Product Substitution After A Real-World Menthol Ban: A Cohort Study.

Objectives The province of Ontario, Canada banned menthol in cigarettes and other tobacco products effective January 1st, 2017 adding to an existing flavour ban. However, all flavoured e-cigarettes, flavoured cigars larger than 6g, and alcohol flavoured cigars without filters over 1.4g were exempted. This paper examines the association between use of flavoured non-cigarette products and self-reported cigarette smoking cessation after the ban. Methods Current past-30 day cigarette smokers (N=913) who were 16 years or older, living in Ontario were recruited between September-December 2016 and re-contacted January-August 2018. Results Both daily and occasional pre-ban menthol cigarette smokers were more likely to use flavoured cigar products (adjusted relative rate, RR=1.53, 95% confidence interval, CI=1.01, 2.31; adjusted RR=1.57, 95% CI=1.06, 2.30) after the ban, while occasional pre-ban menthol cigarette smokers were more likely to use other tobacco products (adjusted RR=1.25, 95% CI=1.02, 1.53) or flavoured other tobacco products (adjusted RR=1.56, 95% CI=1.09, 2.24), conditional on prior use. Conclusions Menthol smokers prior to the ban were more likely to use other tobacco products, or flavoured tobacco products, after the ban. These results suggest that comprehensive menthol bans could be more effective without the option of using flavoured tobacco or nicotine products as substitutes.

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