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Strong state policies in California and Massachusetts significantly reduced youth access to flavored tobacco products
In the face of rising sales of flavored e-cigarettes, state policies are critical to protecting young people, according to a report from the CDC Foundation and Truth Initiative. Two states in particular – California and Massachusetts – demonstrate the effect that strong state policies can have on reducing sales and limiting youth access to flavored nicotine.
U.S. e-cigarette sales increased by 47% between 2019 and 2023 with 80.6% of sales attributed to flavored products, according to the report. The surge in flavored products has played a significant role in youth nicotine use – according to data from the 2024 National Youth Tobacco Survey, almost 90% of middle and high school students who use e-cigarettes use a flavored product. While the number of young people using e-cigarettes has dropped, the survey found that young people who use e-cigarettes are showing signs of nicotine addiction, with 26% using them daily and 38% using them frequently, or at least 20 out of the last 30 days. Frequent and daily e-cigarette use among youth present particular concern because many of today’s e-cigarette products deliver increasingly high levels of nicotine.
Gaps in federal regulation have left many of these illegal, highly addictive, flavored e-cigarettes widely available, and the tobacco industry continues to evade flavor policies that aim to protect young people. In the meantime, individual states have started to take action to address the sale of flavored products, and these policies have proven to be highly successful.
“There is an urgent need for comprehensive federal action to regulate e-cigarettes, and in the meantime, for states, localities and tribal nations to take action to protect their own populations through strong state and local flavored e-cigarette sales restrictions that clearly work.”
Case studies: How strong state policies have curbed sales of flavored e-cigarettes
Two states – California and Massachusetts – have taken significant steps to address the issue of flavored tobacco by enacting strong policies that have resulted in dramatic overall declines in sales of flavored nicotine in their states.
The success of these state policies comes down to three key factors: their comprehensive scope, solid foundation of existing local policies, and emphasis on strong enforcement measures.
Massachusetts’ policy was the first to remove all flavored tobacco products, leading to an 86% decrease in overall e-cigarette sales
Massachusetts made history as the first state to end the sale of all flavored tobacco products, including flavored e-cigarettes, menthol cigarettes and flavored cigars (except in licensed adult-only smoking bars) in June 2020. The statewide measure built upon 179 local flavored tobacco policies which covered 66% of the population by March 2020.
Massachusetts’ comprehensive policy led to a drastic decrease in e-cigarette sales, with overall e-cigarette sales declining by 86% between September 2019 and December 2023. Flavored e-cigarette sales fell 98% during this time, largely driven by the near elimination of e-cigarettes in menthol, mint, and other flavors that include fruit, candy, desserts, chocolate, energy drinks, clove, spice, and alcoholic drinks as well as concept flavors with ambiguous names like “Blue Dream” or “OMG”.
Overall e-cigarette sales in Massachusetts declined by 86% and flavored e-cigarette sales fell 98% between 2019 and 2023.
In California, flavored e-cigarette sales decreased by 67% despite industry interference
California passed its comprehensive flavored tobacco law in 2020, prohibiting the sale of most flavored products including flavored e-cigarettes, menthol cigarettes, and flavored cigars but exempting loose leaf pipe tobacco, hookah in licensed stores, and premium cigars. Prior to the statewide law, 32% of California’s population was covered by 129 local policies, which set a strong foundation for a statewide measure.
Before the law could take effect, the tobacco industry delayed implementation by requiring that Californians vote on the bill. Californians voted in support of the measure, and the law took effect in December 2022.
A year after the policy went into effect, flavored e-cigarette sales decreased by 67%. Young people who used flavored e-cigarettes before California’s policy had significantly greater odds of reporting perceived difficulty in purchasing these products in 2023.
California’s policy was successful in part because the enforcement strategy was updated along the way to increase the policy’s effectiveness. At first, illegal sales of flavored e-cigarettes continued – more than 40 percent of total e-cigarette sales in December 2023 were of prohibited flavors, with disposable e-cigarettes comprising nearly all (93%) prohibited sales. This was due in part to the absence of a designated enforcement agency and funding. With these issues resolved and additional measures introduced, the policy’s effectiveness increased, providing a blueprint for other states that may face similar obstacles.
Young people who used flavored e-cigarettes before California’s policy had significantly greater odds of reporting perceived difficulty in purchasing these products in 2023.
Maximizing the impact of state flavor policies
The success of policies to address sales of flavored tobacco in California and Massachusetts show that these policies work, especially when built on a strong foundation of local policies and paired with strong, equitable enforcement.
To maximize the impact of such policies, community education and outreach is key. This includes opportunities to engage with retailers and those involved with enforcement and establish awareness in the community about which products are prohibited and which are permitted, and why. The report from the CDC and Truth Initiative recommends mailed communications, in-person visits to retailers, and online trainings to facilitate community outreach.
These case studies provide indisputable evidence that state policies can be effective in reducing youth e-cigarette use and curbing nicotine addiction. Lessons learned from effective state and local policies should encourage continued adoption of policies to protect young people and ensure that all Americans have the right to live free from nicotine addiction.
“Left unchecked, sales of new, flavored e-cigarette products will continue to rise, accompanied by youth nicotine use and addiction.”
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