Community Perceptions of Flavor Restriction Policies: A Scoping Review of Disaggregated Outcomes

Increasingly, U.S. states and localities are passing policies to restrict menthol and other characterizing flavors in tobacco products. Given the disproportionate use of flavored tobacco among historically marginalized groups, such restrictions have the potential to promote health equity. This scoping review aimed to characterize community perceptions of flavor restrictions using an equity lens.

We conducted a PubMed search for U.S.-based studies that reported on flavor restriction outcomes, disaggregated by race, ethnicity, or lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity.

Across the 22 studies identified, two foci emerged: factors influencing the passage of flavor restrictions (eg, policy support) and the impacts of implementing these restrictions (eg, cessation intentions). Support for flavor restrictions varied by product and population: menthol cigarette restrictions received notably higher support among African American and Hispanic communities, while evidence for e-cigarette flavor restrictions was mixed-some studies reported minimal subgroup differences, whereas others reported higher support among specific racial/ethnic groups. A few studies discussed unintended consequences, such as product substitution or engagement with illicit channels; these studies were also mixed regarding which racial/ethnic groups would be most impacted. Key research gaps included long-term behavioral outcomes and outcomes across LGBTQ identities.

While there are clear racial/ethnic differences for support of menthol cigarette bans, much of the literature on other types of flavor restrictions is mixed. Further research is needed to resolve these discrepancies and expand beyond race and ethnicity when disaggregating subgroups. Such efforts are critical to ensuring flavor restrictions achieve their intended public health benefits and advance health equity.