Evaluating the impact of menthol cigarette bans on cessation and smoking behaviours in Canada: longitudinal findings from the Canadian arm of the 2016–2018 ITC Four Country Smoking and Vaping Surveys

Abstract

ObjectiveTo evaluate the impact of menthol cigarette bans in seven Canadian provinces between 2016 and 2018.MethodsLongitudinal data from the Canadian arm of the 2016 and 2018 ITC Four Country Smoking and Vaping Survey. 1098 non-menthol and 138 menthol smokers were surveyed pre-menthol and post-menthol cigarette bans. Multivariate logistic regression models examined associations between pre-post ban changes in smoking behaviour, including differences between menthol and non-menthol smokers in quit attempts and quitting.ResultsAt follow-up, 59.1% of pre-ban menthol smokers switched to non-menthol cigarettes; 21.5% quit smoking and 19.5% still smoked menthols, primarily purchased from First Nations reserves. Menthol smokers were more likely than non-menthol smokers to make a quit attempt (adjusted OR (aOR)=1.61, 95% CI 1.03 to 2.51), and to remain quit (aOR=2.30, 95% CI 1.06 to 5.01). Menthol smokers did not differ significantly from non-menthol smokers in quit success (aOR=1.72, 95% CI 0.98 to 3.01); however, daily menthol smokers were more likely than daily non-menthol smokers to quit (aOR=2.21, 95% CI 1.15 to 4.24), and daily menthol smokers who quit before the ban were more likely than daily non-menthol smokers to remain quit (aOR=2.81, 95% CI 1.15 to 6.85).ConclusionsAlthough menthol smokers were most likely to switch to non-menthol cigarettes, the menthol ban was also significantly associated with higher rates of quit attempts and quit success among menthol smokers compared with non-menthol smokers, and may have helped to prevent relapse among menthol smokers who had quit smoking before the ban. Results confirm and extend evaluation of Ontario’s menthol ban across provinces covering 83% of the Canadian population.

Australian Smokers’ Sensory Experiences and Beliefs Associated with Menthol and Non-Menthol Cigarettes

“…The development of tobacco package warning labels and/or multi-media campaigns that reframe these sensory experiences may reduce misperceptions of the potential for reduced risk and undermine the enjoyment that smokers experience when smoking menthol cigarettes, helping these smokers move closer to quitting. In addition, a ban on the use of menthol in tobacco products in Australia would eliminate the source of these sensory experiences and, as has occurred elsewhere [ 51 , 52 ], could be expected to increase quitting behaviours.…”

Evaluating the public health impact of partial and full tobacco flavour bans: A simulation study

“…Studies evaluating the public health impact of tobacco flavour bans in the United States, European Union and Canada reported declines in cigarette use, 17 , 18 , 19 , 20 decreased cigarette sales, 17 , 21 and improved cessation outcomes. 17 , 22 , 23 , 24 Two studies have simulated the impact of a menthol cigarette ban in the United States. A 2011 study estimated a 9.7% reduction in smoking prevalence with over 600,000 deaths averted by 2050, assuming 30% quitting and 30% fewer initiations.…”

Effects of and challenges to bans on menthol and other flavors in tobacco products

“…As more countries work towards adopting tobacco flavor bans, it is critical to understand how these policies are implemented, ascertain their population-level impact, and identify the regulatory challenges.Initial evaluation of these bans has provided evidence for their positive impact as well as the challenges. Population-level data from the International Tobacco Control (ITC) Surveys in Canada and Europe have demonstrated that banning menthol and other flavors in cigarettes can lead to positive public health outcomes including increased quitting, without significant unintended consequences such as illicit purchasing 4,5 . The menthol cigarette ban in Canada led to 7.5% additional quitting among menthol smokers compared to nonmenthol smokers 4 .…”

“…Population-level data from the International Tobacco Control (ITC) Surveys in Canada and Europe have demonstrated that banning menthol and other flavors in cigarettes can lead to positive public health outcomes including increased quitting, without significant unintended consequences such as illicit purchasing 4 , 5 . The menthol cigarette ban in Canada led to 7.5% additional quitting among menthol smokers compared to non-menthol smokers 4 . Findings from the EUREST-PLUS ITC Europe Surveys, before and after the flavor ban, but prior to the menthol ban, found a reduction in menthol use 5 as well as other flavors and improved health knowledge and beliefs among menthol smokers.…”

“…Findings from the EUREST-PLUS ITC Europe Surveys, before and after the flavor ban, but prior to the menthol ban, found a reduction in menthol use 5 as well as other flavors and improved health knowledge and beliefs among menthol smokers. However, a majority of menthol smokers in Canada switched to non-menthol cigarettes rather than quitting, and a substantial proportion of EU smokers continued to smoke menthol cigarettes prior to the ban and intended to either continue or switch to non-menthol cigarettes after the menthol ban, rather than quit 4 , 5 . This is not surprising, given the high addictiveness of cigarettes, coupled with the lack of promotion and availability of smoking cessation support, and the measures taken by the tobacco industry to circumvent and undermine menthol bans 6 .…”