Article Text

Implementation of a comprehensive flavoured tobacco product sales restriction and retail tobacco sales
  1. Doris G Gammon1,
  2. Todd Rogers1,
  3. Jennifer Gaber1,
  4. James M Nonnemaker1,
  5. Ashley L Feld1,
  6. Lisa Henriksen2,
  7. Trent O Johnson2,
  8. Terence Kelley3,
  9. Elizabeth Andersen-Rodgers3
  1. 1 Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina, USA
  2. 2 Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
  3. 3 California Tobacco Control Program, California Department of Public Health, Sacramento, California, USA
  1. Correspondence to Doris G Gammon, Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, NC 27709, USA; dgammon{at}


Objective San Francisco’s comprehensive restriction on flavoured tobacco sales applies to all flavours (including menthol), all products and all retailers (without exemptions). This study evaluates associations of policy implementation with changes in tobacco sales in San Francisco and in two California cities without any sales restriction.

Methods Using weekly retail sales data (July 2015 through December 2019), we computed sales volume in equivalent units within product categories and the proportion of flavoured tobacco. An interrupted time series analysis estimated within-city changes associated with the policy’s effective and enforcement dates, separately by product category for San Francisco and comparison cities, San Jose and San Diego.

Results Predicted average weekly flavoured tobacco sales decreased by 96% from before the policy to after enforcement (p<0.05), and to very low levels across all products, including cigars with concept-flavour names (eg, Jazz). Average weekly flavoured tobacco sales did not change in San Jose and decreased by 10% in San Diego (p<0.05). Total tobacco sales decreased by 25% in San Francisco, 8% in San Jose and 17% in San Diego (each, p<0.05).

Conclusions San Francisco’s comprehensive restriction virtually eliminated flavoured tobacco sales and decreased total tobacco sales in mainstream retailers. Unlike other US flavoured tobacco policy evaluations, there was no evidence of substitution to concept–flavour named products. Results may be attributed to San Francisco Department of Health’s self-education and rigorous retailer education, as well as the law’s rebuttable presumption of a product as flavoured based on manufacturer communication.

  • public policy
  • economics
  • surveillance and monitoring

Data availability statement

Retail scanner data are available from third party vendors and are not publicly available.

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Data availability statement

Retail scanner data are available from third party vendors and are not publicly available.

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  • Contributors TR, DGG, LH and EA-R conceptualised and designed the study; DGG and JG conducted data analyses; DGG, JG, TR and AF drafted the article; all authors contributed to writing and editing, and approved the final version of the article.

  • Funding Funding for this study was provided by the Centers for Disease Control and Prevention Grant #5 NU58DP005969-04-00 and the California Department of Public Health under contract from Stanford Prevention Research Center to RTI International (Contract #17-10041). Additional support for LH and TOJ was provided by the National Institutes of Health/National Cancer Institute, grant #1P01CA225597.

  • Competing interests The California Department of Public Health was involved in the study design, data collection, analysis, interpretation and writing. CDPH reviewed the text prior to submission and did not influence whether and where to submit for publication.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.