Classifying the comprehensiveness of flavoured tobacco sales restrictions: development and application of a tool to examine US state and local tobacco policies

ObjectivesComprehensive tobacco control policies with minimal exemptions can reduce tobacco use and sales. Many states and localities have adopted flavoured tobacco product (FTP) sales restrictions. This study describes the development and application of a schema to characterise the comprehensiveness of these FTP sales restrictions.DesignWe coded state and local FTP sales restrictions enacted June 2007–March 2021 for retailer, tobacco product, and flavour inclusions and exemptions. Guided by FTP literature, legal resources and meetings with FTP policy experts, we developed a six-level classification scheme to characterise coded FTP policies from least to most comprehensive. We present descriptive statistics of FTP policy features and comprehensiveness.ResultsAs of 31 March 2021, 7 state-level and 327 local-level FTP sales restrictions were enacted in the USA. Most state-level policies (71.4%) were categorised in the second lowest comprehensiveness category; local policies most commonly fell within the lowest (48.9%) or highest (26.0%) comprehensiveness categories. Across jurisdictions, adult-only retailers were most frequently exempted from the FTP sales restrictions (state: n=1, 14.3%; local: n=184, 56.3%); and most jurisdictions included electronic cigarettes (e-cigarettes) as a banned product (state: n=6, 87.5%; local: n=227, 100%). While just over half of state (n=4, 57.1%) and local (n=169, 51.7%) sales restrictions included menthol e-cigarettes, most excluded menthol cigarettes and/or menthol smokeless tobacco.ConclusionsComprehensiveness of FTP sales restrictions in the USA varies widely. Current and future FTP policies would be strengthened by including all flavours and all tobacco products—particularly menthol cigarettes—and by avoiding exemptions for certain retailers, particularly adult-only retailers.

Recent, national trends in US adolescent use of menthol and non-menthol cigarettes

ObjectiveIn light of the current U.S. Food and Drug Administration (FDA) proposal to ban menthol cigarettes, this study updates trends in menthol cigarette use among adolescents age 13–18 years up to the year 2020. The study considers a potential role for the ban to reduce black/non-black disparities in menthol cigarette use, as well as a counterargument that a ban is not necessary because menthol use is already diminishing.MethodsData are from annual, cross-sectional, nationally representative Monitoring the Future (MTF) surveys of 85 547 8th, 10th and 12th grade students surveyed between 2012 and 2020. Analyses include trends in past 30-day menthol and non-menthol cigarette smoking among the total adolescent population, as well as stratified by race/ethnicity.ResultsDeclines in adolescent menthol and non-menthol cigarette smoking continued through 2020 so that in 2018–2020 past 30-day prevalence for each was less than 1% for non-Hispanic black adolescents and less than 2.2% for non-black adolescents. For non-Hispanic black adolescents no smoking declines in mentholated or non-mentholated cigarette use from 2015–2017 to 2018–2020 were statistically significant, in part because prevalence levels approached a floor effect and had little room to fall further. Menthol levels were lower for non-Hispanic black versus all other adolescents in all study years.ConclusionsContinuing declines in adolescent menthol prevalence indicate that both menthol prevalence and also black/non-black disparities in its use are steadily decreasing. However, these decreases in adolescence will take decades to reach later ages through generational replacement. Efforts to accelerate menthol decreases will require new initiatives to increase cessation among adult menthol users.

Profile of menthol cigarette smokers in the months following the removal of these products from the market: a cross-sectional population survey in England

IntroductionIn May 2020, the EU Tobacco Products Directive ban on the sale of menthol cigarettes was implemented in England. This study examined the prevalence of menthol cigarette smoking after the ban, according to sociodemographic and smoking characteristics.MethodsCross-sectional data came from a representative survey of current smokers (18+) in England (unweighted n=2681) between July 2020 and June 2021. The weighted prevalence of menthol cigarette smoking as a proportion of total cigarette smoking was calculated, log-binomial regression explored trends over time, and χ2 statistics assessed the relationship between menthol smoking, sociodemographic and smoking characteristics. Sources of purchase of menthol cigarettes were explored.ResultsBetween July 2020 and June 2021, 15.7% (95% CI 14.5 to 17.1) of smokers reported smoking menthol cigarettes. The fitted non-linear trend supported no initial change followed by a possible reduction across April–June 2021 and fit the data better than linear and null (no change) models (χ2(2)=2519.7, p=0.06; χ2(3)=2519.7, p=0.006). Menthol cigarette smoking was more common among younger groups (16–24=25.2%; 25–34=19.9%) and women (19.4%). Menthol cigarette smokers showed lower cigarette dependence compared with other smokers. Past-6-month purchases of menthol cigarettes from any illicit or cross-border source declined from 30.1% in the last 6 months of 2020 to 17.5% in the first 6 months of 2021.ConclusionsA substantial minority of current smokers in England reported menthol cigarette smoking between July 2020 and June 2021, despite the ban, possibly reflecting mitigation of restrictions by a variety of licit means, such as legal menthol accessories. The reduction in menthol smoking across April–June 2021 warrants further monitoring.

Consequences of a match made in hell: the harm caused by menthol smoking to the African American population over 1980–2018

BackgroundFor many years, national surveys have shown a consistently disproportionately high prevalence of menthol smokers among African Americans compared with the general population. However, to our knowledge, no prior study has quantified the harm that menthol smoking has caused on that population. In this work, we estimate the public health harm that menthol cigarettes have caused to the African American community over the last four decades.MethodsUsing National Health Interview Survey data, we employed a well-established simulation model to reproduce the observed smoking trajectory over 1980–2018 in the African American population. Then, we repeat the experiment, removing the effects of menthol on the smoking initiation and cessation rates over that period, obtaining a new hypothetical smoking trajectory. Finally, we compared both scenarios to calculate the public health harm attributable to menthol cigarettes over 1980–2018.ResultsOur results show that menthol cigarettes were responsible for 1.5 million new smokers, 157 000 smoking-related premature deaths and 1.5 million life-years lost among African Americans over 1980–2018. While African Americans constitute 12% of the total US population, these figures represent, respectively, a staggering 15%, 41% and 50% of the total menthol-related harm.DiscussionOur results show that menthol cigarettes disproportionally harmed African Americans significantly over the last 38 years and are responsible for exacerbating health disparities among that population. Removing menthol cigarettes from the market would benefit the overall US population but, particularly, the African American community.

The profile of menthol cigarette smokers in the months following the removal of these products from the market: a cross-sectional population survey in England

IntroductionIn May 2020 the EU Tobacco Products Directive ban on the sale of menthol cigarettes was implemented in England. This study examined the prevalence of menthol cigarette smoking after the ban, according to sociodemographic and smoking characteristics.MethodsCross-sectional data came from a representative survey of current smokers (18+) in England (unweighted n = 2,681) between July/2020 and June/2021. The weighted prevalence of menthol cigarette smoking as a proportion of total cigarette smoking was calculated, log-binomial regression explored trends over time, and chi-squared statistics assessed the relationship between menthol smoking, sociodemographic and smoking characteristics. Sources of purchase of menthol cigarettes were explored.ResultsBetween July 2020 and June 2021, 15.7% (95%CI 14.5–17.1) of smokers reported smoking menthol cigarettes. The fitted non-linear trend supported no initial change followed by a possible reduction across April-June 2021 and fit the data better than linear and null (no change) models (χ2(2) = 2519.7, P = 0.06; χ2(3) = 2519.7, P = 0.006). Menthol cigarette smoking was more common among younger groups (16–24 = 25.2%; 25–34 = 19.9%) and women (19.4%). Menthol cigarette smokers showed lower cigarette dependence compared with other smokers. Past six-month purchases of menthol cigarettes from any illicit source declined from 30.1% in the last 6 months of 2020 to 17.5% in the first 6 months of 2021.ConclusionsA substantial minority of current smokers in England reported menthol cigarette smoking between July/2020 and June/2021, despite the ban, possibly reflecting mitigation of restrictions by a variety of licit means, such as legal menthol accessories. The reduction in menthol smoking across April-June 2021 warrants further monitoring.

Perception of Harmfulness of Various Tobacco Products and E-Cigarettes in Poland: A Nationwide Cross-Sectional Survey

Perceptions of the harmfulness of tobacco products may be a determinant of smoking behaviors. This study aimed to: (1) assess the perception of harmfulness of various tobacco products and e-cigarettes in Poland as well as (2) to assess the awareness of the health effects of using tobacco and e-cigarettes. A cross-sectional survey was conducted in 2019 with a nationally representative sample of 1011 individuals aged 15 and over. In the studied group, 22.3% were smokers. Smokeless tobacco was most likely to be perceived as less harmful than cigarettes (25%), followed by water pipe (24.5%), heated tobacco products (22%), e-cigarettes (21.6%), slim cigarettes (17.1%), flavored cigarettes (except menthol ones) (16.1%), menthol cigarettes (15.6%) and cigarillos (12.6%). In this study, 10% of respondents denied that smoking causes serious diseases. Most of the respondents (88.9%) were aware that smoking causes lung cancer (88.9%), but only 70.4% were aware that smoking causes stroke. Smokers compared to non-smokers were less likely to declare that smoking causes a stroke (OR: 0.43, 95%CI: 0.31–0.59; p < 0.001) or myocardial infarction (OR: 0.41, 95%CI: 0.29–0.60; p < 0.001). There were no significant differences (p > 0.05) in the perception of harmfulness of various tobacco products and e-cigarettes by gender, age, or occupational status.