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Association of nicotine replacement therapy product sales with menthol cigarette sales restriction in Massachusetts
  1. Samuel Asare1,
  2. Zheng Xue1,
  3. Priti Bandi1,
  4. Johann Lee Westmaas2,
  5. Ahmedin Jemal1,
  6. Nigar Nargis1
  1. 1Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
  2. 2Population Science, American Cancer Society, Atlanta, Goergia, USA
  1. Correspondence to Dr Samuel Asare, Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA 30144, USA; samuel.asare{at}


Background Massachusetts was the first to implement a state-wide menthol cigarette sales restriction in the USA. Following its implementation in June 2020, evidence showed declines in cigarette sales in Massachusetts; however, changes in nicotine replacement therapy (NRT) product sales are unknown.

Methods This cohort study analysed NRT products sold by US-based retailers available in 26 states from the Nielsen Retail Scanner Data. Outcomes were state-level 4-week aggregate sales of gum, lozenge and patch NRT products converted into pieces per 1000 adults (aged ≥18 years) who smoke cigarettes based on smoking rates from the Behavioral Risk Factor Surveillance System and corresponding population from the US Census Bureau. We used a difference-in-differences method to compare changes in NRT product sales in Massachusetts before (1 January 2017 to 13 June 2020) and after (14 June 2020 to 4 December 2021) the policy with sales in 25 states.

Results The analysis included 1664 observations for each NRT product, with 1170 from before and 494 from after the policy change. The 4-week NRT product sales per 1000 adults who smoke cigarettes in Massachusetts compared with the comparison states increased for gums by 643.11 (95% CI 365.33 to 920.89; p<0.001) pieces or 12.9% and for lozenges by 436.97 (95% CI 292.88 to 581.06; p<0.001) pieces or 17.9% but no statistically significant change in patches after implementing the policy.

Conclusion The increases in sales of gum and lozenge NRT products in Massachusetts after implementing the policy suggest that a nationwide ban on menthol cigarettes can increase NRT product use; therefore, interventions are needed to strengthen cessation support for adults who smoke cigarettes but intend to quit.

  • Nicotine
  • Non-cigarette tobacco products
  • Surveillance and monitoring

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  • Contributors Access to data and data analysis: SA had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: SA, NN. Acquisition, analysis or interpretation of data: SA, ZX, PB, JLW, AJ, NN. Drafting of the manuscript: SA, NN. Critical revision of the manuscript for important intellectual content: SA, ZX, PB, JLW, AJ, NN. Statistical analysis: SA. Obtained funding: SA, ZX, PB, JLW, AJ, NN.

  • Funding This study was supported by the Department of Surveillance and Health Equity Science of the American Cancer Society.

  • 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.