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-Smoking-Attributable Deaths (SADs) and Deaths Averted if Menthol is Banned Under 3 Scenarios (10%, 20%, and 30% Change in Initiation and Cessation), Projected From 2010 to 2050: Total Population and Black Population, United States

-Smoking-Attributable Deaths (SADs) and Deaths Averted if Menthol is Banned Under 3 Scenarios (10%, 20%, and 30% Change in Initiation and Cessation), Projected From 2010 to 2050: Total Population and Black Population, United States

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We used a validated smoking simulation model and data from the 2003 Tobacco Use Supplement to the Current Population Survey to project the impact that a US menthol ban would have on smoking prevalence and smoking-attributable deaths. In a scenario in which 30% of menthol smokers quit and 30% of those who would have initiated as menthol smokers do n...

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... Blacks in 2050, the pro- jected relative reduction is a 9.1% decrease under the 10% scenario, a 17.0% decrease under the 20% scenario, and a 24.8% decrease under the 30% scenario. Table 1 presents the projected number of smoking-attributable deaths at10-year intervals through 2050 for each scenario and computes deaths averted at 2050 relative to status quo estimates. In 2020, the menthol ban results in 1.06 million fewer smokers under the most conservative scenario, increasing slightly through 2030 and then declining (results not shown). ...

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... 8 Research suggests that banning menthol may reduce overall tobacco use, promote smoking cessation, prevent initiation, and substantially reduce tobacco-attributable deaths and life-years lost. [9][10][11][12][13][14] Most of the research to date, however, has been disadvantaged by the lack of real-world menthol policies in place, 8 consisting of simulation models, [13][14][15][16] analyses of sales data, 17 18 studies relying on expert elicitation to produce estimates of the impact of a hypothetical menthol ban, 19 experimental studies, 20 and survey studies assessing behavioural intentions of menthol smokers in response to a hypothetical or future ban. [21][22][23][24] To date, population-level longitudinal studies of the actual behavioural impact of menthol bans have been conducted in Canada, where menthol cigarettes were banned between May 2015 and July 2017 among some provinces, progressing to a national ban in October 2017. ...
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Introduction To reduce the appeal of tobacco, the European Union (EU) banned menthol as a characterising flavour in cigarettes in May 2020. This pre/post-study evaluated the impact of the menthol ban on smoking cessation outcomes among a representative cohort of Dutch smokers. Methods Adult (18+ years) smokers were recruited at wave 1 (pre-ban) of the International Tobacco Control Netherlands Surveys (February–March 2020) and followed post-ban at wave 2 (September–November 2020) and wave 3 (June–July 2021) (N=1326 participated in all three waves). Weighted bivariate, logistic regression and generalised estimating equation model analyses were conducted. Results Usual menthol use decreased from pre-ban (7.8%) to post-ban (4.0% at wave 2 and 4.4% at wave 3) (p<0.001). Pre-ban menthol smokers had greater odds of making a post-ban quit attempt than non-menthol smokers (66.9% vs 49.6%, adjusted OR (aOR)=1.89, 95% CI: 1.13 to 3.16). Compared with pre-ban non-menthol smokers, a higher proportion of menthol smokers quit by wave 2 (17.8% vs 10.2%, p=0.025) and by wave 3 (26.1% vs 14.1%, p=0.002), although this was not significant after adjusting for other factors. Female pre-ban menthol smokers had greater odds of quitting by wave 3 than female non-menthol smokers (aOR=2.23, 95% CI: 1.10 to 4.51). Most pre-ban menthol smokers (n=99) switched to non-menthol cigarettes (40.0%) or reported that they continued to smoke menthol cigarettes (33.0%) at wave 3. Conclusions The EU menthol ban was effective in reducing menthol use and in increasing quit attempts and quitting among pre-ban menthol smokers. Impact could be maximised by closing gaps that allow post-ban menthol cigarette use.
... Simulation modeling to project the impact of a US menthol ban suggests that by 2050, the relative reduction in smoking prevalence would be 9.7% overall and 24.8% for Blacks. (14,15) While waiting on the FDA rule, on June 1 2020, Massachusetts became the rst state to restrict the sale of all avored tobacco products, including menthol cigarettes. We sought to understand how individuals hospitalized at Boston Medical Center (BMC), a large safety-net hospital, perceived the Massachusetts menthol ban and whether their perceptions and smoking behavior changed over time. ...
... Modeling of predictive reactions from the menthol ban suggests that the reaction period could last longer than 1 year; future studies should follow patients for at least this long. (15) Conclusion Finalizing and implementing the FDA rule to ban menthol as a characterizing avor in cigarettes and ban all characterizing avors, including menthol in cigars, is a critical step to reducing tobacco-related health disparities and promoting health equity (1). Healthcare workers must capitalize on this moment to promote tobacco treatment, and states must ensure that tobacco treatment programs are accessible to support individuals affected by the ban. ...
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Background. Menthol cigarettes have had a profound adverse effect on public health. On June 1 2020, Massachusetts became the first state to restrict the sale of all flavored tobacco products, including menthol cigarettes. In this longitudinal study, we sought to understand how individuals in our hospital system who smoke menthol cigarettes perceived the Massachusetts menthol ban and if their perceptions and smoking behavior changed over time. Methods. We undertook a longitudinal survey and qualitative study (n=27), starting 1-month pre-ban (4/15-5/31/2020) and continuing 6-months post-ban. Pre-ban questionnaires assessed participants’ perceptions of the ban and probed their anticipated smoking behaviors after the ban. The post-ban assessments (1- and 6- months) probed how perceptions and smoking behaviors changed post-ban. We also elicited suggestions to mitigate unintended consequences of the ban that might undermine intended policy effects. Results. Participants were 37% female, 56% Black, and 96% Medicaid-insured. Perceptions of how individuals viewed the ban were dynamic. Many discussed how they smoked less because of the ban, although their smoking behavior was largely influenced by their ability to still obtain menthol cigarettes. Individuals suggested promoting tobacco treatment interventions to help people affected by the ban and a national ban to circumvent out-of-state travel. Conclusions. Banning the sale of menthol cigarettes improves smoking-related health disparities. To be most effective, healthcare workers must capitalize on this moment to promote tobacco treatment and states must ensure that tobacco treatment programs are readily accessible to individuals affected by the ban.
... In 2018, 85% of Black individuals, 50% of Hispanic individuals, 47% of Asian individuals, and 35% of American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander individuals who smoked preferred menthol cigarettes, compared to 29% of white individuals who smoked [30]. A menthol cigarette ban would help reduce the existing Black-white disparity in lung cancer, cardiovascular disease, diabetes, and other tobacco-related health outcomes in North Carolina by reducing smoking prevalence among Black individuals, who use menthol cigarettes at the highest rates [30][31][32]. ...
... Targeted marketing of menthol has contributed to high rates of menthol cigarette smoking among Black individuals. Banning menthol would help reduce existing health disparities [16,17,[29][30][31][32]. ...
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Many states and localities in the United States are implementing evidence-based tobacco control policies at the retail level, including Tobacco 21 laws, tobacco retailer licensing, restrictions on point-of-sale promotions, and bans on flavored tobacco products. With the passage of new point-of-sale tobacco control policies, North Carolina could reduce youth tobacco use rates.
... Our results are also consistent with earlier modelling results that find disproportionately greater health impacts on the NHB than the general population from a menthol cigarette ban 45 and past menthol use. 46 47 Our findings are dependent on the model structure, parameters and assumptions. ...
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Introduction With the US Food and Drug Administration recently proposing to implement a ban on menthol cigarettes, it is critical to estimate the potential public health effects of such a ban. With high rates of menthol cigarette use and important smoking-related health disparity implications, the impact of the ban on the non-Hispanic black (NHB) population merits strong consideration. Methods We apply the previously developed Menthol Smoking and Vaping Model to the NHB population. A status quo scenario is developed using NHB-specific population, smoking and vaping initiation, cessation and death rates. Estimates from a recent expert elicitation on behavioural impacts of a menthol cigarette ban on the NHB population are used to develop a menthol ban scenario implemented in 2021. The public health impacts of the menthol ban are estimated as the difference between smoking and vaping attributable deaths (SVADs) and life years lost (LYLs) in the status quo and the menthol ban scenarios from 2021 to 2060. Results Under the menthol ban scenario, overall smoking is projected to decline by 35.7% in 2026 and by 25.3% in 2060 relative to the status quo scenario. With these reductions, SVADs are estimated to fall by about 18.5% and LYLs by 22.1%, translating to 255 895 premature deaths averted, and 4.0 million life years gained over a 40-year period. Conclusions A menthol cigarette ban will substantially reduce the smoking-associated health impact on the NHB population, thereby reducing health disparities.
... The FDA indicated that nearly 1 million smokers will quit smoking within a year and half of the ban going into effect, and approximately 633 000 deaths would be averted, including 237 000 deaths averted for African American individuals. 4,5 Although the impetus for the ban on characterizing flavors in cigarettes in the 2009 TCA 1 in the US was to protect youth, much of the research exploring the hypothetical outcomes of a menthol ban or policy evaluations of an actual ban has focused on adults and cessation. 4 Indeed, little is known with respect to the potential outcomes among young people who smoke menthol cigarettes. ...
... 28 In April 2021, the Food and Drug Administration announced 29 that they are preparing to ban menthol cigarettes in the USA within the year, citing evidence that Canada's 2015-2017 menthol cigarette ban led to significant increases in quitting 28 and a modelling study projecting that a menthol cigarette ban in the USA would avert 633 000 deaths, of which 237 000 of the averted deaths would be among African-Americans. 30 Nearly all studies that have examined the factors that are associated with menthol use are from HICs and upper middle-income countries. In contrast, much less is known about menthol cigarettes from lower middle-income and low-income countries, especially from Africa, where 6% of the world's adult smokers (about 77 million) reside, 31 ...
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Background: Menthol masks the harshness of cigarette smoke, promotes youth smoking and encourages health-concerned smokers who incorrectly believe that menthols are less harmful to smoke menthols. This study of smokers in Kenya and Zambia is the first study in Africa to examine menthol use, smokers' beliefs about its harmfulness and the factors associated with menthols. Methods: Data were from the International Tobacco Control (ITC) Kenya Wave 2 (2018) and Zambia Wave 2 Survey (2014), involving nationally representative samples of smokers. This study focuses on 1246 adult smokers (644 in Kenya, 602 in Zambia) who reported smoking a usual brand of cigarettes (menthol or non-menthol). Results: Overall, menthol use was significantly higher among smokers in Zambia than in Kenya (48.0% vs 19.0%), females (45.6% vs 31.2% males), non-daily smokers (43.8% vs 30.0% daily) and those who exclusively smoked factory-made (FM) cigarettes (43.0% vs 15.2%). The erroneous belief that menthols are less harmful was more likely among smokers in Zambia than in Kenya (53.4% vs 29.3%) and among female smokers (38.5% vs 28.2%). In Kenya, menthol smoking was associated with being female (adjusted odds ratios (AOR)=3.07; p=0.03), worrying about future health (AOR=2.28; p=0.02) and disagreeing with the statement that smoking was calming (AOR=2.05; p=0.04). In Zambia, menthol use was associated with being female (AOR=3.91; p=0.002), completing primary school (AOR=2.14; p=0.03), being a non-daily smoker (AOR=2.29; p=0.03), exclusively using FM cigarettes (AOR=14.7; p<0.001), having a past quit attempt (AOR=1.54; p=0.02), believing that menthols are less harmful (AOR=3.80; p<0.001) and choosing menthols because they believed it was less harmful (AOR=3.52; p<0.001). Conclusions: Menthols are highly prevalent among females in both countries. There is a need in African countries to combat the myth that menthols are less harmful and to ban menthol and other flavourings.
... A 2011 study estimated a 9.7% reduction in smoking prevalence with over 600,000 deaths averted by 2050, assuming 30% quitting and 30% fewer initiations. 25 A 2021 study estimated an overall 15% decline in smoking prevalence, with over 11.3 million life years saved by 2060. 26 These simulation studies suggest that a tobacco flavours ban would reap substantial public health benefits, especially in countries such as the United States, Singapore, Malaysia and the Philippines where flavoured cigarettes comprise a large portion of the total cigarette market. ...
... These were further compared to and adjusted for in view of quitting and switching rates observed from evaluative studies of partial and full bans in the United States, European Union and Canada and read in the comparative contexts of Singapore's flavoured use proportions and low illicit trade volume. 5,20,22,24,25 Post-ban transition probabilities for smoking initiation were similarly estimated from these evaluative studies. Supplements 2 and 3 present the parameters for the transition probabilities across the scenarios, and a summary of the scenarios is provided in Table 1. ...
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Background Tobacco flavours such as menthol and fruits, which appeal to youth, remain unregulated in Western Pacific countries. Our goal was to evaluate the potential impact of tobacco flavour bans in Singapore, which has the region's highest flavoured cigarette market share. Methods Using an open-cohort microsimulation model, we estimated the impact of full ban and partial ban (excluding menthol and clove) scenarios versus the status quo (no ban) over a 50-year horizon. We used a Markov chain with four states (never, unflavoured, flavoured and ex-smokers), updating each individual's state across each year. We estimated between-state transition probabilities using Markov chain Monte Carlo, with prior distributions derived from national survey data. Findings Without a ban, smoking prevalence gradually increases from 12.7% (2018) to 15.2% (2068). In both ban scenarios, smoking prevalence decreases immediately after the ban: by 1.6% points in the full ban, and 0.4% points in the partial ban scenario. In addition, there is a sustained long-term impact as fewer initiate. In the full ban scenario, smoking prevalence decreases to 10.6% by 2068 with a cumulative gain of over 40,000 QALYs. In the partial ban scenario, it remains stable at 12.5% with a cumulative gain of over 20,000 QALYs. Interpretations A tobacco flavours ban would reap substantial public health benefits in countries that, like Singapore, have a large flavoured cigarette market share, especially with a full ban compared to a partial ban not covering menthol or clove-flavoured cigarettes. Funding This study was funded by the Singapore Ministry of Health.
... 17 While the overall population has experienced decreases in flavoured tobacco product use, a menthol ban is estimated to have large reductions in smoking prevalence 18 with considerable benefits for populations who disproportionately smoke menthol cigarettes like African-Americans. 19 Limited research exists assessing public support for policies to regulate flavoured tobacco or e-cigarette products, particularly in rural regions. This study assesses support for policies to regulate tobacco and e-cigarette products (particularly flavoured products) using a public opinion survey conducted in August 2020 with registered voters in California's Central Valley. ...
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Introduction Flavoured tobacco control policy exemptions and electronic cigarette products may contribute to increased youth access and tobacco use disparities. Methods We assessed public support among California Central Valley residents for four policies to regulate flavoured tobacco products and e-cigarettes. The probability-based, multimode survey was conducted with English-speaking and Spanish-speaking registered voters (n=845) across 11 counties between 13 and 18 August 2020. Weighted logistic regression analyses measured odds of policy support, adjusting for predictor variables (attitudes and beliefs) and covariates. Results The weighted sample was 50% female and predominantly Latino (30%) or non-Hispanic white (46%); 26% had a high school education or less, and 22% an annual household income <US$30 000. Overall, 58% support a comprehensive flavoured tobacco product sales ban, and 59% support a flavoured e-cigarette product sales ban. In addition, 81% support limiting the amount of nicotine in e-cigarette pods, and 91% support mandating vaping health warning signs at local retailers. Flavour bans were more likely to be backed by women, seniors, Latinos, non-smokers and non-vapers. Participants who believe minors have more access to flavoured products had greater odds of supporting all policies. Those aware of the association between e-cigarettes and lung injury were more likely to support non-ban policies. Participants who believe e-cigarettes help to reduce tobacco use or e-cigarettes are relatively less addictive were less likely to support bans. Discussion Findings add to mounting evidence of support for policies to regulate flavoured tobacco and e-cigarette products. Results on attitudes and beliefs elucidate how these factors influence support.
... non-menthol) was associated with transitions to established cigarette use and greater nicotine dependence [12,13]. Among young adults, studies demonstrated initiating with menthol cigarettes in [18][19][20][21][22][23][24] year olds [15] and preference for menthol cigarettes in [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] year olds [11] increased likelihood of subsequent cigarette use. First use of a menthol cigarette was associated with subsequent daily cigarette use in youth, young adults, and adults [14]. ...
... If Black smokers and females have greater likelihood of changing smoking behavior (i.e., increasing or decreasing cigarette smoking) over a relatively short time period (one year), we may be able to use this information to target smoking cessation/reduction interventions within these groups, especially given evidence that both of these subgroups have lowered success with smoking cessation [25][26][27][28][29][30][31]. Given the high prevalence of menthol use among both populations [1,3], and that they may be susceptible to changing smoking behavior, policies restricting availability of menthol cigarettes, such as the current federal proposal of a menthol ban in cigarettes [10], may harness underlying changes in smoking behavior and have greater impact on reducing smoking in these populations than previously estimated [32]. This is in line with research demonstrating restricting availability to menthol cigarettes reduced smoking rates with this effect shown to strongest among Black smokers [33]. ...
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Menthol cigarette use has been shown to be a contributing factor in the changes in smoking over time among youth. The current study aim was to use prospective survey data to identify if menthol cigarette use was associated with changes in smoking among adults. A representative cohort from the 2010 U.S. Tobacco Use Supplement to the Current Population Survey was interviewed at two time points one year apart. Respondents were past-30-day cigarette smokers at Wave 1 or Wave 2 categorized by menthol vs. non-menthol flavor preference (n = 3668). Trajectories were categorized as maintained, increased, or decreased smoking behavior between Waves. Multinomial logistic regressions examined if menthol cigarette use was associated with an increase/decrease in smoking behavior, adjusting for age, race/ethnicity, and sex. Menthol cigarette use was not associated with change over time in cigarette smoking in adult smokers. Age, race/ethnicity and sex were associated with changes in cigarette smoking. Young (vs. older) adults were more likely to increase smoking. Black and Hispanic smokers (vs. white smokers) were more likely to report any change in smoking. Males were less likely than females to change smoking behavior. Menthol status was not associated with changes in smoking among adults; however, young age, race/ethnicity, and sex were, suggesting populations to target for intervention.
... Researchers have used different methods to evaluate the impact of tobacco control policies that have not yet been implemented, or have recently been implemented but have not yet been extensively evaluated (e.g., surveys to assess smokers' predictive behaviours, simulation modelling and experimental studies) [37-42, [58][59][60]. And while predicted behaviors may not actually predict future behavior, the use of surveys and other designs based on hypothetical scenarios helps to fill a gap in the evidence given the limited evaluations of existing policies. ...
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Introduction Some jurisdictions have implemented nicotine vaping product (NVP) flavor restrictions because of concerns about rising adolescent use. However, little is known how these restrictions may impact adult vapers. This study describes the level of support and predictive behavioral responses to a hypothetical NVP ban on non-tobacco flavors among regular adult vapers who use the flavors that would be banned. Methods Data came from 851 regular vapers (all current or ex-smokers) participating in the 2020 ITC Four Country Smoking and Vaping Survey in Canada, England, and the United States (US). A random sample of respondents in each country received and completed the questions about flavor bans: (1) do you support or oppose a ban on all non-tobacco flavors; and (2) what would you do if all flavors were banned, with the exception of tobacco in the US, and tobacco and menthol in Canada and England. Those who used tobacco-flavored or unflavored NVPs were excluded from all analyses, and additionally, vapers of menthol flavor in Canada and England were excluded from Aim 2. Results Overall, 53.6% of vapers were strongly opposed to flavor bans, 28.2% were opposed, 9.3% were in support, 3.6% were in strong support, and 5.2% did not know. Predicted behavioral responses were: 28.8% would continue vaping an available flavor, 28.3% would find a way to get their banned flavor(s), 17.1% would stop vaping and smoke instead, 12.9% said that they would stop vaping and not smoke, and 12.9% do not know what they would do. Responses to a potential flavor ban largely varied by smoking and vaping status, and by the level of support of a flavor restriction policy. Conclusions At this time, it is not clear what net population-level consequences would occur if non-tobacco flavored NVPs were prohibited. While a majority of vapers in this study opposed this policy, and many vapers would not be willing to switch to available flavors, there was considerable variability in predicted behavioral responses.