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.”