Prior daily menthol smokers more likely to quit two years after a menthol ban than non-menthol smokers: a population cohort study.

Abstract

BACKGROUND AND AIMS\nThe province of Ontario, Canada, banned the use of menthol-flavoured tobacco products as of January 1 st, 2017. This study aims to assess the longer-term impact of a menthol ban on smoking behaviour at two years, which is unknown.\n\n\nMETHODS\nPopulation cohort study with baseline survey (n=1821) conducted September-December 2016 and follow-up survey January-August 2019 among current smokers in Ontario (16+) prior to the menthol ban. Poisson regression was used to assess probability of quitting smoking by pre-ban menthol status, controlling for differences in smoking and demographic characteristics, with multiple imputation used to address missing data.\n\n\nFINDINGS\nMenthol smokers were more likely to report having quit smoking (12% (daily menthol) and 10% (occasional menthol) vs. 3% (non menthol); p<0.001) than non-menthol smokers in the two years after a menthol ban. After adjustment for smoking and demographic characteristics, daily menthol smokers had higher likelihood of quitting smoking (ARR 2.08; 95% CI 1.20-3.61) and reported more quit attempts (ARR 1.45; 95% CI 1.15-1.82). Among those who attempted to quit, menthol smoking was not associated with relapse (daily ARR =0.96; 95% CI: 0.86, 1.07; occasional ARR= 0.99; 95% CI: 0.90, 1.08). However, there was a statistically significant interaction among menthol users who reported using other flavoured tobacco products one year after the ban (ARR=0.26 (95%CI: 0.08, 0.90).\n\n\nCONCLUSIONS\nThe study found increased probability of quitting among daily menthol smokers and more quit attempts among daily and occasional menthol smokers compared with non-menthol smokers in Ontario two years after the implementation of a menthol ban.