Abstract IA02: Science to policy for a ban on the sale of menthol and flavored tobacco products: The San Francisco Cancer Initiative (SF CAN)
Authors: Hiatt Robert A. 
Published: September 2020

Abstract
The San Francisco Cancer Initiative (SF CAN) seeks to implement evidence-based interventions for the top five most prevalent cancers for which prevention and early detection procedures are available. In San Francisco, breast, prostate, colorectal, liver, and lung and other tobacco-caused cancers account for 48% of cancer mortality, and cancer is now the leading cause of death. SF CAN uses a “collective impact” structure whereby multiple health systems, the Department of Public Health, safety net clinics, nongovernmental agencies, and community groups all work together on the same goal of accelerating the reduction in cancer mortality at the population level, with the University of California San Francisco (UCSF) serving as the backbone entity. SF CAN has been active for 3 years and is supported by philanthropy, grants, and in-kind contributions from collaborative partners. Implementation work is carried out by five task forces, each made up of members from UCSF and collaborating institutions and agencies. The Tobacco Task Force, led by Dr. Stanton Glantz and his colleagues, has sought to have an impact on the use of menthol and flavored cigarettes on African Americans and other targeted ethnic groups, youth, and young adult tobacco use and tobacco cessation among homeless and substance-abusing populations within the city. Some of the interventions they are implementing, based on scientific evidence of impact, have had or will have direct policy implications. Foremost among these has been the use of evidence on the impact of menthol cigarettes, commonly used by African American, Latino, and LGBT communities. The Task Force investigators assembled data on both the biologic mechanisms by which menthol additives increase the likelihood of addiction and the historical data from examination of documents obtained through legal channels from the tobacco industry. These data were first supplied to the FDA to assist in their decision-making and then made available to San Francisco Supervisors for their consideration for actions by local government ordinance. After consideration of the evidence and motivated by the health issues of their constituents, they wrote an ordinance completely banning the sale of all flavored tobacco products (including menthol). The ordinance passed unanimously in June 2017 and was signed into law by then-Mayor Lee. A petition drive to revoke the ordinance by referendum, heavily financed by RJ Reynolds Tobacco (maker of the leading menthol cigarette, Newport) with support from other tobacco companies, failed with 68% of voters in favor of keeping the ban. The ordinance went into effect in July 2018 with systematic outreach and education to retailers of tobacco by the SF DPH, and initial inspections were begun in Dec 2018 and have continued as routine since April of 2019 and found strong by tobacco outlets. This and other efforts at policy change in tobacco that have been conducted in the area of health economics of tobacco use and in the institution of smoke-free areas in homeless shelters around the city will be described.
Citation Format: Robert A. Hiatt. Science to policy for a ban on the sale of menthol and flavored tobacco products: The San Francisco Cancer Initiative (SF CAN) [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA02.