Table 1

Concepts and themes to consider related to programme planning and legislative preparations for a state-wide flavoured tobacco ban

ThemesCodesSample responses
Full comprehensive ban
  • Value of full ban to promoting public health and health equity.

  • Partial bans have proven difficult to enforce.

  • Partial bans can have unintended consequences.

‘My biggest personal takeaway for any tobacco policy is, when it comes to any new bill or law that goes through, once it’s passed, people will adjust. That’s why I’m like really trying to push to make it as strong as possible, because if it passes, if it goes through, they’ll adjust. Everyone will get used to it.’
  • Valuable partner support could be lost if menthol excluded.

  • Need to include priority populations historically targeted by industry.

  • Framing this as a health equity issue is important for building support.

  • Assessing political readiness: recognise that menthol is valuable to industry and state revenue.

‘If it (Hawai'i’s ban) doesn’t include menthol, a number of health groups, like the group I work with, would not support this.’
‘And the reason these people are using these products, it’s not because they were born to do it. It’s because the industry has very successfully targeted them and taken advantage of them. And to leave menthol out, which is the most important cigarette flavor, is to leave the most vulnerable behind.’
Legislative considerations
  • Critical to include comprehensive language in bill to avoid loopholes.

  • Identifying responsible actors and granting authority sets the stage for successful implementation and enforcement.

  • Include penalties for retailers, not users.

‘It’s just important not to leave loose ends like that unresolved. If you have people who are inspecting, you’ve got to give them the authority to do their job completely, or else you have to go back to the drawing board and rewrite. Even making a small change to legislation is a pretty big lift, so it’s best to try to put all that authority in the law the first time around.’
Economic and financial considerations
  • Accounting for potential programme costs.

  • Limited evidence of retailers going out of business as the result of flavour bans or restriction.

  • Communicate that tobacco regulation will inevitably lead to reductions in state revenues and the need for alternative sources of funding.

  • Building the case for long-term health expenditure savings from tobacco cessation.

‘If a state is relying on the sale of a product that’s killing half of the people who are using it to fund anything, it’s problematic. I think we know that the healthcare costs that are going to be saved as a result of decreasing dependency on smoking cigarettes, or any of their tobacco products, far, far outweigh the revenue that we generated through taxation…And similarly, I think if retailers are relying on the sale of this product as their main lifeblood for staying in business, it might be time to consider selling a different product that’s not so dangerous and damaging to clientele.’