On May 20th of last year, the EU ban on the manufacture and sale of menthol cigarettes went into effect for the Union’s 27 member countries. This regulatory move was predicated on the view that such a ban would discourage people from starting smoking or encourage existing smokers to quit—thus contributing to general public health.
To evaluate the validity of this supposition, the Foundation sponsored surveys of adult menthol cigarette smokers in eight EU countries before and after the menthol cigarette ban. The pre-ban survey queried awareness and intention to quit or switch; and the post-ban survey queried actual behavior. In light of COVID-19, the surveys also monitored behavioral changes among adult tobacco users as a result of the pandemic.
In the post-ban survey, only about 8% of respondents indicated that they had quit smoking completely. This rate was notably lower than the 12% who, in the pre-ban survey, indicated that they planned to quit completely as a result of the ban. Across the eight countries, an average of 40% of respondents indicated that they reduced their menthol cigarette consumption, but either continued or increased their consumption of non-menthol varieties. Other common actions taken as a result of the ban were: switching to menthol products not affected by the ban (18%); buying menthol cigarettes from other sources (13%); and buying products to manually add a menthol flavor to regular tobacco products (13%).
An unexpected outcome of the post-ban survey was that a relatively large proportion of respondents indicated they started purchasing so-called “mentholizing” products. This products class includes menthol flavor cards, filter tips, capsule tubes, and sprays, all of which allow consumers to manually add a menthol flavor to regular tobacco products.
Responses varied by country and demographic factors. Quit rates were lowest in Poland, the UK, and Hungary. Of the eight countries surveyed, menthol consumption rates had been highest in Poland and Hungary. Respondents in the same two countries indicated the highest rate of buying from other sources following the ban (18%). Latvia and Sweden had the highest percentage of respondents indicating that they completely quit smoking, at 12% and 11%, respectively.
The post-ban survey indicates that 18% of respondents switched to menthol tobacco products not affected by the ban. Of these switchers, 57% indicated they switched to e-cigarettes. However, switching trends varied by market, with respondents tending to switch to products used at higher rates in their country. For example, the highest percentage of switching to e-cigarettes among switchers was observed in Poland (67%), followed by the UK (57%). The UK and Poland markets exhibit high vaping prevalence, relative to the other countries surveyed.
Prior to the ban, 71% of respondents indicated that they were aware of the upcoming ban on menthol cigarettes and hand-rolled tobacco products. In the post-ban survey, 74% of respondents indicated they were aware of the ban. A possible explanation for the relative lack of awareness after the ban is the proliferation of nicotine products that purport to offer similar menthol flavoring as banned products, potentially confusing consumers.
In the post-ban survey, more than 53% of all respondents indicated that COVID-19 had not impacted their consumption of tobacco or nicotine products—a finding similar to the pre-ban survey. About 31% of post-ban survey respondents indicated that they had been consuming more tobacco or nicotine products than usual; and approximately 16% of respondents in both surveys indicated they had been consuming less tobacco or nicotine products than usual.
Among the eight countries surveyed, the two largest tobacco-consuming markets are Poland and the UK. These two also exhibited the lowest quit rates of those surveyed and the highest percentage of switching to e-cigarettes (among switchers). Here, it is relevant to consider that Poland has historically exhibited the highest menthol cigarette prevalence within the EU. Further, both UK and Poland markets exhibit high vaping prevalence relative to the other countries surveyed.
The US is the largest menthol cigarette market in the world, with menthol accounting for about 29% of the total cigarette volume, according to Euromonitor. It is also the largest vaping market in the world. As such, Poland and UK case studies could, to some degree, be useful in understanding the implications of a menthol ban in the US, should it be enacted. Of course, important differences exist across the markets that could affect comparability (e.g., illicit trade, affordability, and public perception).
Finally, we are unable to draw conclusions on the ban’s deterrence relative to youth initiation of smoking, as the respondents were all at least 18 years of age, which is the legal smoking age in all countries surveyed.
The @FDATobacco's decision to ban #menthol cigarettes is a good start, but not enough. @JamesKGlassman1 believes we can accelerate an end to combustible cigarettes by countering disinformation & providing incentives to switch to harm reduced alternatives. https://amp.usatoday.com/amp/4972316001
Will the Biden-Harris administration’s embrace of #harmreduction extend to tobacco? Derek Yach (@swimdaily) believes recent policy choices bode well for #tobaccoharmreduction and represent an important step toward ending the smoking epidemic.
https://filtermag.org/evali-misinformation-increased-smoking/ The implications of @Alex_Norcia @Filtermag_org @mbsiegel comments are clear. #Disinformation (Deliberately spread false info) increases adult smoking & will kill people. @FDATobacco & @CDC need to aggressively oppose falsehoods. @SmokeFreeFdn @GregTHR
It’s #MentalHealthAwarenessWeek. Did you know that those who struggle with #mentalillness are also disproportionately suffering from smoking-related illnesses? #Smokingcessation services should be included in more #mentalhealth treatment plans. https://bit.ly/34EKUHI
.@Doctor_Sud was interviewed by @snusforum about the consequences of rampant nicotine misinformation. @Doctor_Sud says, “One of the most common nicotine misconceptions is that nicotine, in quantities consumed in cigarettes or pouches, is carcinogenic.”
Following up on my recently co-authored #OpenScience @qeios pre-print with Dr Fagerström, here is an interview discussing the prevalent nicotine illiteracy that is preventing the realisation of a world free from risky forms of tobacco.
Sign up with your email address to receive news and updates