Policy Objective: Prevention of Youth Initiation of Tobacco Use
Setting: State
Below, you will see a list of goals for this policy objective. Click on the specific goal to read strategies you can use to achieve that goal in this setting.
Media and Advertising Restrictions
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The Master Settlement Agreement, a result of litigation between 46 state attorneys general and the tobacco industry, prohibits targeting youth in advertising, promotions or marketing, as well as outdoor advertising. Additionally, the Master Settlement Agreement provides court enforcement of implementation and enforcement of these restrictions. Under Section 203 of the 2009 Family Smoking Prevention and Tobacco Control Act, states and local lawmakers can impose specific restrictions on the time, place, and manner of cigarette advertising, provided they do not restrict the content of cigarette advertisements.
Accordingly, it is inferred that states have the authority to regulate cigarette advertising so long as measures directly advance the government’s substantial interest in reducing tobacco use and/or protecting public health; are no more extensive than necessary to promote such interests; and will allow the tobacco industry and retailers to reasonably communicate with legal tobacco product customers. It is essential to measure and monitor compliance with and the impact of regulations and restrictions in order to combat the amount of money the tobacco industry spends on advertising.
The public can also take an active role and report violations of these restrictions by accessing the FDA Center for Tobacco Products website.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 22
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- U.S. Tobacco Master Settlement Agreement, 1998
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E
For more information:
- AAP Issue Brief– Tobacco Product Control
- National Association of Attorneys General– NAAG Center for Tobacco and Public Health
- Tobacco Control Legal Consortium– Restricting Tobacco Advertising
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All forms of advertising and media, especially advertising and media aimed at low-income, minority, youth or young adult populations should not contain messages that promote tobacco use or images of tobacco or tobacco use. The single exception is historically accurate depictions of real people who used tobacco. Media that depicts use of any tobacco product should be rated for adults: rated R (movies), TV-MA (television), or Mature (video games).
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 22
- CDC– Health Equity in Tobacco Prevention and Control
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E
For more information:
- AAP Julius B Richmond Center– Smoke-free Movies and Media
- AAP Issue Brief– Tobacco Product Control
- Smoke Free Movies
- Tobacco Control Legal Consortium– Restricting Tobacco Advertising
Eliminate Self-Service Displays and Vending
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Tobacco sales should be strictly monitored and enforced to assure that children and adolescents do not have easy access to any tobacco products. One way to do this is to eliminate vehicles for unsupervised purchase of tobacco products, such as vending machines and online merchants, including daily deal sites and other third-party vendors. If a facility has public/open access computers, these types of websites should be blocked, as they may enable youth to purchase tobacco products without face-to-face age verification.
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 22
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 11
- Surgeon General Report– Reducing Tobacco Use, 2000- page 261
For more information:
- AAP Issue Brief– Tobacco-free Environments
- AAP Issue Brief– Tobacco Product Control
- Tobacco Control Legal Consortium– Placement of Tobacco Products
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To further ensure that minors have no access to tobacco, states should enforce provisions of the 2009 Family Smoking Prevention and Tobacco Control Act requiring retailers to sell tobacco products in a direct, face-to-face manner. State law enforcement can monitor compliance and report violations to the Food and Drug Administration (FDA). If a business does have self-service tobacco sales, proper licensure will allow for safe, approved tobacco sales.
The public can also take an active role and report violations of these restrictions by accessing the FDA Center for Tobacco Products website.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 11
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
For more information:
- AAP Issue Brief– Tobacco Product Control
Evidence-Based Pricing Strategies
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Raising taxes has been shown to deter the purchase and use of tobacco, prompt cessation attempts and decrease youth initiation. In turn, revenue from these taxes can be used to support evidence-based tobacco control programs in the community and state to prevent youth initiation, secondhand smoke exposure and decrease the prevalence of tobacco use. States with excise tobacco product tax rates below the level imposed by the top quintile of states should substantially increase their rates to reduce consumption, smuggling and tax evasion. All tobacco products should be taxed the same, including smokeless tobacco, hookah, cigars and electronic nicotine delivery systems.
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 2 and 34
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 812
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention R
For more information:
- AAP Issue Brief– Tobacco Control Funding
- AAP Issue Brief– Tobacco Product Control
- Campaign for Tobacco-Free Kids– U.S. State and Local Issues: State Tobacco Taxes
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Encourage states to prohibit tobacco products from being sold below a certain price, which may be calculated by a formula determined in the created statute. A minimum price law can counteract the tobacco industry’s effort to keep prices low. Smokeless tobacco products, cigars, and electronic nicotine delivery systems should be included in such policies, as they are popular with youth.
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 812
For more information:
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Review, April 9, 2010– State Cigarette Minimum Price Laws--- United States, 2009
- Counter Tobacco– Raising Tobacco Prices Through Non-Tax Approaches
- Tobacco Control Legal Consortium– Point-of-Sale Strategies: A Tobacco Control Guide
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
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Increasing excise taxes on tobacco products makes tobacco use less attractive to minors who have limited incomes. With this concept in mind, states should increase the unit price of tobacco products through legislation that raises the excise tax on these products. Accordingly, states should use tobacco product excise taxes for both reducing consumption and funding tobacco control programs.
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 64
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 2
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 812
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention R
For more information:
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- AAP Issue Brief– Tobacco Control Funding
- AAP Issue Brief– Tobacco Product Control
- Campaign for Tobacco-Free Kids– Raising Cigarette Taxes Reduces Smoking, Especially Among Kids (And the Cigarette Companies Know It)
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Revenue derived from state tobacco excise taxes should be utilized to enhance the state's tobacco control programs. The Centers for Disease Control and Prevention (CDC) recommend that each state's tobacco control activities should be $10.53 (with a minimum of $7.41) per capita, depending on the population demographics of that state. If states were able to set aside money from tobacco tax revenue, meeting the target for state tobacco control activity funding would be more easily attainable.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 2
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 812
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention R
For more information:
- AAP Issue Brief– Tobacco Control Funding
- AAP Issue Brief– Tobacco Product Control
- American Lung Association– State Funding for Tobacco Prevention & Cessation Programs
- Campaign for Tobacco-Free Kids– Broken Promises to Our Children: 1998 State Tobacco Settlement 17 Years Later
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
Point of Purchase Advertising Restrictions
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One way to restrict the product placement and advertisement of tobacco products is to require that retailers carrying tobacco products must allocate a similar amount of space for cessation aids as there is space for tobacco products. This can also include various forms of nicotine replacement therapy.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 30
For more information:
- Tobacco Control Legal Consortium– Point-of-Sale Strategies: A Tobacco Control Guide
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
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Encourage states to enact legislation regulating tobacco advertisements in order to reduce impulse purchases by tobacco users trying to quit. In enacting legislation, states must ensure that such measures are constitutional, meaning that they directly advance the government's substantial interest in reducing tobacco use and/or protecting public health; are no more extensive than necessary to promote such interests; and will allow the tobacco industry and retailers to reasonably communicate with legal tobacco product customers. According to Section 203 of the 2009 Family Smoking Prevention and Tobacco Control Act, states may restrict time, place, and manner of point of purchase advertising.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 22
- CDC– Health Equity in Tobacco Prevention and Control
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
For more information:
- Campaign for Tobacco-Free Kids– The Impact of the New FDA Tobacco Law on State Tobacco Control Efforts
- Counter Tobacco– Restricting Tobacco Advertising and Promotions
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
- Tobacco Control Legal Consortium– Restricting Tobacco Advertising
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Commercial displays in retail outlets should be eliminated, with the exception of text-only informational displays (eg, price or health-related product characteristics) within regulatory constraints. These text-only displays should bear black text on a white background. States should require retailers carrying tobacco products to display and distribute warnings about the health consequences of tobacco use, information regarding products and/or services for cessation.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 30 and 35
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E
For more information:
- Counter Tobacco– Restricting Tobacco Advertising and Promotions
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
- Tobacco Control Legal Consortium– Restricting Tobacco Advertising
Countering Industry Messaging
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State funding should be supplemented by funding from the U.S. Department of Education, under the Safe and Drug-Free School Act, or by an independent body that administers funds collected from the tobacco industry through excise taxes, court orders or litigation agreements. Children and adolescents need skills to discourage tobacco use, resist peer influences and counter aggressive tobacco industry advertising tactics. Middle schools and high schools should receive appropriate levels of funding to integrate a comprehensive curriculum designed to provide this information to their students and parents. Evidence-based curricula, combined with counter-advertising media campaigns, can strengthen youths' ability to resist tobacco initiation.
Warning: The tobacco industry is well-known for its effective marketing schemes and hidden-meaning campaigns. The industry frequently releases youth prevention and adult cessation programs that appear to be benign, but have been shown to do more harm than good. Be aware of these programs when looking to take action on this recommendation.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 31
- CDC Morbidity and Mortality Weekly Review, February 25, 1994– Guidelines for School Health Programs to Prevent Tobacco Use and Addiction- Recommendations 2, 3, 4, and 5
- National Academy of Medicine Report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 13
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- pages 602, 812
- Surgeon General Report– Reducing Tobacco Use, 2000- page 85
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention W
For more information:
- AAP Issue Brief– Tobacco Control Funding
- Campaign for Tobacco-Free Kids– Broken Promises to Our Children: 1998 State Tobacco Settlement 17 Years Later
- CDC– Registries of Programs Effective in Reducing Youth Risk Behaviors
- Food and Drug Administration (FDA)– The Real Cost
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
- Truth Initiative– Truth Campaign
For more information about tobacco industry tactics:
- Americans for Nonsmokers' Rights– Tobacco's Dirty Tricks
- Campaign for Tobacco-Free Kids– Big Surprise: Tobacco Company Prevention Campaigns Don't Work; Maybe It's Because They Are Not Supposed To
- The Rise and Fall of Tobacco Media Campaigns, 1967-2005
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State-based tobacco prevention and control programs can collaborate with other programs to address diseases for which tobacco is a major cause, including multiple cancers, heart disease and stroke, and chronic lung and respiratory diseases. Addressing tobacco control strategies in the broader context of tobacco-related diseases is beneficial for three reasons.
First, it is critical that interventions are implemented to alleviate the existing burden of disease from tobacco use. Second, the incorporation of tobacco prevention and cessation messages into broader public health activities ensures wider dissemination of tobacco control strategies. Finally, tobacco use in conjunction with other diseases and risk factors, such as sedentary lifestyle, poor diet, and diabetes, poses a greater combined risk for more chronic diseases than the sum of each individual degree of risk.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 31
- CDC– Health Equity in Tobacco Prevention and Control
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 812
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention W
For more information:
- AAP Issue Brief– Tobacco Product Control
- CDC– Tips from Former Smokers campaign
- CDC– Tobacco-Related Mortality
- Food and Drug Administration (FDA)– The Real Cost
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
- National Academy of Medicine– Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence- 2009
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The National Institutes of Health identified mass-media campaigns as one of three effective approaches in preventing tobacco use among youth. Media interventions should be research-based, tested, evaluated, independent from political pressures and funded on an ongoing basis.
Advertising campaigns with strong messages about the health consequences of using tobacco perform better than humorous or emotionally neutral campaigns. Particularly, advertisements that evoke negative emotions about the health consequences of tobacco use have been shown to be effective. Such advertisements often depict real people that have suffered from using tobacco, display graphic pictures of diseased organs and/or address the tobacco industry's dishonesty. Content for these messages should be developed through formative research, and campaigns should be combined with additional interventions. Effective messaging should be applicable to all audiences, bridging the gap between race, gender, sexual orientation and social group.
Warning: The tobacco industry is well-known for its effective marketing schemes and hidden-meaning campaigns. The industry frequently releases youth prevention and adult cessation programs that appear to be benign, but have been shown to do more harm than good. Be aware of these programs when looking to take action on this recommendation.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 31, 50
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine Report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 15, 16, and 36
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- pages 602, 812
- Surgeon General Report– Reducing Tobacco Use, 2000- page 85
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention W
For more information:
- AAP Julius B Richmond Center– Tobacco Control and Specific Populations
- AAP Issue Brief– Tobacco Product Control
- CDC– Tips from Former Smokers campaign
- Food and Drug Administration (FDA)– The Real Cost
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
- National Cancer Institute– The Role of the Media in Promoting and Reducing Tobacco Use
- Tobacco Control Legal Consortium– Restricting Tobacco Advertising
- Truth Initiative– Truth Campaign
For more information about tobacco industry tactics:
- Americans for Nonsmokers' Rights– Tobacco's Dirty Tricks
- Campaign for Tobacco-Free Kids– Big Surprise: Tobacco Company Prevention Campaigns Don't Work; Maybe It's Because They Are Not Supposed To
- The Rise and Fall of Tobacco Media Campaigns, 1967-2005
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Initiation of tobacco use is often brought about by exposure to tobacco use by parents or peers, depiction in movies and other media. Adults and youth continue to be heavily targeted and exposed to images of smoking in the movies and other mass media. Effective counter-marketing messages that are culturally appropriate must be coordinated and implemented by statewide and community-level programs to change the cultural norm. A comprehensive counter-marketing program must consist of integrated components and be: long term, integrated into a larger tobacco control program, culturally relevant, strategic, evaluated and adequately funded. Effective messaging should be applicable to all audiences, bridging the gap between race, gender, sexual orientation and social group.
Tobacco use prevalence declines when adequately funded mass-media counter-marketing campaigns are combined with other strategies in multi-component tobacco control programs. Counter-advertising media campaign can be effective in increasing negative beliefs and attitudes about the tobacco industry and lead to lower levels of youth smoking initiation. The images used in tobacco marketing associate smoking with lifestyles and experiences that appeal to young people, and these positive associations tend to mask risk information in adolescent decision making. The evidence shows that youth exposure to images that create a positive association with smoking is also associated with a likelihood of smoking initiation.
Warning: The tobacco industry is well-known for its effective marketing schemes and hidden-meaning campaigns. The industry frequently releases youth prevention and adult cessation programs that appear to be benign, but have been shown to do more harm than good. Be aware of these programs when looking to take action on this recommendation.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 31, 50
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine Report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 15 and 16
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- pages 602, 812
- Surgeon General Report– Reducing Tobacco Use, 2000- page 85
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention W
For more information:
- AAP Julius B Richmond Center– Tobacco Control and Specific Populations
- AAP Issue Brief– Tobacco Control Funding
- AAP Issue Brief– Tobacco Product Control
- California Youth Advocacy Network
- Campaign for Tobacco-Free Kids– Kick Butts Day
- Campaign for Tobacco-Free Kids– Youth Anti-tobacco State Resources
- CDC– Tips from Former Smokers campaign
- Food and Drug Administration (FDA)– The Real Cost
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
- National Cancer Institute– The Role of the Media in Promoting and Reducing Tobacco Use
For more information about tobacco industry tactics:
- Americans for Nonsmokers' Rights– Tobacco's Dirty Tricks
- Campaign for Tobacco-Free Kids– Big Surprise: Tobacco Company Prevention Campaigns Don't Work; Maybe It's Because They Are Not Supposed To
- The Rise and Fall of Tobacco Media Campaigns, 1967-2005
Tobacco Product Placement
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One way to restrict the product placement and advertisement of tobacco products is to require that retailers carrying tobacco products must allocate a similar amount of space for cessation aids as there is space for tobacco products. This can also include various forms of nicotine replacement therapy.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
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Because of their colorful packaging, attractive flavors and placement near candy displays, tobacco products can easily be mistaken for candy by both adults and children. Under Section 203 of the 2009 Family Smoking Prevention and Tobacco Control Act, states may regulate the time, place and manner of the advertising or promotion of cigarettes. States should extend this regulation to other types of tobacco products, particularly flavored cigars.
It can be inferred that prohibiting the placement of flavored tobacco products near candy would comply with federal regulations so long as measures directly advance the government's substantial interest in reducing tobacco use and/or protecting public health; are no more extensive than necessary to promote such interests; and will allow the tobacco industry and retailers to reasonably communicate with legal tobacco product customers.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
For more information:
- Campaign for Tobacco-Free Kids– Big Tobacco's Guinea Pigs: How an Unregulated Industry Experiments on America's Kids and Consumers
- Tobacco Control Legal Consortium– Placement of Tobacco Products
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
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Encourage states to enact legislation regulating such ads in order to reduce impulse purchases by tobacco users trying to quit. Section 203 of the 2009 Family Smoking Prevention and Tobacco Control Act authorizes states to regulate the time, place and manner of the advertising or promotion of cigarettes.
Accordingly, it is inferred that states have the authority to regulate the placement of tobacco products and ads so long as measures directly advance the government's substantial interest in reducing tobacco use and/or protecting public health; are no more extensive than necessary to promote such interests; and will allow the tobacco industry and retailers to reasonably communicate with legal tobacco product customers. For example, a reasonable restriction on the placement of tobacco products may include placing tobacco products underneath the counter at the point of sale during hours when minors are more likely to visit the retail establishment.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 30
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E
For more information:
- Campaign for Tobacco-Free Kids– The Impact of the New FDA Tobacco Law on State Tobacco Control Efforts
- Counter Tobacco– Restricting Product Availability, Placement and Packaging
- Tobacco Control Legal Consortium– Restricting Tobacco Advertising
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
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Commercial displays in retail outlets should be eliminated, with the exception of text-only informational displays (eg, price or health-related product characteristics) within regulatory constraints. All tobacco products should be placed behind sales counters to reduce youth access and shoplifting.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 30
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
Eliminate Branded Promotional Items
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Pursuant to the 2009 Family Smoking Prevention and Tobacco Control Act, the Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and Adolescents expressly prohibit cigarette and smokeless tobacco companies from selling branded nontobacco merchandise. These companies are also prohibited from giving items away in consideration of product purchases (ie, in exchange for proofs of purchase). States should enforce these current regulations as a way of preventing youth tobacco use and subsequent lifelong addiction.
The public can also take an active role and report violations of these restrictions by accessing the FDA Center for Tobacco Products website.
Recommended by:
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E
For more information:
- AAP Issue Brief– Tobacco Product Control
- Tobacco Control Legal Consortium– Placement of Tobacco Products
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Allowing tobacco-branded promotional items at places where children and adolescents spend time implies support for use of tobacco products. As a result of the 2009 Family Smoking Prevention and Tobacco Control Act, cigarette and smokeless tobacco companies are not able to sell or market these items.
These non-tobacco promotional items are items which “which bears the brand name (alone or in conjunction with any other word), logo, symbol, motto, selling message, recognizable color or pattern of colors, or any other indicia of product identification identical or similar to, or identifiable with, those used for any brand of cigarettes or smokeless tobacco.” These nontobacco branded items can include beach towels, t-shirts, water bottles, pens or other common items. Legislation should be expanded to prohibit promotional distribution promotional items from any tobacco or electronic nicotine delivery system company in order to avoid tobacco initiation.
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 22
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 8
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E
For more information:
- AAP Issue Brief– Tobacco Product Control
- Tobacco Control Legal Consortium– Placement of Tobacco Products
Eliminate Brand Name Sponsorships
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Federal laws prohibit cigarette and smokeless tobacco brand name sponsorship of athletic, musical, artistic and other cultural or societal events. Tobacco parent corporations may sponsor such events as long as the corporation was registered and in use in the US before January 1, 1995 and the corporation name does not use a tobacco product brand name, logo, motto, color or other product identifier. When a state inspector identifies a violation of this regulation, it should be reported to the Food and Drug Administration (FDA). The FDA holds jurisdiction to inspect and act on reported sponsorship violations.
The public can also take an active role and report violations of these restrictions by accessing the FDA Center for Tobacco Products website.
Recommended by:
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
- U.S. Tobacco Master Settlement Agreement, 1998
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E
For more information:
- AAP Issue Brief– Tobacco Product Control
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The Master Settlement Agreement (MSA), a result of litigation between 46 state attorneys general and the four largest US tobacco companies, eliminated sponsorship or hosting of events with a large youth audience and events with underage participants. The MSA also limited brand name sponsorship of athletic, musical, artistic and other cultural or societal events by the four participating tobacco companies to one per year.
These restrictions were strengthened by the 2009 Family Smoking Prevention and Tobacco Control Act Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and Adolescents, which stated that no cigarette or smokeless tobacco brand can sponsor these types of events. By having a sponsorship restriction on any tobacco product company, including electronic nicotine delivery system companies, the tobacco industry will lose a major method of product promotion.
The public can report violations of these restrictions by accessing the Food and Drug Administration (FDA) Center for Tobacco Products website.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
- U.S. Tobacco Master Settlement Agreement, 1998
For more information:
- AAP Issue Brief– Tobacco Product Control
- Federal Register Docket No. FDA-1995-N-0259: Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and Adolescents
Zoning Restrictions
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The concentration of tobacco retailers in a specific geographic area can lead to competition, which can foster sales or discounts on particular brands of tobacco. Such sales or discounts can attract young smokers who have limited funds and are more likely to purchase tobacco products if discounted. Zoning ordinances can counter this effect by forcing tobacco retailers to be located away from child-oriented facilities and residential zones. For example, an ordinance can prohibit a retailer from being located within 1000 feet of a school, child care facility, playground, youth center, recreational facility, arcade, park or library.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
For more information:
- AAP Issue Brief– Tobacco Product Control
- ChangeLab Solutions– Model Ordinance Regulating the Licensing of Tobacco Retailers in California
- Counter Tobacco– Licensing and Zoning
- Tobacco Control Legal Consortium– Point-of-Sale Strategies: A Tobacco Control Guide
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
Eliminate Free Samples and Discounts
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The 2009 Family Smoking Prevention and Tobacco Control Act stated that cigarette free samples are no longer allowed, but smokeless tobacco products were eligible as long as they are given to legal adults in adult-only facilities. The regulation also stated that states and local governments can prohibit or restrict the distribution of free samples of smokeless tobacco.
Initiation of tobacco use is often brought about by the accessibility to tobacco products. Tobacco products should be monitored to ensure that children and adolescents do not have easy access and are not lured into purchasing tobacco products at a discounted price. Smokeless tobacco products, cigars and electronic nicotine delivery systems should be included in such policies, as they are popular with youth.
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 812
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention E
For more information:
- AAP Issue Brief– Tobacco Product Control
- Campaign for Tobacco-Free Kids– Youth Anti-tobacco State Resources
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Pursuant to the 2009 Family Smoking Prevention and Tobacco Control Act, the Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco To Protect Children and Adolescents expressly prohibit free samples of cigarettes and place limitations on the distribution of smokeless tobacco products. States should enforce these current regulations as a way of preventing youth tobacco use and subsequent lifelong addiction.
The public can also take an active role and report violations of these restrictions by accessing the Food and Drug Administration (FDA) Center for Tobacco Products website.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- U.S. Family Smoking Prevention and Tobacco Control Act, 2009
For more information:
- AAP Issue Brief– Tobacco Product Control
- Campaign for Tobacco-Free Kids– Youth Anti-tobacco State Resources
Tobacco Product Sales Restrictions
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Retailers with this licensure should be required to verify the date of birth, by photo ID, of purchasers appearing to be 25 years old or younger; place tobacco products behind the counter and sell them only in a direct face-to-face exchange; and eliminate self-service displays and vending machines. Repeat violations of laws restricting youth access should warrant license suspension or revocation. States should avoid preempting local governments from licensing retail outlets that sell tobacco products.
Recommended by:
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 19
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 11 and 30
For more information:
- AAP Issue Brief– Tobacco Product Control
- Counter Tobacco– Licensing, Zoning and Retailer Density
- Tobacco Control Legal Consortium– License to Kill?: Tobacco Retailer Licensing as an Effective Enforcement Tool
- Tobacco Control Legal Consortium– Point-of-Sale Strategies: A Tobacco Control Guide
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
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Tobacco sales should be strictly monitored and enforced to assure that children and adolescents do not have easy access to any tobacco products. One way to do this is to remove the sale of tobacco products from places children, adolescents and young adults frequent. This can include schools, universities, hospitals, clinics and pharmacies, among other places.
Sales of tobacco products at places in which young people spend their time removes protections needed to assure underage youth do not have access to tobacco products. Venues for unsupervised purchase of tobacco products, such as vending machines and online merchants, including daily deal sites and other third-party vendors, should be eliminated. If a facility has public/open access computers, these types of websites should be blocked, as they may enable youth to purchase tobacco products without face-to-face age verification.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 22
- CDC– Health Equity in Tobacco Prevention and Control
- Surgeon General report– Reducing Tobacco Use, 2000- page 23
For more information:
- AAP Issue Brief– Tobacco-free Environments
- AAP Issue Brief– Tobacco Product Control
- Campaign for Tobacco-Free Kids– Where Do Youth Smokers Get Their Cigarettes?
- Campaign for Tobacco-Free Kids– Youth Anti-tobacco State Resources
- ChangeLab Solutions– A Prescription for Health: Tobacco Free Pharmacies
- Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities
- Tobacco Control Legal Consortium– Point-of-Sale Strategies: A Tobacco Control Guide
- Tobacco Control Legal Consortium– Policy Strategies: A Tobacco Control Guide
- U.S. Department of Health and Human Services– Tobacco-Free College Campus Initiative
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Because 90% of smokers begin by age 18, it is crucial to prevent adoption of smoking in young populations. Since some high school students are 18 and legally able to buy cigarettes in some places, it is easy for those students to purchase cigarettes and give them to younger students who cannot buy cigarettes themselves. Pushing back the age of tobacco purchase to 21 helps keep products like cigarettes, hookah, cigars, smokeless tobacco and electronic nicotine delivery systems out of the hands of younger potential smokers- the majority of people who purchase for distribution to minors are between the ages of 18 and 20, and younger students likely do not share social circles with 21 year olds.
Critics of Tobacco 21 laws use a variety of arguments to voice concerns about these laws. One of the most frequently heard arguments against Tobacco 21 laws is that eliminating tobacco sales from those under 21 will cause convenience stores to lose business. The total loss of revenue is only 2.12% of total tobacco sales. In addition, not a single convenience store in Needham, MA went out of business when the Tobacco 21 law was implemented in 2005. Another concern for implementation of these laws is that underage smokers will go to a neighboring town to buy cigarettes. However, this has not been the case in Needham since 2005, and there is no evidence that it will occur. Most high school students have limited mobility, and each town that raises its sales age increases the likelihood that surrounding towns will do the same.
Additional concerns center around the added burden this would place on retailers. However, current FDA policy requires that retailers check the ID of anyone attempting to purchase tobacco who appears to be under age 27. Raising the purchase age to 21 would make things consistent with alcohol regulations- in some states, driver’s licenses for people under 21 are different than for those over 21. Compliance protocols can easily be modified to match those of alcohol sales. If the minimum age of legal access for tobacco products were raised to 21 now, it estimated that by the time today’s teenagers were adults, there would be a 12% decrease in prevalence of tobacco use among those adults.
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products
For more information:
- AAP Issue Brief– Tobacco Product Control
- Campaign for Tobacco-free Kids– Increasing the Sale Age for Tobacco Products to 21
- Campaign for Tobacco-free Kids– Increasing Minimum Legal Sale Age for Tobacco Products to 21
- Tobacco21.org
100% Tobacco-Free Policies
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All places where children and adolescents learn, live, play, and work (eg, schools, universities, child care settings, restaurants, cars, public parks, multi-unit housing, sporting arenas, airports and vehicles) should be smoke free in order to discourage smoking initiation as well as to eliminate exposure to secondhand and thirdhand smoke. Children and adolescents with chronic conditions (eg, asthma) face significant health harms from tobacco use and secondhand smoke exposure. Those who suffer from chronic conditions, which are often not visible, could be at an even greater risk for adverse reactions if environments are not smoke or tobacco free. Smoke-free laws should include electronic nicotine delivery systems (ENDS, or e-cigarettes), as secondhand vapor from these products contains some of the same chemicals as secondhand smoke.
As of September 2014, 36 states have implemented smoke-free laws in non-hospitality workplaces, restaurants, or bars and 24 states have smoke-free laws in all three places. Areas with smoke-free laws do not experience any economic harm from implementing these laws- States such as Minnesota, Washington, New York, California, Massachusetts and Florida did not experience any economic harm due to implementing smoke-free laws. Additionally, a number of state and local chapters of business associations now endorse smoke-free laws. It is important to emphasize to lawmakers that the majority of the population does not smoke, supports smoke-free air laws, and that such laws do not harm businesses (and may actually improve business).
Smoke-free policies improve indoor air quality, reduce negative health outcomes among nonsmokers, decrease cigarette consumption, encourage smokers to quit and change social norms regarding the acceptability of smoking.
Warning: The tobacco industry is well-known for its effective marketing schemes and retaliation tactics. The industry battles pending smoke-free or clean air ordinances by contending that such laws will negatively impact business owners, or that the use of proper ventilation will alleviate secondhand smoke exposure. The industry also lobbies for preemption laws that take power from local governments, which is where tobacco control advocates typically are the most successful. Be aware of these tactics when looking to take action on this recommendation.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 6, 50
- CDC– Health Equity in Tobacco Prevention and Control
- CDC Morbidity and Mortality Weekly Review, February 25, 1994– Guidelines for School Health Programs to Prevent Tobacco Use and Addiction- Recommendation 1
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 4
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 460
- Surgeon General report– Children and Secondhand Smoke Exposure, 2007- pages 6, 70-71, 88-89
- Surgeon General report– Reducing Tobacco Use, 2000- page 261
- U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Owners/Management Agents of Federally Assisted Public and Multi-family Housing
- U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Residents of Federally Assisted Public and Multi-family Housing
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention P
For more information:
- AAP Issue Brief– Tobacco-free Environments
- American Nonsmokers' Rights Foundation– Smoking Policies in the 35 Busiest US Airports
- Americans for Nonsmokers’ Rights– Going Smoke-free in Your Community
- Campaign for Tobacco-Free Kids– Smoke-Free Laws
- Campaign for Tobacco-Free Kids– Smoke-Free Laws Do Not Harm Business at Restaurants and Bars
- ChangeLab Solutions– Model Ordinance: Comprehensive Smokefree Places
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
- Public Health Law Center– Vehicles
- University of Michigan– Smoke-free Campus Supervisor's Toolkit
For more information about tobacco industry tactics:
- Americans for Nonsmokers’ Rights– Advice to Business Owners
- Americans for Nonsmokers’ Rights– Tobacco’s Dirty Tricks
- CDC Morbidity and Mortality Weekly Review, March 18, 2005- Preemptive State Smoke-free Indoor Air Laws--United States, 1999--2004
- Surgeon General report– The Health Consequences of Involuntary Exposure to Tobacco Smoke- page 11
Tobacco Product Regulation
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Research has demonstrated that there is a high likelihood that flavored tobacco increases the risk of tobacco initiation. Flavored cigarettes (other than menthol) were banned by the 2009 Family Smoking Prevention and Tobacco Control Act. The law did not extend the ban to other tobacco products. When one type of flavored tobacco product is banned and others aren't, there is room for re-branding.
Following the ban on flavored cigarettes by the Family Smoking Prevention and Tobacco Control Act, some brands of flavored cigarettes changed how they were made and were re-released as flavored cigars— perfectly legal under the terms of the law. In the absence of federal legislation, communities and states have started taking action on this issue. Prohibiting all flavored tobacco products would ensure that re-branding can't happen and that the rates of tobacco use initiation would decrease. Laws should include menthol-flavored products, which are popular with youth.
Recommended by:
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Health Equity in Tobacco Prevention and Control
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 827
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 205
For more information:
- Campaign for Tobacco-Free Kids– Not Your Grandfather’s Tobacco: A New Generation of Cheap and Sweet Cigars Threatens a New Generation of Kids
- Tobacco Control Legal Consortium– Regulating Flavored Tobacco Products
- Tobacco Control Legal Consortium– The Problem with Menthol: A Backgrounder
- Tobacco Control Legal Consortium– Regulating Menthol Tobacco Products
- Tobacco Control Legal Consortium– Regulating Menthol Flavored Tobacco Products: Lessons Learned
- Tobacco Control Legal Consortium– Chicago’s Regulation of Menthol Flavored Tobacco Products: A Case Study
Last Updated
05/05/2021
Source
American Academy of Pediatrics