Ban on menthol-flavoured tobacco products predicts cigarette cessation at 1 year: a population cohort study

Abstract

ObjectivesThe province of Ontario, Canada, banned the use of menthol-flavoured tobacco products as of 1 January 2017. The long-term impact of a menthol ban on smoking behaviour has not been previously evaluated.MethodsPopulation cohort study with baseline survey conducted September–December 2016 and follow-up January–August 2018 among residents of Ontario, Canada, 16 years old and over who reported current smoking (past 30 days) at baseline survey and completed follow-up (n=913) including 187 reporting smoking menthol cigarettes daily, 420 reported smoking menthol cigarettes occasionally, and 306 were non-menthol cigarette smokers. Relative rates of making a quit attempt and being a non-smoker at follow-up were estimated with Poisson regression controlling for smoking and demographic characteristics at baseline.ResultsAt follow-up, 63% of daily menthol smokers reported making a quit attempt since the ban compared with 62% of occasional menthol smokers and 43% of non-menthol smokers (adjusted relative rate (ARR) for daily menthol smokers compared with non-menthol smokers: 1.25; 95% CI 1.03 to 1.50). At follow-up, 24% of daily menthol smokers reported making a quit since the ban compared with 20% of occasional menthol smokers and 14% of non-menthol smokers (ARR for daily menthol smokers compared with non-menthol smokers: 1.62; 95% CI 1.08 to 2.42).ConclusionsThe study found higher rates of quitting among daily and occasional menthol smokers in Ontario 1 year after the implementation of a menthol ban compared with non-menthol smokers. Our findings suggest that restrictions on menthol may lead to substantial improvements in public health.

The actual and anticipated effects of a menthol cigarette ban: a scoping review

“…Regarding smoking cessation, an Ontario menthol cigarette ban study provided the most direct results of an actual ban, with 24% of daily menthol smokers quit by one-year post-ban [17]. Another Ontario study found that all cigarette sales declined by 11%, with minimal substitution of non-menthol for menthol cigarettes [16].…”

“…There are also limitations related to the outcomes reported in the original studies. For example, the measure of cessation reported by Chaiton et al [17] in their study of Canada's menthol ban was a statement of "not at all" in response to being asked about their current use of menthol or non-menthol cigarettes. No results to follow-up questions about how long the individual had quit smoking or biochemical verification of cessation were reported, thereby potentially overestimating the effect of a ban.…”

“…Chaiton et al [17,18], conducted two studies analyzing the impact of the 2017 Ontario, Canada ban on menthol cigarettes. Both studies used random-digit dialing to identify a sample of smokers aged 16 and older prior to the menthol ban's implementation.…”

“…The first study, with 324 smokers at one-month post-ban [18], found that 28% of menthol smokers switched to non-menthol cigarettes, 29% attempted to quit, and 29% used an alternative flavored tobacco or e-cigarette product. A second study [17] conducted one-year post-ban with a sample of 913 smokers (including non-menthol and menthol users) found that 56% of all smokers had made at least one quit attempt, and 19% reported no current tobacco use. Daily menthol smokers were more likely to have made a quit attempt (63% vs. 43%) and quit smoking (24% vs. 14%; adjusted risk ratio 1.62; 95% CI 1.08 to 2.42) compared to daily non-menthol smokers.…”

E‐cigarette regulation: a delicate balance for public health

“…In fact, flavored tobacco product use is common among current tobacco‐using middle and high school students, with almost half this group using flavored smokeless tobacco (48%), menthol cigarettes (47%), flavored cigars (42%) and almost a third using flavored hookah (31%) [3]. Taken together, enforcement against e‐cigarette flavors without a restriction on all flavored tobacco products [2], including menthol products [4–6], may inadvertently provide flavored alternatives to e‐cigarettes and potentially lead to an increase in youth use of more harmful products.…”