The US Food and Drug Administration (FDA) on Thursday proposed rules for banning menthol cigarettes and all flavoured cigars, a move likely to have the deepest impact on Black smokers and young adults.
In its fact sheet, the FDA said nearly 85% of Black smokers use menthol cigarettes as compared to 30% white smokers, and that modelling studies estimate a 15% overall reduction in smoking over age 40 if menthol cigarettes were unavailable.
If India were to ban menthol and other flavoured cigarettes, the impact might be limited, given that chewing tobacco and bidi are the most common forms of tobacco use.
India has 26.7 crore tobacco users aged 15 and above, as per the last available Global Adult Tobacco Survey (GATS 2016-17) — 18% of the population uses smokeless tobacco, 7% smoke, and 4% use both.
Even among smokers, “the impact of such a step would only be on young adults and women who are just starting to smoke. Apart from giving tobacco a pleasant flavour, menthol reduces the harshness, irritation, and somewhat the smell, making it appealing to those who have just started smoking or those who need to hide the smell from family members”, said Dr S K Arora, a chest physician, a former head of Delhi’s Tobacco Control Cell, and winner of a World Health Organization (WHO) award for his role in controlling tobacco use in India.
“However, once a person continues smoking for two weeks to a month, the flavour is of no consequence. If we ban menthol flavour, they will just continue smoking regular cigarettes,” he said.
Monika Arora, Director of the Public Health Promotion Division, Public Health Foundation of India, said, “Menthol cigarettes usually attract adolescents who initiate with a flavoured product, then switch to regular cigarettes. Banning it could prevent new users” from beginning smoking.
Banning products has logistical issues as well. “Banning is not the solution. How much can you ban? Things will be smuggled in,” said Dr G K Rath, former head of the National Cancer Institute. Gutkha and e-cigarettes, which are banned in India, are still available.
India has no official estimate on the number of people who use menthol or other flavoured cigarettes, but availability of various flavours has increased over the years.
Tobacco use among 15-24-year-olds has been reducing in India, from 18.4% in GATS-1 (2009-10) to 12.4% in GATs-2 (2016-17), a relative reduction of 33%.
On the other hand, there has been an increase in tobacco use among American youth, driven mostly by e-cigarettes. More than 1 in 4 high school students used tobacco product in the previous 30 days in 2018, with e-cigarette use increasing from 11.7% to 20.8% among high school students from 2017 to 2018, according to the US Centers for Disease Control and Prevention (CDC). In India, e-cigarettes are banned.
“If such a step is taken by India, there will likely be a proportion of current users who will stop smoking. But it is likely to reduce initiation to smoking. There are several studies from across the world that show this,” said Dr Jagdish Kaur, regional advisor to WHO’s Tobacco Free Initiative.
A recent study from Canada shows that after menthol cigarettes were banned, 8% more menthol smokers quit smoking than non-menthol smokers.
Another modelling based study from Singapore, where use of flavoured cigarettes is predominant, showed that in 50 years, smoking prevalence will increase from 12.7% to 15.2% if flavoured cigarettes are not banned, go down by 10.6% if there is a complete ban, and remain the same if there is a partial ban.
What additional measures need to be taken for tobacco control?
Other than banning tobacco products that draw in young new users, experts stressed a need for oversight on social media platforms, content streaming websites, and web based shopping portals.
“These websites not only advertise a tobacco product, which is against the law, they also make misleading claims such as menthol cigarettes being less harmful than regular cigarettes… These are the avenues that need to be regulated…,” Dr Monika Arora said.
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