Canada-Wide Ban on Menthol Cigarettes

Bans on menthol cigarettes across Canada from 2015 to 2017 led to a significant increase in the numbers of smokers who attempted to quit and who quit successfully, while reducing relapse rates among former smokers. Canada was the one of the first countries to implement a ban on menthol cigarettes, and the first country where such a ban was evaluated.

Background

Smoking had been the leading cause of preventable death in Canada, according to the Canadian Cancer Society. Menthol is a common cigarette flavoring. It has a flavour that many find pleasant and, because it creates a cooling sensation, it makes cigarette smoke feel less harsh. This leads to more experimentation and more people becoming regular smokers. From this perspective, the addition of menthol to cigarettes increases motivation and is a barrier to avoiding and stopping smoking. At the time of this program, menthol cigarettes were being used by a third of high school smokers. 

For these reasons, a number of Canadian provinces had banned methol-flavoured tobacco products.

• Nova Scotia (May 31, 2015)
• Alberta (Sept. 20, 2015)
• New Brunswick (Jan. 1, 2016)
• Quebec (Aug. 26, 2016)
• Ontario (Jan. 1, 2017)
• PEI (May 1, 2017)
• Newfoundland and Labrador (July 1, 2017) 

Setting Objectives

•  To reduce cigarette smoking among youth

Getting Informed

Ontario was one of the Canadian provinces that had banned the use of menthol-flavoured tobacco products. Its ban began on January 1, 2017. One year later, a team of academics from the USA and Canada had conducted a population cohort study with 913 Ontario citizens aged 16 and over, who at baseline had smoked within the past 30 days. The evaluation team calculated the relative rates of making a quit attempt and being a non-smoker at follow-up, using a Poisson regression and controlling for baseline smoking status and demographic characteristics.

This study found that after the ban, menthol smokers were nearly 50% more likely than non-menthol smokers to attempt to quit (63% vs. 43%). And daily menthol smokers were 70% more likely to quit than daily non-menthol smokers (24% vs. 14%).

In addition, mandatory sales reports by tobacco manufacturers to Health Canada (October 2012 to September 2017) were analyzed using interrupted time-series analysis. The province of British Columbia was used for comparison and the data were seasonally adjusted. This study found that the sales of both menthol and non-menthol cigarettes rose from 2013 until the 2017 Ontario-wide ban. After the ban was implemented, there was a quick decline in Ontario sales of 55 million menthol cigarettes and 128 million total cigarettes. By comparison, there had been no significant change in British Columbia.

Delivering the Program

In summary, the availability of menthol cigarettes increased both the motivation to smoke and the barriers to reducing cigarette use. The Canadian Federal Government therefore amended its Tobacco Act to ban menthol in most tobacco products, as of October 2, 2017. This was in addition to other flavourings such as bubblegum and chocolate, that had already been prohibited eight years earlier.

Barrier	How it was Addressed
The addition of menthol to cigarettes makes the smoke feel less harsh and is a barrier to avoiding and stopping smoking.	Ban menthol as an ingredient in tobacco products.

Measuring Achievements

A team from the University of Waterloo conducted an evaluation study using longitudinal data from the Canadian arm of the 2016 and 2018 ITC Four Country Smoking and Vaping Survey. 1,098 non-menthol and 138 menthol smokers were surveyed before and after the bans on menthol cigarettes. The team used multivariate logistic regression to look at associations between changes in smoking behaviour.

Results

• After the Canadian ban, menthol smokers were almost 10 percentage points more likely than non-menthol smokers to attempt to quit (58.7% vs. 49%).
• Daily menthol smokers were almost two times as likely to quit after the ban (21% vs. 11.6 %).
• Menthol smokers who had quit smoking before the ban were significantly less likely to have relapsed back to smoking.
• Under 10 per cent of menthol smokers were still smoking a menthol cigarette (now illicit) after the ban.

Contacts

Dr. Janet Chung-Hall
Psychology Department, University of Waterloo
Waterloo, ON Canada
jchunghall@uwaterloo.ca

Notes

This case study was compiled in 2021 by Jay Kassirer based on information provided in the source reports noted in the left hand column.

Designation as a Landmark (best practice) case study through our peer selection process recognizes programs and social marketing approaches considered to be among the most successful in the world. They are nominated both by our peer-selection panels and by Tools of Change staff and are then scored by the selection panels based on impact, innovation, replicability and adaptability.