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Public health impact of a US ban on menthol in cigarettes and cigars: a simulation study
  1. David T Levy1,
  2. Rafael Meza2,
  3. Zhe Yuan1,
  4. Yameng Li1,
  5. Christopher Cadham2,
  6. Luz Maria Sanchez-Romero1,
  7. Nargiz Travis1,
  8. Marie Knoll1,
  9. Alex C Liber1,
  10. Ritesh Mistry2,
  11. Jana L Hirschtick2,
  12. Nancy L Fleischer2,
  13. Sarah Skolnick2,
  14. Andrew F Brouwer2,
  15. Cliff Douglas2,
  16. Jihyoun Jeon2,
  17. Steven Cook2,
  18. Kenneth E Warner2
  1. 1Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
  2. 2School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr David T Levy, Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20009, USA; dl777{at}georgetown.edu

Abstract

Introduction The US Food and Drug Administration most recently announced its intention to ban menthol cigarettes and cigars nationwide in April 2021. Implementation of the ban will require evidence that it would improve public health. This paper simulates the potential public health impact of a ban on menthol in cigarettes and cigars through its impacts on smoking initiation, smoking cessation and switching to nicotine vaping products (NVPs).

Methods After calibrating an established US simulation model to reflect recent use trends in cigarette and NVP use, we extended the model to incorporate menthol and non-menthol cigarette use under a status quo scenario. Applying estimates from a recent expert elicitation on the behavioural impacts of a menthol ban, we developed a menthol ban scenario with the ban starting in 2021. We estimated the public health impact as the difference between smoking and vaping-attributable deaths and life-years lost in the status quo scenario and the menthol ban scenario from 2021 to 2060.

Results As a result of the ban, overall smoking was estimated to decline by 15% as early as 2026 due to menthol smokers quitting both NVP and combustible use or switching to NVPs. These transitions are projected to reduce cumulative smoking and vaping-attributable deaths from 2021 to 2060 by 5% (650 000 in total) and reduce life-years lost by 8.8% (11.3 million). Sensitivity analyses showed appreciable public health benefits across different parameter specifications.

Conclusions and relevance Our findings strongly support the implementation of a ban on menthol in cigarettes and cigars.

  • advocacy
  • electronic nicotine delivery devices
  • public policy
  • smoking caused disease

Data availability statement

Data are available upon reasonable request. The model and data will be provided upon request.

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Data availability statement

Data are available upon reasonable request. The model and data will be provided upon request.

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Footnotes

  • Twitter @AlexCLiber, @cdoug

  • Contributors DTL and RM supervised the project and were the principal writers of the original manuscript and the revised manuscript. ZY conducted the original data analysis and wrote the original methods and results sections. YL conducted the original data analysis and helped write the original methods and results sections. CC led the original expert elicitation and helped write the methods section and revisions. LMS-R and NT helped lead the original expert elicitation and helped write the methods section and revisions. MK conducted the data analysis on the expert elicitation and helped write the methods section and revisions. RMi, JLH, NFL, SS, AFB, ACL and CD helped write the original paper and revisions. JJ helped conduct the analysis, and write the original paper and revisions. KEW was a major contributor to the original paper and revisions.

  • Funding This project was funded through the National Cancer Institute (NCI) and the Food and Drug Administration (FDA) grant U54CA229974.

  • Disclaimer The opinions expressed in this article are the authors’ own and do not reflect the views of the National Institutes of Health, the Department of Health and Human Services, or the US government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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