Abstract
BackgroundThe United States (US) Food and Drug Administration (FDA), under the 2009 Family Smoking Prevention and Tobacco Control Act, banned characterizing flavors in cigarettes; however, mentholated tobacco products were exempt. Since 2009, over 20 US jurisdictions and numerous countries around the world have extended this restriction to menthol. Currently, the FDA is reconsidering its position on a nation-wide menthol cigarette ban. However, the effects of such a ban remain unclear. We conducted a scoping review to explore the impact of a menthol cigarette ban on individual behaviors (initiation, cessation, and product switching), sales, and compliance.MethodsWe conducted a search of the international literature using PubMed, EBSCO, and Web of Science (to November 25, 2019). We retrieved articles relevant to the impacts of an implemented or hypothetical menthol ban. We also included studies of flavored tobacco product bans due to their potential relevance in gauging compliance and product substitutability.ResultsThe search identified 493 articles, of which 24 were included. Studies examined the effects of implemented menthol bans (n = 6), hypothetical menthol bans (n = 12) and implemented flavor bans that exclude menthol (n = 6). Menthol bans were found to reduce sales and increase smoking cessation with only partial substitution for non-menthol cigarettes. US smokers’ reactions to a hypothetical ban indicate that about 25–64% would attempt to quit smoking and 11–46% would consider switching to other tobacco products, including 15–30% to e-cigarettes. Flavor ban studies indicate reductions in initiation of 6%. Ban compliance was high, but studies indicate that the tobacco industry and retailers have attempted to circumvent their impact via packaging changes and online sales.ConclusionOur review finds that extending the US cigarette flavor ban to menthol products would promote smoking cessation and reduce initiation. This evidence supports further action by the FDA towards mentholated tobacco products. However, few studies have been conducted in the vaping era.
Highlights
The United States (US) Food and Drug Administration (FDA), under the 2009 Family Smoking Prevention and Tobacco Control Act, banned characterizing flavors in cigarettes; mentholated tobacco products were exempt
Studies were excluded because they were not original research studies (n = 10), were not specific to a menthol or flavored tobacco ban (n = 18), did not report on the outcomes of interest (n = 9), reported outcomes already reported in another study (n = 1) or analyzed a ban exempting a large class of retailers, such as tobacco shops or other over 21 establishments (n = 9)
Implemented menthol ban Of the six studies that explored the impact of an implemented menthol ban, two evaluated individual behavior, one examined a change in sales, and three assessed compliance (Table 1)
Summary
The United States (US) Food and Drug Administration (FDA), under the 2009 Family Smoking Prevention and Tobacco Control Act, banned characterizing flavors in cigarettes; mentholated tobacco products were exempt. Drug Administration (FDA) the authority to regulate the manufacture, sale, distribution, and marketing of tobacco products [1] Under this act, the FDA banned characterizing flavors in cigarettes, citing their appeal to youth and young adults. The FDA banned characterizing flavors in cigarettes, citing their appeal to youth and young adults Cadham et al BMC Public Health (2020) 20:1055 They must demonstrate that such a ban would reduce the initiation of and increase the cessation from the use of tobacco products [2, 3]. With the stable trend in menthol cigarette use [7], there is growing concern that menthol flavoring continues to increase youth smoking initiation and dependence and reduce cessation [8, 9]
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