Abstract
Importance
Menthol cigarettes were prohibited in England in May 2020 and nationally in Canada in October 2017 but remain permitted in the United States (US). Evidence on the impact of menthol cigarette bans among youth outside of Canada, and on the characteristics of youth smokers, is lacking.
Objectives.
To 1) evaluate the impact of menthol cigarette bans on youth menthol cigarette smoking; 2) characterise youth menthol cigarette smokers in terms of demographics and cigarette consumption/dependence.
Design. Quasi-experimental.
Setting. Online repeat cross-sectional ITC Youth Surveys conducted in 2018, 2019, February 2020, August 2020.
Participants. Past 30-day smokers aged 16-19.
Outcome. Usually smoke a brand of cigarettes that was menthol, including capsule.
Exposure. Menthol cigarette ban, contrasting three countries over time: Canada, where a ban already existed, England, where a ban was implemented during the study, and the US, where no national ban was present. Age, sex, race, and consumption/dependence were also examined by menthol smoking in each country, and in England pre- vs. post-ban.
Results. The analytic sample comprised 7,067 participants aged 16-19, of which n=4,129 were female and n=5,019 were White. In England, the proportion of youth smokers who reported smoking a menthol/capsule cigarette brand was stable in the three pre-menthol ban waves (2018-Feb 2020: 9.4-12.1%; AOR=1.03, 95%CI=0.99-1.06) but decreased to 3.0% after the ban (Feb vs. Aug 2020: AOR=1.07, 1.04-1.10). The decrease between Feb and Aug 2020 in England was similar across all demographic groups (all p≥.068) but greater among youth who perceived themselves as 68 addicted to cigarettes (p=.044). In the two comparison countries, menthol/capsule smoking was stable across all waves (2018-August 2020; US: 33.6-36.9%; Canada: 3.1-2.3%; all p≥.325) and was most prevalent in the US (all country comparisons: p<.001). Menthol/capsule smoking was also more prevalent among smokers who: in England, were female vs. male (10.9% vs. 7.2%; p=.002); in the US, identified as Black vs. White (60.6% vs. 31.9%; p<.001) or were frequent smokers, smoked more cigarettes per day, or had urges to smoke every or most days (all p≤.026); and, in Canada, perceived themselves as addicted to cigarettes (p=.013).
Conclusions. In this survey study, the proportion of youth smokers who smoke menthol (including capsule) cigarettes decreased substantially following the menthol ban in England. This effect was consistent across all demographic groups. Perceived addiction among menthol smokers was also lower where menthol cigarettes were banned.
Menthol cigarettes were prohibited in England in May 2020 and nationally in Canada in October 2017 but remain permitted in the United States (US). Evidence on the impact of menthol cigarette bans among youth outside of Canada, and on the characteristics of youth smokers, is lacking.
Objectives.
To 1) evaluate the impact of menthol cigarette bans on youth menthol cigarette smoking; 2) characterise youth menthol cigarette smokers in terms of demographics and cigarette consumption/dependence.
Design. Quasi-experimental.
Setting. Online repeat cross-sectional ITC Youth Surveys conducted in 2018, 2019, February 2020, August 2020.
Participants. Past 30-day smokers aged 16-19.
Outcome. Usually smoke a brand of cigarettes that was menthol, including capsule.
Exposure. Menthol cigarette ban, contrasting three countries over time: Canada, where a ban already existed, England, where a ban was implemented during the study, and the US, where no national ban was present. Age, sex, race, and consumption/dependence were also examined by menthol smoking in each country, and in England pre- vs. post-ban.
Results. The analytic sample comprised 7,067 participants aged 16-19, of which n=4,129 were female and n=5,019 were White. In England, the proportion of youth smokers who reported smoking a menthol/capsule cigarette brand was stable in the three pre-menthol ban waves (2018-Feb 2020: 9.4-12.1%; AOR=1.03, 95%CI=0.99-1.06) but decreased to 3.0% after the ban (Feb vs. Aug 2020: AOR=1.07, 1.04-1.10). The decrease between Feb and Aug 2020 in England was similar across all demographic groups (all p≥.068) but greater among youth who perceived themselves as 68 addicted to cigarettes (p=.044). In the two comparison countries, menthol/capsule smoking was stable across all waves (2018-August 2020; US: 33.6-36.9%; Canada: 3.1-2.3%; all p≥.325) and was most prevalent in the US (all country comparisons: p<.001). Menthol/capsule smoking was also more prevalent among smokers who: in England, were female vs. male (10.9% vs. 7.2%; p=.002); in the US, identified as Black vs. White (60.6% vs. 31.9%; p<.001) or were frequent smokers, smoked more cigarettes per day, or had urges to smoke every or most days (all p≤.026); and, in Canada, perceived themselves as addicted to cigarettes (p=.013).
Conclusions. In this survey study, the proportion of youth smokers who smoke menthol (including capsule) cigarettes decreased substantially following the menthol ban in England. This effect was consistent across all demographic groups. Perceived addiction among menthol smokers was also lower where menthol cigarettes were banned.
| Original language | English |
|---|---|
| Journal | JAMA Network open |
| Publication status | Accepted/In press - 10 Mar 2022 |
Keywords
- Menthol
- smoking behavior
- E-cigarettes
- policy measures
- England
- Canada
- USA
- youth