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9.A. - Page 8 of 31 <br />companies have used flavorings such as mint and wintergreen in smokeless <br />tobacco products as part of a "graduation strategy" to encourage new users to <br />start with tobacco products with lower levels of nicotine and progress to products <br />with higher levels of nicotine. It is therefore unsurprising that young people are <br />much more likely to use menthol-, candy- and fruit -flavored tobacco products <br />than adults, including not just cigarettes but also cigars, cigarillos, and hookah <br />tobacco. Data from the National Youth Tobacco Survey indicate that more than <br />two-fifths of U.S. middle school and high school smokers report using flavored <br />little cigars or flavored cigarettes. Further the Centers for Disease Control and <br />Prevention has reported a more than 800% increase in electronic cigarette use <br />among middle school and high school students between 2011 and 2015. Nicotine <br />solutions, which are consumed via electronic smoking devices such as electronic <br />cigarettes are sold in thousands of flavors that appeal to youth, such as cotton <br />candy and bubble gum. <br />d) Certain minority groups also disproportionately use flavored tobacco products, <br />including menthol cigarettes. In one survey, the percentage of people who smoke <br />cigarettes that reported smoking menthol cigarettes in the prior month included, <br />most dramatically 82.6% of Blacks or African-Americans who smoke cigarettes. <br />The statistics for other groups were: 53.2% of Native Hawaiians or Other Pacific <br />Islanders who smoke cigarettes; 36.9% of individuals with multiracial <br />backgrounds who smoke cigarettes; 32.3% of Hispanics or Latinos who smoke <br />cigarettes; 31.2% of Asians who smoke cigarettes; 24.8% of American Indians or <br />Alaska Natives who smoke cigarettes; and 23.8% of Whites or Caucasians who <br />smoke cigarettes. People who identify as LGBT and young adults with mental <br />health conditions also struggle with disproportionately high rates of menthol <br />cigarette use. The disproportionate use of menthol cigarettes among targeted <br />groups, especially the extremely high use among African-Americans, is troubling <br />because of the long-term adverse health impacts on those populations. <br />e) Between 2004 and 2014 overall smoking prevalence decreased, but use of <br />menthol cigarettes increased among both young adults (ages 18-25) and other <br />adults (ages 26+). These statistics are consistent with the finding that smoking <br />menthol cigarettes reduces the likelihood of successfully quitting smoking. <br />Scientific modeling has projected that a national ban on menthol 17 cigarettes <br />could save between 300, 000 and 600, 000 lives by 2050. <br />f) By selling tobacco products, pharmacies reinforce positive social perceptions of <br />smoking, convey tacit approval of tobacco use, and send a message that it is not <br />dangerous to smoke. <br />g) The Tobacco and Education Research Oversight Committee for California, as <br />well as the American Pharmacists Association, the California Pharmacists <br />Association, and the California Medical Association have called for the adoption <br />of state and local prohibitions of tobacco sales in drug stores and pharmacies. <br />2 <br />285 <br />