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6 supported a menthol cigarette ban,23 with a 2012 survey in two metropolitan areas indicating similar support (60%).24 More recently, a 2014- 15 survey found that 33% of U.S. adults support a menthol ban, whereas 62% did not support one. One possible explanation for this divergence is that the latter survey did not remind participants about the 2009 flavored cigarette ban or indicate that a scientific panel told the FDA that removing menthol cigarettes would reduce the number of people who start smoking.22 Support for a menthol cigarette ban also appears to be higher among never and former smokers, non-whites (including African Americans), the less educated, females, and older adults.22-25 Public support data on little cigars and cigarillos are limited to a single study from 2014-15, which found 56% of U.S. adults supported banning candy and fruit flavors. Nearly 40% did not support this policy, with 4% indicating they did not know.22 Data regarding flavor bans or restrictions of other tobacco products were not identified as part of our literature search. PUBLIC HEALTH IMPACT A comprehensive flavor ban or restriction may impact two key groups: 1) youth and young adults and 2) adults who smoke and vape. For youth and young adults, it has been argued that these policies will reduce smoking and vaping via reduced attractiveness and less palatable products. Others have stated that these policies or particular provisions may encourage adults who vape to switch to cigarettes, which would be an unintended consequence to the extent one can argue e-cigarettes may be less harmful than cigarettes. Policies that include exemptions to particular flavors, such as menthol/mint, or to particular products, such as cigars, risk losing their effectiveness (e.g., youth e-cigarette users may switch to menthol flavor only) or risk funneling current users to exempted products (e.g., adult e-cigarette users may switch to cigars). The literature modeling or evaluating comprehensive flavor bans or restrictions is limited; however, there are additional modeling studies suggestive of what might occur for product-specific bans or restrictions on e- cigarettes, menthol cigarettes, and cigars. Comprehensive Flavored Tobacco Product Ban or Restriction In 2010, New York City restricted sales of flavored cigars, cigarillos, little cigars, chew, snuff, snus, tobacco, pipe tobacco, roll-your-own tobacco, and dissolvables, excluding menthol. Evaluation data suggest sales of all flavored tobacco products declined by 87%, with sales of flavored cigars decreasing by 86% and flavored pipe and roll-your-own cigarettes decreasing by 91%. As compared to 2010, teens in New York City during 2013 had 37% lower odds of ever trying flavored tobacco products and 28% lower odds of using any type of tobacco product. Sales of non-flavored tobacco products did not significantly increase, but product-specific sales of non-flavored cigars and pipe and roll-your- own increased by 5% and 4%, respectively. These increases in non-flavored product-specific sales may have been due to the restriction; however, they also came during a period of increasing national cigar sales. It should be noted that the New York City restriction did not cover e-cigarettes and therefore they were not included as part of the study’s results.26 Another study of discarded cigar packages in New York City following the comprehensive restriction, found 19% of the discarded packages were products with characterizing flavors and 9% were products with concept flavors. Concept flavoring in cigars along with the availability of flavored products from neighboring jurisdictions remain a challenge for New York City.27 In 2013, Providence, Rhode Island restricted the sale of all non-cigarette tobacco products with characterizing flavors and included an exemption for menthol. An assessment of the impact of the policy found a 51% decrease in flavored cigar sales after policy implementation compared to a 10% sales increase in other areas within the state that had no such policy.