Objectives The 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.
Methods Population 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.
Results At 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).
Conclusions The 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.
- tobacco products
- smoking cessation
- public policy
- menthol ban
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Contributors MOC, RS, JEC, TE and ES contributed to study design. MOC and BZ conducted the analysis. IN wrote the initial draft manuscript. All authors contributed to the writing and contributing intellectually to the manuscript.
Funding This research was supported by the National Institute on Drug Abuse (NIDA) of the US National Institutes of Health (NIH) under Award Number P50DA036105 and the Center for Tobacco Products (CTP) of the US Food and Drug Administration (FDA) and the NIH Office of the Director under award number 1R21DA047358-01. Dr Eissenberg’s effort is also supported by NIDA and CTP/FDA under U54DA036105. The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH or the FDA.
Competing interests Dr Eissenberg is a paid consultant in litigation against the tobacco industry and is named on a patent application for a device that measures the puffing behavior of electronic cigarette users.
Patient consent for publication Not required.
Ethics approval This study was approved by the research ethics board of the University of Toronto, Ontario, Canada and participants gave consent to participate.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available upon reasonable request.