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12 <br />Compliance data from Boston, <br />St.Paul/Minneapolis, and other Massachusetts <br />communities suggest that high compliance can <br />be achieved. However, the challenges in <br />Minneapolis demonstrate that adult-only store <br />exemptions can threaten the public health <br />benefits of such a policy and should be avoided. <br />If such a provision is unavoidable, including a <br />sizeable buffer zone between retailers and/or a <br />cap on the total number of retailers‡‡‡ may, in <br />theory, mitigate unintended consequences. In <br />addition, concept flavors represent a unique <br />challenge to retailer compliance, but this can be <br />mitigated by issuing a Guidance List and <br />implementing a robust education program. Data <br />from Chicago forewarn that partial bans may be <br />difficult to implement and therefore unlikely to <br />be successful. <br /> <br />SUMMARY AND POLICY <br />RECOMMENDATIONS <br /> <br />Flavored tobacco bans or restrictions are a <br />relatively new phenomenon. Even so, the latest <br />public opinion polls indicate the majority of <br />Americans support these policies, and both <br />predictive and evaluation studies, including <br />compliance studies, suggest that under the right <br />conditions comprehensive flavor bans or <br />restrictions have the ability to reduce tobacco <br />use and save lives. Furthermore, a <br />comprehensive ban or restriction is unlikely to <br />adversely impact the retail economy in Maryland. <br />Relative to other retailers, it is plausible that <br />vape shops that do not diversify product <br />offerings may be more negatively affected by the <br />policy; however, there are not enough publicly <br />available data to accurately predict the <br />magnitude of the impact on their businesses and <br />labor market. <br /> <br />Policymakers should consider lessons learned <br />from previous flavor ban or restriction attempts. <br />Based on the available evidence we make the <br />following recommendations: <br /> <br />1. The FDA’s flavored cigarette ban had the <br />unintended consequence of pushing users to <br />other flavored products. Minneapolis’ <br />restriction had an adult-only store <br />exemption that threatened to undermine <br />the intended public health benefits. <br />Chicago’s partial menthol ban was too <br />difficult to implement and enforce. In <br />Massachusetts communities, retailers were <br />selling concept flavored tobacco products. <br />These four examples suggest limited product <br />and flavor bans, partial bans, and adult-only <br />retailer restrictions have negative public <br />health consequences and create loopholes <br />that are likely to be exploited by industry. A <br />comprehensive flavor ban without product, <br />flavor, and retailer exemptions may <br />maximize public health benefits and <br />minimize the opportunity for unintended <br />consequences. <br /> <br />2. To ensure maximal benefit now and in the <br />future, policymakers should consider <br />providing the Maryland Department of <br />Health with the resources needed for a <br />robust retailer education campaign and <br />provide the Department of Health with the <br />flexibility to include all characterizing and <br />concept flavored tobacco products on a <br />Guidance List that can be periodically <br />updated. <br /> <br /> <br /> <br /> <br /> <br />‡‡‡ St. Paul, MN has a cap on the number of adult-only tobacco product shops allowed.