Background
Methods
Results
Implemented menthol ban
Author, Year | Location | Age group | Study Design (Theme) | Sample Size | Ban Specifics (Implementation Date) | Data Sources | Main Outcomes | Results |
---|---|---|---|---|---|---|---|---|
Borland, T. 2018 [14] | Ontario, Canada | NA | Pre and post analysis (Compliance) | N = 63 packs (n = 30menthol and n = 33 non-menthol) | 2017 Provincial ban on menthol cigarettes and other tobacco products | Eight retail outlets, Toronto, Ontario. Pre-ban Oct/Nov 2016; Post-ban Feb and Sept 2017. Evaluation of menthol packs matched with their non-menthol alternatives | Content analysis of the pack: visual, textual and physical design. Inside and outside colors, foil color, filter tip, filter type, and taste descriptors | Post-ban, blue was the most prominent pack color. Blue and silver filter tips continued to be used. Use of “smooth” instead of “menthol” or “fresh” descriptors in the pack. |
Brown, J. 2017 [15] | Alberta and Nova Scotia, Canada | NA | Pre and post analysis (Compliance) | N = 498 cigarette packs (n = 199 packs of menthols) | 2015 Provincial ban on menthol tobacco products (Nova Scotia, May 2015. Alberta, Sept 2015. | Retail outlets cigarette pack purchases. Sept/Dec 2015. Pre-ban in Alberta; Post-ban Alberta and Nova Scotia. | Content analysis of the pack: visual, textual and physical design. In and out colors, foil color, filter tip, filter type, and taste descriptors | Post-ban, no cigarette packs labeled as “menthol” were purchased.Brands identified as menthol pre-ban were repackaged to connote products that were menthol replacements. Menthol was replaced with “Green” descriptor in Alberta. |
Chaiton, M. 2019 [16] | Ontario, Canada | NA | Time Series (Sales) | NA | 2017 Provincial ban on menthol cigarettes and other tobacco products | Ontario (ban) and British Columbia (no ban) monthly wholesale data from Health Canada from 2012 to 2017 (80 months). | Sales of cigarettes | Post-ban, menthol cigarette sales fell to near zero (55 million unit reduction), a 4% decrease in non-menthol and 11% decrease in total cigarette sales. British Columbia saw a 15% decline in menthol sales, a 1% increase in non-menthol sales and a 1% decrease in overall sales. |
Chaiton, M. 2019 [17] | Ontario, Canada | 16+ | Cohort study (Individual Behavior) | N = 913 current smokers | 2017 Provincial ban on menthol cigarettes and other tobacco products | Telephone Survey. Baseline Sept/Dec 2016. Follow-up Jan/Aug 2018. Stratified by daily and occasional menthol and non-menthol smokers. | Current use, intention to quit and quit attempt one-year post ban | Post-ban, 56% of all respondents reported at least one quit attempt and 19% reported successful quitting. Menthol users were more likely to have made a quit attempt (62% vs. 43% of non-menthol users). 24% of daily menthol users reported having quit post-ban compared to 19% of non-menthol smokers. Daily and occasional menthol smokers made more quit attempts (adjusted relative rate of 1.62 and 1.09) than non-menthol smokers. |
Chaiton, M. 2018 [18] | Ontario, Canada | 16+ | Cohort study (Individual Behavior) | N = 325 individuals who smoked at least one menthol in the past year | 2017 Provincial ban on menthol cigarettes and other tobacco products | Telephone Survey. Baseline Sept/Dec 2016. Follow-up Jan 2018. Stratified by menthol daily, menthol someday and nonmenthol users. | Current use, intention to quit and quit attempt one-month post-ban | Pre-ban, 123 menthol smokers [59.7%] said that they would switch to non-menthol cigarettes, but only 51 (28.2%) switched post-ban.Pre-ban, 30 (14.5%) said they quit vs. 60 [29.1%]) attempted to quit post-ban. Pre-ban, 12 [5.8%] intended to use other flavored tobacco or e-cigarette products (menthol was not banned in e-cigarette products) vs. 60 [29.1%]) who switch post-ban. |
Stokolsa, M. 2019 [19] | Nova Scotia, Canada | NA | Time series (Compliance) | NA | 2015 Provincial ban on menthol cigarettes | Provincial Tax Commission data on illicit cigarettes seized from 2007/08 to 2017/18. Pre-ban (2012 to 2015). Post-ban (2015–2018) Data not specifically stratified by menthol or non-menthol cigarettes. | Number of seized illicit cigarettes | Post-ban, the number of illicit cigarette cartons decline from > 60,000 to < 10,000 in 2017. Afterward, the seizure volume remained stable, with no statistically significant difference in the number of cigarettes seized before and after the menthol ban. Amount of menthol cigarettes seized was not significant. |
Individual behavior
Sales
Compliance
Hypothetical menthol ban
Author, Year | Location | Age group | Study Design (Theme) | Sample Size | Ban Specifics (Implementation Date) | Data Sources | Main Outcomes | Results |
---|---|---|---|---|---|---|---|---|
Buckell, J. 2019 [23] | US | 18–64 | Cross-Sectional (Individual Intentions) | N = 2031 smokers and recently quit smokers | Hypothetical national ban on menthol cigarettes and menthol/flavored e-cigarettes | Discrete choice experiment considering various combinations of menthol cigarette and menthol or fruit/sweet e-cigarette bans. | Change in product choice shares | Current and former smokers preferred cigarettes to e-cigarettes, but differences by age, race, and education exist. Banning menthol cigarettes would produce the greatest reduction in the choice of cigarettes (−5.2%), but with an accompanying increase in e-cigarette use (3.8%). Banning flavors, including menthol, in e-cigarettes without banning menthol cigarettes would result in an 8.3% increase in the use of combustible cigarettes and an 11.1% decline in e-cigarette use. Banning all flavors across all products would increase ‘opting-out’ the most (5.2%), but would also increase cigarette choice by 2.7%. |
D’Silva, J. 2015 [24] | Minnesota, US | 18+ | Cross-Sectional (Individual Intentions) | N = 1158 current menthol smokers (100+ cigarettes and smoked some or everyday with menthols as their usual brand) | Hypothetical ban on menthol cigarettes | Minnesota Adult Tobacco Survey | Cessation and product switching | Nearly half (46.4%, [37.9, 54.9]) of menthol smokers responded that they would quit smoking. Approximately one-fourth of menthol smokers (26.6%, [19.0, 34.1]) reported that they would switch to non-menthol cigarettes; 12.3% [6.3, 18.3] would switch to menthol e-cigarettes, 5.8% [1.8, 9.7] would buy menthol cigarettes online, 2.8% [0.4, 5.2] would switch to some other menthol tobacco product, 2.7% [0.0, 6.0] would buy menthol cigarettes from another country, and 1.5% [0.0, 3.8] would switch to some other non-menthol tobacco product. African-American menthol smokers were more than twice as likely to report an intention to quit in the event of a ban (76.0%, [57.6, 94.3]) compared to their white counterparts (30.3%, [21.7, 38.9]) (RR = 2.5, [1.7, 3.6], p < .001). |
Guillory, J. 2019 [25] | US | 18+ | Cross-Sectional (Individual Intentions) | N = 1197 menthol smokers | Hypothetical national ban on menthol cigarettes | RTI iShoppe virtual convenience store. Four types of virtual ban: a) no ban; b) replacement of menthol cigarettes and ads with green versions; c) menthol cigarette ban; d) all menthol tobacco products ban. | Consumer behavior in response to bans, brand loyalty, and perceived response. | Cigarette purchases were higher in the no ban (59%) and green conditions (59%) than the menthol cigarette ban (49%) and all menthol ban conditions (47%). Menthol cigarette purchases were highest in the no ban condition (50%). Other tobacco product (OTP) purchases were low across conditions, ranging from 16 to 17%, with 2–3% of all tobacco purchases being menthol e-cigarettes. Purchases of a substitute cigarette brand were highest in the menthol cigarette ban condition (61%) and the all menthol ban (60%).OTP purchases were similar across four scenarios, suggesting menthol bans may not increase OTP purchases. |
Hartman, A. 2011 [22] | US | 18+ | Cross-Sectional (Individual Intentions) | N = 10,441 (n= 2887 regular menthol smokers) | Hypothetical national ban on menthol cigarettes | Tobacco Use Supplement-current Population Survey 2010 | Cessation and product switching | 39% of usual menthol users (30% of the smokers’ sample) reported they would quit and not switch to an alternative tobacco product. This included 40.6% of the 18–44 year-olds and 36.7% of the 45+. Women and non-Hispanic blacks report less intention to quit compared to men and non-Hispanic whites. |
O’Connor, R. 2012 [26] | US | 14–65 | Cross-Sectional (Individual Intentions) | N = 417 (n = 170 menthol users). | Hypothetical national ban on menthol cigarettes | Global Market Institute, Inc. online survey panel, July 2010. Sample stratified smokers and non-smokers by age group | Cessation and product switching | More than 35% of menthol smokers reported the intention to quit smoking, 25% plan to seek out menthol cigarettes. Demand elasticity for non-menthol products in menthol smokers was 50% higher than for non-menthol smokers. |
Pacek, L. 2019 [27] | US | 18–29 | Cross-Sectional (Individual Intentions) | N = 240 (n = 126 menthol users) | Hypothetical national ban on menthol cigarettes (also considered low nicotine content cigarettes) | Amazon Mechanical Turk survey, 2017. Dual (combusted and e-cigarette) users. | Use of e-cigarettes in response to menthol cigarette ban | Approximately 25% (aged 18–29) would plan to quit and 32.5% would reduce the amount smoked. Approximately 30% of menthol cigarette/e-cigarette dual users reported an intention to increase e-cigarette use following a menthol ban. |
Pearson, J. 2012 [28] | US | 18+ | Cross-Sectional (Individual Intentions) | N = 2649 | Hypothetical national ban on menthol cigarettes | Data from the Knowledge Panel. Never, former and current smokers. Stratified by sex, ethnicity, age group, education, health status, intention to quit and quit attempts | Attitudes towards menthol bans; cessation and product switching. | Menthol smokers were more likely than non-menthol smokers to disagree with a menthol ban (50.5% vs. 31.2%; P < 0.001). 38.9% of menthol smokers said that they would quit, 13% would switch to a nonmenthol cigarette, 25% would switch to regular cigarettes and try to quit. |
Rose, S. 2019 [29] | US | 18–34 | Cohort (Individual Intentions) | N = 806 | Hypothetical national ban on menthol cigarettes | Truth Initiative Young Adult Cohort from 2011 to 2016 | Cessation and product switching | Switching to non-menthol cigarettes was most common post-ban intention (mean of 32.3% across multiple waves). 30.8% did not know what they would do in response to a menthol ban. 23.5% reported they would quit and 10.7% reported the intention to use an alternative tobacco product. |
Wackowski, O. 2014 [30] | US | 18–34 | Cross-Sectional (Individual Intentions) | N = 2871 (n = 619 menthol users) | Hypothetical national ban on menthol cigarettes | National Young Adult Health Survey, 2011. Menthol smokers | Cessation and product switching | 64% would try to quit smoking, 18% would switch to non-menthol cigarettes, 15.7% would switch to OTP, and 1% didn’t know. |
Wackowski, O. 2015 [31] | US | 18+ | Cross-Sectional (Individual Intentions) | N = 519 (n = 187 menthol users) | Hypothetical national ban on menthol cigarettes | Online survey panel, April 2014. Stratified by ethnicity. | Cessation and product switching | 28.4% would try to quit smoking; 45.9% switch to nonmenthol cigarettes; 3.9% would switch to OTP; 15.1% would switch to menthol e-cigarettes. |
Wackowski, O. 2018 [32] | New Jersey, US | 18–24 | Cross-Sectional (Individual Intentions) | N = 45 (in 6 focus groups) | Hypothetical ban on menthol cigarettes | Focus groups from Dec 2014 to Mar 2015 | Attitudes and perspective towards menthol cigarettes | 59.1% indicated that either all (34.1%) or most (25%) of their first few cigarettes were mentholated.Easy accesses to loosies influenced menthol use (particularly among African Americans). Several people noted that they were willing to smoke a friend’s non-menthol cigarette if they didn’t have their cigarettes. Many participants were highly skeptical that a ban could be effective, believing that people would still find a way to get menthol cigarettes, either on the “black market” or by making bootleg versions.Some stated that a ban would not make much of an impact on them because they would just switch to non-menthol cigarettes. However, others thought a ban might motivate them to quit and increase their likelihood of doing so. |
Zatoński, M. 2018 [33] | Europe | 18+ | Cross-Sectional (Individual Intentions) | N = 10,760 smokers (100+ cigarettes in their lifetime) | Hypothetical ban on menthol cigarettes | Smokers from 8 European countries from the International Tobacco Control Policy Evaluation | Cessation and product switching | When asked about their intended behavior following a hypothetical ban, most respondents reported intending to find menthol cigarettes regardless of the ban (27.3%; 95% CI 23.7–31.3), 20% reported an intention to switch to another product (95% CI 16.9–23.4), 17.6% reported an intention to reduce their smoking amount (95% CI 14.5–21.1), 16.0% reported an intention to quit (95% CI 13.3–19.2), and the remainder reported that they would ‘do something else’ or did not know. |
Implemented flavor ban
Author, Year | Location | Age group | Study Design (Theme) | Sample Size | Ban Specifics (Implementation Date) | Methods | Main Outcomes | Results |
---|---|---|---|---|---|---|---|---|
Chaiton, M. 2019 [34] | Canada | NA | Time Series (Sales) | NA | 2009 National ban on flavored cigarettes and little cigars, except menthol | Quarterly sales data from Health Canada from 2004 to 2015. | Sales of cigars | Post-ban, a there was a decline in flavored cigars sales after 2009 of 59 million units. Incomplete substitution with an increase of 9.6 million in non-flavored cigars. |
Courte-manche, C. 2017 [35] | US | 11–19 | Trend Analysis (Individual Behavior) | Not Specified | 2009 National ban on flavored cigarettes, except menthol | National Youth Tobacco Surveys from 1993 to 2013. Controlled by age, sex, and race, tax-inclusive price indices for cigarettes and Other tobacco products (OTP). | Type of tobacco product use in the past 30 days. Cigarettes, menthol cigarettes, or OTP (cigars, smokeless, pipes) or non-cigarette tobacco products | Post-ban, there was a decrease of 6% in the probability use of any tobacco products. Adolescents were more likely to choose menthol cigarettes, cigars and pipes. Substitution to other tobacco products increased by 14%. |
Delnevo, C. 2015 [13] | US | NA | Trend Analysis (Sales) | NA | 2009 National ban on flavored cigarettes, except menthol | Nielsen’s convenience store data on clove cigars, 2009–2012.USDA/ GATS data on imported cigars and cigarettes from 2008 to 2012. Quantity and value of cigars and cigarettes from Indonesia 2008–2012 | Sales and total imports of clove cigars. Marketing Strategies. | Kretek International’s development of clove cigar started in 2007 by changing only the product’s wrapper from cigarette to cigar. Kretek took advantage of the disparities between cigarette and cigars warning labels and excise tax. Clove cigars sales increased from 444,000 in 2009 to 6.7 million in 2012 (1400%). Cigars imports increase to > 626 million sticks by 2012. |
Delnevo, C. 2017 [36] | US | NA | Trend Analysis (Sales) | NA | 2009 National ban on flavored cigarettes, except menthol | US Nielsen convenience store sales data from 2008 to 2015 to identify cigar’s specific brand, flavor, and packaging characteristics | Sales of cigars packaging characteristics, or flavors. | From 2008 to 2015, unit sales of cigars steadily increased from 994.2 million to over 1.5 billion. More than half of cigars sold in 2015 were flavored, an 8.5% absolute change in market share. From 2008, the number of unique flavor names doubled during this period, from 108 individual flavors to 250 by 2015. Sales of single and 5-pack cigars fell in favor of 2–3 packs which rose from 1% in 2008 to 40% in 2015. |
Jo, C. 2014 [37] | US | NA | Pre and Post Analysis (Compliance) | N = 200 internet cigarette vendors | 2009 National ban on flavored cigarettes, except menthol | Internet tobacco vendors product availability, Internet Cigarette Vendor study 2009, 2010, and 2011 | Sales of flavored tobacco products | Post-ban, 89% of vendors continued to sell flavored products however, the majority (67.8–82.5%) of these retailers were international. Percentage of flavored US vendors fell from 50.9% in 2019 to 28.6%. Vendors were 1.71 times more likely to sell flavored little cigars in 2010 compared to 2009; and 5.50 times more likely to sell clove cigarettes. The percentage of vendors selling clove cigarettes and cigars increased from 20.6% in 2009 to 25.5% in 2010 and then decrease to 15.5% in 2011. |
Nguyen, H. 2014 [38] | Canada | 15–65 | Trend Analysis (Individual Behavior) | N = 46,000 observations | 2010 Ban on flavored cigarillos and unflavored packs with > = 20 units | 2007–2011 Canadian Tobacco Use Monitoring Survey | Change in young person’s use of cigarillos and regular cigars | For entire sample, 39% reported ever smoking cigarillos and 9% reported past 30-day use. Past 30-day use of cigarillos by those aged 15–24 declined from 13.7 to 9.3% (p = 0.000) for male respondents and from 5.3 to 3.3% (p = 0.001) for female respondents. Reductions in cigarillo use for the older age group were not statistically significant. Regression analysis found a 2.3 percentage point decline in past 30-day cigarillo use among young people (22% relative decline); a 4.3 percentage point increase in past 30-day abstinence. For youth, all cigar ever use declined by 2.2 percentage points (5.1% relative reduction) and by 3.1% for ever use of cigarillos (8% relative decline). |
Individual behavior
Sales
Compliance
Implemented Menthol Ban (Actual Effects) | Hypothetical Menthol Ban (Intended Effects) | Implemented Flavor Ban – Cigarettes Only | Implemented Flavor Ban – All Tobacco Products | |
---|---|---|---|---|
Sales change (banned product) | ~ 100% reduction | NA | NA | 39% reduction in flavored cigar sales |
Sales change (all tobacco products) | 11% reduction | NA | 47% increase in cigar sales; 1400% increase in clove cigar sales | 27% reduction in all cigar sales |
Quit Attempt | 29–63% | 24–64% | NA | NA |
Successful Quit | 24% | NA | NA | NA |
Switch to other tobacco product | 28.2–76.1% | 11–46% | 14% | 0–11% |
Switch and attempt to quit | NA | 20–25% | NA | NA |
Switch to e-cigarettes | 29.1% | 12–30% | NA | NA |
Find product regardless of ban | NA | 9–25% | NA | NA |
Reduced Odds of Trying Any Tobacco Product | NA | NA | 6% | NA |
Reduced Odds of Trying Cigars | NA | NA | NA | 5% |