Bans on menthol cigarettes across Canada from 2016 to 2017 led to a significant increase in the number of smokers who attempted to quit, smokers who quit successfully, and lower rates of relapse among former smokers, according to a new research study from the International Tobacco Control Policy Evaluation Project (the ITC Project) at the University of Waterloo.
Menthol is the most common flavoring for cigarettes in many countries. Menthol creates a cooling sensation, which reduces the harshness of cigarette smoke. Because of this, menthol leads to increased experimentation and progression to regular smoking among new smokers, especially among youth.
"Our study demonstrates the substantial benefits of banning menthol cigarettes," said Geoffrey T. Fong, Professor of Psychology and Public Health and Health Systems at Waterloo, and principal investigator of the ITC Project. "The enormous success of the Canadian menthol ban makes it even clearer now that the U.S. should finally ban menthol, which the tobacco industry has used for decades to attract new smokers and to keep many of them as customers, especially among the African-American community.
"The positive effects of the Canada menthol ban suggest that a U.S. menthol ban would lead to greater benefits since menthol cigarettes are much more popular in the U.S. From our findings, we estimate that banning menthol cigarettes in the U.S. would lead an additional 923,000 smokers to quit, including 230,000 African-American smokers."
The study conducted by Fong and his team examined the impact of menthol bans across seven Canadian provinces, covering 83 per cent of the Canadian population, which saw menthol cigarettes banned between August 2016 and October 2017. Canada was the one of the first countries to implement a ban on menthol cigarettes, and the first country where a menthol ban has been evaluated.
"The Canadian menthol ban did not lead to a high level of illicit menthol cigarette purchasing, which has been a concern by regulators considering a menthol ban," said Fong. "Fewer than 10 per cent of menthol smokers reported still smoking a menthol brand after the ban."
Scientific reviews conducted by the Tobacco Products Scientific Advisory Committee to the U.S. Food and Drug Administration (FDA), the FDA itself, and the World Health Organization have also concluded that banning menthol would have significant public health benefits.
The harms of menthol cigarettes in the U.S. have been much greater among African-Americans. Menthol cigarettes are smoked by 85 per cent of African-American smokers, over 2.8 times the percentage of menthols among white smokers.
A national sample of 1098 non-menthol and 138 menthol smokers participating in the ITC Canada Smoking and Vaping Survey were surveyed both before the menthol ban (in 2016) and after the menthol ban (in 2018).
The survey demonstrated three benefits of the Canadian menthol ban. Menthol smokers were significantly more likely than non-menthol smokers to attempt to quit after the menthol ban (58.7 per cent vs. 49 per cent).
Daily menthol smokers were almost twice as likely than daily non-menthol smokers to quit after the menthol ban (21 per cent vs. 11.6 per cent).
Finally, those menthol smokers who had quit smoking before the menthol ban were significantly less likely than non-menthol smokers who had quit smoking to have relapsed back to smoking.
The study, 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, was published today in the journal Tobacco Control.