Intended for healthcare professionals

Rapid response to:

Editorials

The path to a smoke-free England by 2030

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m518 (Published 17 February 2020) Cite this as: BMJ 2020;368:m518

Rapid Response:

The Loophole in the New Menthol Cigarette Ban

Dear Editor,

Hopkins stresses the importance of discouraging smoking, particularly in younger people. One important intervention to achieve the target of reducing smoking prevalence to under 5% by 2030 is the banning of menthol flavoured cigarettes. However, tobacco companies are exploiting a loophole in the new legislation, which threatens to undermine it and damage public health.

Menthol is considered an entry level tobacco product; it can reduce irritation caused by smoking tobacco and increase addiction by enhancing the action of nicotine in the brain[1]. Menthol cigarettes are also potentially dangerous due to higher levels of tobacco dependence and greater withdrawal symptoms amongst menthol smokers compared to non-menthol smokers[2].

Canada was the first to implement a menthol ban on all tobacco products in 2017 and experienced a significant reduction of menthol cigarette and total cigarette sales[3] and higher quitting after 1 year as a result [4]. On May 20th, the EU is set to follow suit as the second phase of the EU Products Directive (2014) comes into force and includes a ban on menthol in cigarettes[5].

Public health professionals are therefore justifiably optimistic about the potential impact of such legislation in the UK. However, tobacco companies are exploiting a loophole which threatens to undermine the ban and further harm public health.

The tough advertising controls on cigarettes, referred to by Hopkins, have helped to reduce smoking by introducing a minimum pack size of 20 cigarettes (to make ‘one-off’ smoking less affordable), compulsory health warnings, and a ban on logos to make packs significantly less attractive. However, these restrictions do not apply to cigars. Similarly, the menthol ban focuses almost exclusively on cigarettes and ignores other tobacco products[5].

The characteristic feature of a cigar is that it is covered in a tobacco leaf or a substance containing tobacco, while cigarettes are covered in tobacco-free paper. By altering the material which covers the tobacco, with very little cost to any manufacturing process or profit margin, companies can sidestep this ban.

Hence Japan Tobacco International has introduced a new product; Sterling Dual Capsule Cigarillos are the same size as cigarettes, and contain mentholated capsule filters[6]. By virtue of containing a minimal amount of tobacco in its paper covering, cigarillos can claim to be cigars, and therefore avoid the menthol ban, and all advertising restrictions which solely focus on cigarettes. Cigarillos are cheaper and more attractive because they can be sold in branded packs of 10 and priced at £4-4.50 a box.

Instead of reducing the prevalence of young smokers, there is a risk that this regulation, by only focusing on cigarettes, could inadvertently lead to a Cigarillo trend. The menthol ban should follow in Canadian footsteps, and apply to all tobacco products.

Regulation which is currently being enforced on the manufacturing, sale, and consumption of cigarettes should also be applied to cigars in order to be fully effective.

References:

[1] World Health Organisation: Case studies for regulatory approaches to tobacco products: Geneva: World Health Organization 2018. (WHO/NMH/ PND/18.1). Licence: CC BY-NC-SA 3.0 IGO: https://www.who.int/docs/default-source/regulating-tobacco-products/who-...
[2] Andrea C. Villanti, Lauren K. Collins,1 Raymond S. Niaura, Stacey Y. Gagosian, and David B. Abrams: Menthol cigarettes and the public health standard: a systematic review: 2017
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747135/
[3] Chaiton M, Schwartz R, Shuldiner J, Tremblay G, Nugent R: Evaluating a real world ban on menthol cigarettes: an interrupted time series analysis of sales: 2019
https://www.ncbi.nlm.nih.gov/pubmed/30887032
[4] BMJ: Ban on menthol-flavoured tobacco products predicts cigarette cessation at 1 year: a population cohort study: 2020: https://tobaccocontrol.bmj.com/content/early/2019/05/29/tobaccocontrol-2...
[5] Journal of the European Union: Directives 2014: https://ec.europa.eu/health/sites/health/files/tobacco/docs/dir_201440_e...
[6] Financial Times - JTI’s menthol cigar an attempt evade UK ban, say campaigners: 2020:
https://www.ft.com/content/992249d4-438d-11ea-a43a-c4b328d9061c

Competing interests: No competing interests

24 April 2020
Maya S Rashid
Medical Student
Mhairi L Ellis
York, UK