Public health impact of a US ban on menthol in cigarettes and cigars: A simulation study

David T. Levy, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA dl777@georgetown.edu.
Rafael Meza, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Zhe Yuan, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Yameng Li, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Christopher Cadham, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Luz Maria Sanchez-Romero, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Nargiz Travis, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Marie Knoll, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Alex C. Liber, Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
Ritesh Mistry, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Jana L. Hirschtick, Advocate Aurora HealthFollow
Nancy L. Fleischer, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Sarah Skolnick, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Andrew F. Brouwer, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.Follow
Cliff Douglas, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Jihyoun Jeon, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Steven Cook, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.Follow
Kenneth E. Warner, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.

Abstract

Introduction: The US Food and Drug Administration most recently announced its intention to ban menthol cigarettes and cigars nationwide in April 2021. Implementation of the ban will require evidence that it would improve public health. This paper simulates the potential public health impact of a ban on menthol in cigarettes and cigars through its impacts on smoking initiation, smoking cessation and switching to nicotine vaping products (NVPs).

Methods: After calibrating an established US simulation model to reflect recent use trends in cigarette and NVP use, we extended the model to incorporate menthol and non-menthol cigarette use under a status quo scenario. Applying estimates from a recent expert elicitation on the behavioural impacts of a menthol ban, we developed a menthol ban scenario with the ban starting in 2021. We estimated the public health impact as the difference between smoking and vaping-attributable deaths and life-years lost in the status quo scenario and the menthol ban scenario from 2021 to 2060.

Results: As a result of the ban, overall smoking was estimated to decline by 15% as early as 2026 due to menthol smokers quitting both NVP and combustible use or switching to NVPs. These transitions are projected to reduce cumulative smoking and vaping-attributable deaths from 2021 to 2060 by 5% (650 000 in total) and reduce life-years lost by 8.8% (11.3 million). Sensitivity analyses showed appreciable public health benefits across different parameter specifications.

Conclusions and relevance: Our findings strongly support the implementation of a ban on menthol in cigarettes and cigars.

Document Type

Article

PubMed ID

34475258

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