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5 <br />etc.; and, 2) concept, such as “Jazz”, “Golden”, <br />“Snap”, etc. <br />The Surgeon General Report on e-cigarettes <br />previously concluded that flavors are among the <br />most commonly cited reasons for using e- <br />cigarettes among youth and young adults.10 <br />With over 7700 flavors and 460 brands being <br />available on the e-cigarette market alone, flavors <br />play a significant role in making these products <br />appealing to youth, especially first-time users.11 <br />In fact, a systematic review of the literature <br />found flavored e-cigarettes increase willingness <br />to try and initiation of e-cigarette use,12 and a <br />2016-17 study found that 96% of youth who had <br />initiated e-cigarette use started with a flavored <br />product.13 For adult users of e-cigarettes, <br />flavored e-cigarettes are also a primary reason <br />for use; however, the role of flavors in helping <br />smokers quit cigarettes remains uncertain.12 <br /> <br />The FDA’s latest move to stop the sale of <br />flavored pods and cartridges is unlikely to be <br />sufficient in preventing youth use. The move <br />applies to a limited number of manufacturers <br />and may not prevent companies, like JUUL, from <br />manufacturing refillable pods with the flavored <br />e-liquids sold separately. Moreover, refillable <br />pods for JUUL are already available through <br />other manufacturers. <br /> <br />The FDA’s plan also allows menthol flavored <br />pods to remain on the market and does not <br />address menthol-flavored combustible <br />cigarettes. Menthol flavoring, in particular, <br />masks the harshness of smoking14 and is <br />associated with increased smoking initiation,15 <br />and higher likelihood of addiction.16 The tobacco <br />industry has targeted youth and minority <br />populations with menthol cigarette advertising, <br />and menthol cigarettes are disproportionately <br />smoked by vulnerable populations such as <br />African Americans, who have the highest rates of <br /> <br />‡ Comprehensive flavor bans and restrictions are defined in this report as policies that ban or restrict the use of flavors for <br />multiple tobacco products. For example, a policy that bans all flavors and exempts menthol is still considered comprehensive <br />assuming it applies to multiple products. <br />§ Michigan, Montana, New York, Oregon, and Utah are attempting to implement similar policies, pending legal challenges. <br />use compared to other racial and ethnic <br />groups.17 <br /> <br />Comprehensive flavor bans and restrictions‡ are <br />an increasingly popular means of combating <br />youth vaping. Massachusetts became the first <br />state to pass a bill restricting use of flavors in <br />November 2019. Other jurisdictions, including <br />San Francisco, Minneapolis/St. Paul, and Boston <br />have previously passed such policies. Less <br />comprehensive flavor bans and restrictions have <br />been implemented in Rhode Island and <br />Washington,§ which have temporarily banned <br />the sale of flavored e-cigarettes, and in Maine, <br />which banned the sale of flavored non-premium <br />cigars. Local restrictions have been approved in <br />over 250 localities.18 <br /> <br />PUBLIC SUPPORT <br /> <br />Comprehensive flavored tobacco product bans <br />or restrictions are a relatively new phenomenon <br />thereby limiting the available public support <br />data on flavor bans or restrictions to specific <br />tobacco products. <br /> <br />For e-cigarettes, the latest data indicate the <br />majority of U.S. adults support a flavor ban. A <br />USA Today/Ipsos survey conducted September <br />25-26th, 2019 indicated 52% of U.S. adults are in <br />favor of a ban, with 72% of those over age 55 and <br />one in five current e-cigarette users supporting <br />the move.19 During 2018, a separate survey <br />found public support for an e-cigarette flavor <br />ban among parents of middle- and high school <br />students was 75%.20 <br /> <br />Recent data on support for a menthol cigarette <br />ban or restriction is limited. Data that exist are <br />mixed and vary by smoking status, race/ethnicity, <br />education, gender, and age.21,22 In 2009, a public <br />opinion survey of U.S. adults indicated 56%