Today, April 18, 2017, Supervisor Malia Cohen introduced an ordinance to end the sale of all flavored tobacco products in San Francisco. Breathe California, Golden Gate Public Health Partnership, which has been working on the issue of flavored tobacco through Project E-NUFF since 2015, strongly supports this ordinance, directly designed to protect youth and our most vulnerable communities from the deadly impacts of tobacco. For decades, the tobacco industry has proven it will stop at nothing to lure children to tobacco and today we express our sincerest gratitude to Supervisor Cohen for her leadership in helping safeguard San Francisco from tobacco-related death and disease.
Breathe California staff attended the press conference today, which also included the San Francisco Cancer Initiative, African American Tobacco Control Leadership Council, UCSF professors, Mayor Ed Lee, Supervisor Ahsha Safaí, San Francisco Department of Public Health, and the San Francisco Tobacco Free Coalition.
We need this legislation because the tobacco industry targets our children
Tobacco is still the number one preventable cause of death in the United States, killing an estimated 540,000 Americans every year,1 with 90% of adult smokers beginning before age 18.2 The tobacco industry has tried every way possible to get children and teens to start smoking. One of its most successful methods has been the extensive targeted marketing and sale of flavored tobacco products. As a result, 80% of teen smokers started with a flavored tobacco product such as menthol cigarettes, fruit-flavored cigars, or candy-flavored vapes/e-cigarettes.3 This is something that tobacco companies would rather the public not know.
Tobacco companies target youth by flavoring, packaging, and pricing tobacco like candy.
- Tobacco companies are flavoring tobacco to taste like candy and other flavors that kids enjoy, such as popcorn, cotton candy, chocolate, gummy bear, and cola. There are over 7,000 flavored tobacco products sold today, most of which also include the addictive chemical nicotine.4
- The tobacco industry packages these products like candy to further target youth. Bright colored wrappers attract attention, while chocolate-flavored cigars are packaged in long foil wrappers to look like chocolate candy bars, and mint-flavored chewing tobacco is packaged in circular green cans just like wintergreen mints.
- Tobacco companies price flavored tobacco like candy, right at the price point for teens. Double packs of little flavored cigars are sold for just 50 cents throughout San Francisco (“2 for 99 cents”).
What does this legislation mean for adults?
San Francisco voters have a history of safeguarding youth health, most recently when they overwhelmingly approved taxes on soda to deter youth from purchasing sugar sweetened beverages that contribute to the obesity epidemic. Adults will still be able to purchase as much tobacco as they want in San Francisco, it just won’t be flavored. The presence of the flavor is what primarily targets children. It is similar to the inclusion of toys in fast food children’s meals, which the San Francisco Board of Supervisors has already made illegal to protect youth health; the very presence of the toy encourages children to choose unhealthy food, ultimately leading to higher rates of obesity.
Adults will not be penalized for using flavored tobacco products. The proposed legislation simply restricts selling flavored tobacco products.
E-cigarettes are extremely harmful, regardless of flavor
E-cigarettes use a metal filament to heat liquid, creating ultrafine metal particles that get lodged deeply in the lungs. Heating them at high temperatures also produces extra formaldehyde (a dangerous cancer-causing gas), and use of e-cigarettes also reduces cardiovascular flow, increasing heart attack risk.5 E-cig liquid frequently contains diacetyl, a chemical causing bronchiolitis obliterans, also known as “popcorn lung”, an irreversible and painful deteriorating lung disease.6
The Food and Drug Administration has already declared that e-cigarette companies cannot advertise their products as a smoking cessation device. In fact, studies have proven that youth who start smoking e-cigarettes are three times as likely to also be smoking traditional, combustible cigarettes a year later.7
We need this legislation because it is an issue of social justice
This is an issue not just of youth health, but of social justice, because the youth smokers who most use menthol cigarettes (the largest category of flavored tobacco) are disproportionately African American, Asian American, and LGBT.8,9 This means that in the communities already disproportionately impacted by lung disease such as cancer and asthma,10 flavors are killing more individuals than in other communities.
Menthol cigarettes are a key part of why flavored tobacco is an issue of social justice. In 2009, when Congress banned the sale of all flavored cigarettes, they did not include menthol.11 This decision angered the Congressional Black Caucus because of the decades of extreme targeted marketing of menthol tobacco products to the African American community, already disproportionately impacted by lung disease. As a result, the African American Tobacco Control Leadership Council has been working to end the sale of menthol for nearly a decade and the National Association for the Advancement of Colored People (NAACP) fully supports this new legislation.
What has Breathe California been doing about it?
Breathe California’s Project E-NUFF has been working since 2015 on a campaign to end the sale of flavored tobacco in San Francisco. Our team of young adult policy advocates and emerging community leaders has worked to draw community attention to how the tobacco industry uses flavors in tobacco to target young people. Our efforts have included surveying youth tobacco knowledge and behavior, conducting adult focus groups about tobacco industry targeting of flavors to youth, key informant interviews, researching current policies, circulating petitions calling for action, and establishing partnerships with local community agencies. Breathe California’s Project E-NUFF is supported by a grant from the San Francisco Department of Public Health.
More information about flavored tobacco and youth health, and social justice
Find Breathe California’s infographics about the health effects of flavored tobacco and nicotine products, including menthol cigarettes, health effects of electronic cigarettes specifically, and facts and myths about e-cigarettes, the product that comes in the most flavors options and which youth use most.
- Carter B, et al., “Smoking and Mortality – Beyond Established Causes”, New England Journal of Medicine, 2015:372:631-40.
- US Department of Health and Human Services. 2012. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center For Chronic Disease Prevention And Health Promotion, Office on Smoking and Health.
- Ambrose BK, et al., “Flavored Tobacco Product Use Among US Youth Aged 12-17 Years, 2013-2014”. JAMA 2015; 314(17): 1871-1873.
- National Cancer Institute. Harms of Cigarettes Smoking and Health Benefits of Quitting. https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet
- Temesgen N, et al. 2017. A cross sectional study reveals an association between electronic cigarette use and myocardial infarction. School of Medicine and Health Sciences Poster Presentations, George Washington University.
- Allen JG. 2016. Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 Products, Including Fruit-, Candy-, and Cocktail-Flavored E-Cigarettes. Environmental Health Perspectives 124(6): 733-739.
- Primack BA, et al. 2015. Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults. JAMA Pediatrics 169(11): 1018-1023.
- Giovino GA, et al., “Differential trends in cigarette smoking in the USA: is menthol slowing progress?” Tobacco Control 2015; 24: 28-37.
- National Youth Advocacy Coalition. 2010. “Coming Out About Smoking: A Report from the National LGBTQ Young Adult Tobacco Project.”
- San Francisco Health Improvement Program. 2017. Community Health Dashboard data available at www.sfhip.org.
- Tobacco Control Act, U.S. Food and Drug Administration, https://www.fda.gov/TobaccoProducts/Labeling/RulesRegulationsGuidance/ucm246129.htm