BACKGROUND: Governments are adopting diverse approaches to restricting flavored tobacco/nicotine products. We aimed to understand the challenges of structuring and implementing regulations restricting flavors to inform jurisdictions considering these policies.
METHODS: Comparative, qualitative case studies of tobacco/nicotine product flavor restrictions across six jurisdictions (Canada, Netherlands, UK, California, Massachusetts, New York, inclusive of lower level governments). Integrated analysis of existing research/grey literature; relevant laws, regulations, policy documents; 42 semi-structured interviews with regulators and experts in advisory roles. Two independent researchers thematically coded transcripts across multiple iterations to reach agreement.
RESULTS: Governments classify flavors across two dimensions: Holistic (e.g., characterizing flavor) versus Additive (e.g., specific chemical) assessment of individual products; and Restricted versus Permitted approaches to building lists of what is or is not prohibited. Interviewees noted that Permitted Lists are likely to result in greater market restriction. This could impact switching behaviors. Permitted Lists were seen as potentially simpler for regulators contending with novel products amid resource constraints.
Three tools for flavor determination were commonly used: product testing; sensory evaluation; and use of attestations/written evidence. Each comes with trade-offs, e.g., product testing is accurate but is resource intensive. Interviewees noted the utility of being able to use a variety of industry statements and promotional materials as evidence of flavor, but expressed concern about related regulatory burdens.
Common challenges included the difficulty of maintaining accurate physical and online/social media retail information, coordinating domestic restrictions and import measures, and evasive practices, e.g., cash sales or stashing. Keeping up with evasive industry adaptations designed to evade regulations, e.g., ‘Non-menthol’ menthol products or redesigned disposable vapes, was a key concern.
CONCLUSIONS: This study affirms the usefulness of sharing policy practices and frameworks that focus on regulatory details. Moving forward, evaluation of practices such as Permissive Listing will be vital.