organization that it at the end of its lifespan. Passing bold impactful policies that reduce tobacco use and exposure to secondhand smoke has been a core mission of the organization. For over ten years, the organization funded a cohort of local policy grants aimed at passing strong local and state policies. Join this webinar to learn how the program was structured, the outcomes achieved and lessons learned from a decade of funding public education, coalition building and policy advocacy.
LAAMPP Institute: Advocacy Leadership Beyond the Fellowship
CoCo Villaluz, Associate Director of Health Equity Programs (with Ani Ryan Koch, Vayong Moua and Sandy Johnson)
Presented August 19, 2020
The Leadership and Advocacy Institute to Advance Minnesota’s Parity for Priority Populations (LAAMPP) is a cross-cultural leadership program designed to build the capacity of Minnesota’s priority populations to effectively respond to tobacco control and health justice issues. Priority populations are defined here as the Black (African and African American), American Indian, Asian American and Pacific Islander, Latinx, and Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) communities. Historically, priority populations have been underrepresented within the mainstream tobacco control movement and are disproportionately impacted by commercial tobacco. Former LAAMPP Fellows and Coaches will highlight lessons learned during their fellowship to their work they are currently doing now. Highlights from their cohorts and policy successes will be shared.
Nineteen Years of Helping Minnesotans Quit
Randi Lachter, M.P.H, Director of Tobacco Treatment Programs
Presented July 29, 2020
Strategies for helping people quit commercial tobacco have changed over the past 19 years, from a focus solely on treatment delivery to a comprehensive, population-based approach that better fit commercial tobacco users’ needs and included treatment, systems change, community engagement and policy. This webinar will provide a brief history of that evolution, discuss how we implemented this approach and report how we measured our impact. Lessons learned will also be discussed.
Operation Impact: How to Set Goals, Measure Change and Leave a Legacy
Ann St. Claire, M.P.H, Director of Evaluation and Survey Research
Presented July 16, 2020
ClearWay Minnesota was challenged to address the harms of tobacco on the people of Minnesota over 25 years with $200 million. As a life-limited organization, we have saved Minnesota thousands of lives and billions of dollars. In this webinar, we will highlight key steps ClearWay Minnesota took to set long-term goals, monitor progress and ultimately leave a legacy of change. These strategies can be useful to other organizations or initiatives seeking to define success and achieve meaningful impact.
Today, Minnesotans for a Smoke-Free Generation, a coalition of 60-plus organizations co-chaired by ClearWay Minnesota, released the following statement on the recent legal action against the U.S. Food & Drug Administration:
Ending Menthol Tobacco Sales Will Protect the Health and Lives of African Americans
Minnesotans for a Smoke-Free Generation Urges Local, State and Federal Action to Prohibit the Sale of Menthol and All Flavored Tobacco Products
This week, the African American Tobacco Control Leadership Council (AATCLC) and Action on Smoking and Health (ASH) announced a joint complaint against the U.S. Food and Drug Administration (FDA) to compel the FDA to ban the sale of menthol tobacco products. Minnesotans for a Smoke-Free Generation supports this bold action and urges all levels of government to protect the health and lives of African Americans by ending the sale of menthol tobacco products.
African Americans are unjustly affected by the addiction, death and disease associated with menthol tobacco use – a result of decades of targeting by the tobacco industry. Since 2010, menthol has been the only flavor of cigarette allowed on the U.S. marketplace, despite conclusive evidence that menthol tobacco causes great harm, especially among African Americans.
In announcing their lawsuit, national partners said:
“We stand before you today to announce that we are suing the United States Food and Drug Administration for their failure to implement public health policy that protects the health and welfare of African Americans with respect to menthol cigarettes,” said Carol McGruder, founding member and Co-Chair of the AATCLC. “Our mission is to save the 45,000 Black lives lost each year from tobacco-induced diseases and we have resolutely pursed that mission since our inception.”
“By continuing to delay, the FDA and the U.S. government are failing to protect the health of U.S. citizens, particularly African Americans, and the U.S. is also falling behind the global trend as countries around the world are increasingly banning menthol,” said Kelsey Romeo-Stuppy, Managing Attorney at ASH.
Minnesotans for a Smoke-Free Generation, a coalition of more than 60 organizations that share a common goal of reducing youth smoking and ending tobacco’s harm for good, supports action to end the sale of flavored tobacco products – especially menthol products. The coalition is working to pass bold flavored tobacco restrictions in local communities and in the State Legislature. The current focus on Black lives and Black health – as well as the COVID-19 pandemic – adds urgency to these efforts.
“Prohibiting menthol tobacco products is one of the biggest steps we can take to improve the health and livelihood of Black people,” said LaTrisha Vetaw, Health Policy and Advocacy Manager for NorthPoint Health & Wellness Center and Co-Chair of the Menthol Coalition. “As we celebrate Juneteenth, let’s channel our energy toward protecting our Black brothers and sisters from menthol tobacco and a lifetime of addiction and suffering. The tobacco industry has targeted African Americans for far too long, and we can take that tool away by eliminating menthol tobacco products.”
Despite all Minnesota’s progress to reduce smoking among youth and adults, smoking remains the leading cause of preventable death and disease. Menthol flavoring makes it easier for kids to start smoking and harder for adults to quit. Fourteen percent of Minnesota adults still smoke and every year smoking kills more than 6,300 Minnesotans and costs residents over $7 billion in health care and lost productivity. The burden of tobacco use and disease remains unconscionably high in diverse communities, in large part because menthol tobacco products have been heavily marketed toward African Americans, LGBTQ, youth and other priority populations. Among African American smokers, 88 percent smoke menthol, compared to 22 percent of white smokers.
The FDA’s refusal to include menthol tobacco in its flavor ban is exacerbating these disparities and costing precious lives. Research estimates that if menthol had been banned in 2010 when all other flavors were disallowed, by 2050 there would be a 10 percent reduction in overall smoking prevalence and up to 633,252 lives would be saved, a third of whom would be African Americans.
In the absence of federal action, states and local governments have stepped up to protect their residents from menthol tobacco and other flavored products. Earlier this week, the City of Edina passed a policy to prohibit the sale of all flavored tobacco products. Edina is the fifth Minnesota community to completely prohibit the sale of all flavored tobacco products – joining Golden Valley, Mendota Heights, Lilydale and Arden Hills. In total, 16 Minnesota communities have restricted flavored tobacco products in some form including major cities – St. Paul, Minneapolis and Duluth – that restrict where menthol cigarettes can be sold.
Tobacco companies have shown that they will fight tooth and nail to block progress to protect residents from menthol tobacco. Just this week, Big Tobacco filed a suit against the City of Edina for passing a bold public health policy that prohibits menthol tobacco sales to save lives and reduce tobacco-related health disparities.
At the State Capitol, a bill to end the sale of all flavored tobacco products in Minnesota made significant progress in the House this session. The bill (HF3032), chief authored by Representative Laurie Halverson (DFL-Eagan), passed two committees and was ready for a House floor vote when the Legislature shifted its focus to the COVID-19 pandemic.
Ending flavored tobacco sales is extremely popular among Minnesotans. A recent statewide poll found that 74 percent of Minnesotans support prohibiting the sales of all flavored tobacco products, including menthol cigarettes. Support for this policy was high across demographics and regions, including among African Americans (77 percent support) and rural residents (81 percent support).
The time is now to unite against an industry that has profited off of addiction and disease disproportionately borne by African Americans and other marginalized communities. Minnesotans for a Smoke-Free Generation is grateful for lawmakers, advocates and partner organizations that have stood up to Big Tobacco and pushed for bold action against menthol tobacco.
About Minnesotans for a Smoke-Free Generation
Minnesotans for a Smoke-Free Generation is a coalition of more than 60 organizations that share a common goal of saving Minnesota youth from a lifetime of addiction to tobacco. The coalition supports policies that reduce youth smoking and nicotine addiction, including increasing tobacco prices, raising the tobacco sale age to 21, limiting access to candy-, fruit- and menthol-flavored tobacco, and funding tobacco prevention and cessation programs.
Partners include: The African American Leadership Forum, Allina Health, Allina Health | Aetna, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association in Minnesota, Apple Tree Dental, Association for Nonsmokers – Minnesota, Aurora/St. Anthony Neighborhood Development Corporation, Becker County Energized, Blue Cross and Blue Shield of Minnesota, A Breath of Hope Lung Foundation, Cancer Legal Care, CentraCare, Children’s Defense Fund-MN, Children’s Minnesota, ClearWay MinnesotaSM, Comunidades Latinas Unidas En Servicio – CLUES, Dodge County Public Health, Education Minnesota, Essentia Health, Gillette Children’s Specialty Healthcare, A Healthier Southwest, HealthPartners, Hennepin Healthcare, Horizon Public Health, Indigenous Peoples Task Force, ISAIAH, JustUs Health, LAAMPP Alumni, Lake Region Healthcare, Local Public Health Association of Minnesota, LPCFC – Lincoln Park Children and Families Collaborative, March of Dimes, Masonic Cancer Center – University of Minnesota, Mayo Clinic, Medica, Meeker McLeod Sibley Community Health Services, Minnesota Academy of Family Physicians, Minnesota Association of Community Health Centers, Minnesota Cancer Alliance, Minnesota Council of Health Plans, Minnesota Dental Association, MHA – Minnesota Hospital Association, Minnesota Medical Association, Minnesota Nurses Association, Minnesota Oral Health Coalition, Minnesota Public Health Association, MNAAP – Minnesota Chapter of the American Academy of Pediatrics, ModelCities, NAMI Minnesota, North Memorial Health, NorthPoint Health & Wellness, Olmsted Medical Center, Open Cities Health Center, PartnerSHIP 4 Health, Perham Health & Living, Preventing Tobacco Addiction Foundation, SEIU Healthcare Minnesota, ShiftMN, St. Paul Area Chamber of Commerce, Steele County Public Health, Tobacco-Free Alliance, Twin Cities Medical Society, UCare, Vision In Living Life – Change is Possible, WellShare International and Zumbro Valley Medical Society. Find out more at: smokefreegenmn.org.