The CDC found that the younger a person is when he or she starts to smoke, the more difficult it is to quit. About 90% of adult smokers began smoking before the age of eighteen.

Both the U.S. Food and Drug Administration (FDA) and the U.S. Surgeon General have warned that flavored tobacco products, such as electronic smoking devices (e.g., e-cigarettes and vapes), little cigars, and cigarillos, help new users establish habits that can lead to long-term addiction.

Until the age of twenty-five, nicotine can negatively change an adolescent’s brain, harming cell activities that control attention span, learning, and memory. Nicotine is also highly addictive. The amount of nicotine in e-cigarettes varies greatly between products and is often not labeled clearly. Youth may not be aware that one pod of a popular e-cigarette device may contain as much nicotine as an entire pack of regular cigarettes.

More than 80% of youth who have ever used a tobacco product reported that their first product was flavored. Sweet flavors, such as watermelon, cherry, chocolate, mint, and gummy bear, appeal to youth. Flavorings mask the harsh taste of tobacco, making it easier for youth to initiate tobacco use.

While cigarette use has reached a historic low among youth at under 2%, the use of electronic smoking devices has overtaken the use of traditional tobacco products. In 2018, one (1) in ten (10) high school students in LAC is a current e-cigarette user; fruit or sweet flavors are the most popular among products.

As of February 2020, the CDC reported over 2,800 cases of people experiencing e-cigarette or vaping product use-associated lung injury (EVALI) across all fifty states and two (2) U.S. Territories. Most of them were young adults or youth, and all required hospitalization and supportive care to help them breathe (i.e., mechanical ventilation). Many who survived have permanent lung damage. Over sixty deaths nationally and one (1) in LAC have been attributed to this severe lung illness. Although most cases were associated with vaping tetrahydrocannabinol (THC)-containing e-cigarettes, some were associated with e-cigarettes that contained only nicotine.

Nationally, about 4.47 million middle and high school students were current users (used in the past thirty days) of some type of tobacco product in 2020, down an estimated from 1.73 million from 2019. In California, between 2018 to 2020, the use of electronic smoking devices among high school students declined from 10.5% to 8.2%, respectively. Although the decrease was likely attributed to the awareness surrounding the EVALI cases, the current rate of youth tobacco users is driven largely by a surge in the use of electronic smoking devices and has erased past progress in reducing youth tobacco product use. In 2018, the U.S. Surgeon General declared e-cigarette use among youth an epidemic.

The CDC recommends that e-cigarette or vaping products (nicotine- or THC-containing) should never be used by youths, young adults, or women who are pregnant. In addition, adults who do not currently use tobacco products should not start using e-cigarette or vaping products.

E-cigarette and other vape products are not FDA-approved quit smoking aids. People attempting to quit should use FDA-approved treatments and/or medications, such as nicotine patches or gum.

Menthol cigarettes have been shown to increase youth initiation, inhibit cessation, and promote relapse. Studies have shown that because of its sensory effects and flavor, minty taste, and cooling sensation, menthol may enhance the addictiveness of cigarettes. Although the use of regular cigarettes is declining in the U.S., sales of menthol cigarettes have steadily increased in recent years, especially among young people, new smokers, and in certain communities, representing a health inequity issue.

Hookah tobacco, also known as shisha, is available in an array of fruit, alcoholic beverage, and herbal flavors. Hookah smoking has been associated with lung cancer, respiratory illness, and periodontal disease. One hookah session delivers approximately 125 times the smoke, 25 times the tar, 2.5 times the nicotine, and 10 times the carbon monoxide as a single cigarette. A recent study found that people younger than 25 years of age were more likely to say that hookahs and e-cigarettes were safer than cigarettes. Recent declines in the prevalence of cigarette smoking among youth have coincided with an increased use of e-cigarettes and hookah tobacco.

Little cigars and cigarillos are often sold in small packages for less than a dollar and are promoted as a low-cost alternative to cigarettes. They come in flavors that appeal to youth such as grape, peach, and wine. A recent study found that more than 87 percent of adolescents who used cigarillos in the past 30 days used flavored cigarillos.

In 2016, California raised the minimum age of sale for tobacco products to twenty-one (21) to help reduce youth access to tobacco products through regulations on retail sales. Furthermore, in December 2019, the minimum age of sale for tobacco products expanded outside of California when the federal government amended the Federal Food, Drug, and Cosmetic Act to prohibit the sale of tobacco products to anyone under the age of twenty-one (21), including active military personnel.

Although there are state and federal regulations on the sale of tobacco products, there are limited resources to conduct local enforcement activities, which may lead retailers to illegally sell tobacco products to youth and young adults. To assess tobacco retailers’ willingness to sell tobacco products to youth, the Los Angeles County Dept. of Public Health, in coordination with local community-based organizations, conducts Young Adult Purchase Surveys (YAPS). These surveys are conducted using a comprehensive “attempted buy” protocol developed by Public Health and involve young adults between the ages of eighteen to twenty who attempt to buy tobacco products in tobacco retail stores. Between 2019 and 2020, YAPS were conducted in eleven jurisdictions in LAC. The rate of retailers willing to sell tobacco products to youth ranged from as low as 6% in the City of Maywood to as high as 48% in the City of Los Angeles’ Council District 10.

Strategies that have been identified as successful in reducing youth access to tobacco products include laws that regulate the sale of tobacco products such as tobacco retailer licensing (TRL). TRL policies require each merchant to obtain a license to sell tobacco products and provide for the suspension or revocation of the license if the merchant sells tobacco products to individuals under the age of twenty-one or violates other local, state, or federal tobacco laws.

In addition, TRL policies can include provisions that prohibit the sale of flavored tobacco products, among other provisions. In addition to reducing youth access to tobacco products, strong TRL policies may lower rates of cigarette and e-cigarette use among youth and young adults.

In response to local problems with tobacco sales to youth and young adults, over 110 jurisdictions in California have established strong TRL policies. In LAC, forty-eight jurisdictions have adopted such policies.

A strong TRL includes four core components: 1) a requirement that all retailers that sell tobacco products obtain a license and renew it annually; 2) a fee set high enough to sufficiently fund an effective program, including administration of the program and enforcement efforts; 3) coordination of tobacco regulations so that a violation of any existing local, state, or federal tobacco regulation violates the license; and 4) financial deterrents through fines and penalties, including the suspension and revocation of the license.

Strong TRL ordinances, such as those implemented in LAC, have proven to be effective in reducing youth access to tobacco products. For example, in Pasadena, illegal tobacco sales to minors dropped from 20% to 5% and then to 0% after the city adopted a retail licensing law in 2004. In Burbank, the rate fell from 26.7% down to 4% after a tobacco licensing program was implemented in 2007.

In addition, TRLs can be strengthened by including key provisions that further reduce youth access to tobacco products. These provisions include: 1) restricting the sale of flavored tobacco products including menthol; 2) prohibiting the sale of tobacco products in pharmacies; 3) establishing minimum prices for certain tobacco products (e.g., cigarettes, cigars, little cigars, and cigarillos); 4) establishing minimum packaging size for little cigars and cigarillos; 5) establishing tobacco retailer location restrictions; 6) limiting the total number of available TRLs; 7) restricting tobacco sales to adult-only stores; and 8) requiring in-person, over-the-counter tobacco sales. Many of these policy provisions can, and have been, included in newly adopted TRLs.

Laws prohibiting the possession, use, and purchase (PUP laws) of tobacco products by youth under twenty-one are ineffective as deterrents to youth smoking and are often enforced inequitably. Instead of holding the tobacco industry and retailers accountable, PUP laws shift responsibility to young consumers who are purchasing and using a deadly and highly addictive product. PUP laws are unlikely to reduce youth initiation and smoking prevalence at the population level. PUP laws disproportionately affect youth of color and youth from low-income communities. Thus, PUP law policy provisions are not included in the RFP.

The Family Smoking Prevention and Tobacco Control Act (2009), a federal statute, expressly preserves state and local power to enact measures relating to the sale or distribution of tobacco products. According to a report by the Attorney General of California, “a state or local government may restrict or prohibit the sale and or distribution of flavored tobacco products.” In California, over 100 jurisdictions prohibit the sale of flavored tobacco products. This includes 18 jurisdictions in Los Angeles County including, Alhambra, Hermosa Beach, Culver City, and unincorporated Los Angeles County.

In 2019, the County Board of Supervisors strengthened the County’s TRL, which licenses tobacco retailers in the unincorporated areas of LAC, to require that little cigars must be sold in packages of at least twenty (20) units and to prohibit the sale of all flavored tobacco products, including mentholated cigarettes and hookah tobacco, among other provisions.

On August 28, 2020, California became the second state, after Massachusetts, to ban the sale of flavored tobacco products. The new California law, Senate Bill 793, prohibits the sale of flavored tobacco products by tobacco retailers statewide. The law exempts certain types of tobacco products from the ban, such as the sale of shisha if sold by a licensed hookah tobacco retailer that limits entry to those aged 21 and over. The law allows the sale of premium cigars and loose-leaf tobacco. The law does not preempt local action that goes beyond State law in prohibiting the sale of flavored tobacco products, therefore leaving open the opportunity for local jurisdictions to close the exemptions created in State law. Also, the State law does not override laws passed by California jurisdictions that have already enacted comprehensive bans on flavored tobacco products. On August 31, 2020, a referendum to overturn the law was filed by the tobacco industry. The referendum qualified for the ballot, and SB 793 was suspended until the referendum is voted on in the November 2022 general election.