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Building evidence for the landmark U.S. ban on menthol cigarettes
OICR Senior Investigator Dr. Geoffrey Fong’s research helped inform the newly proposed tobacco control policy.

OICR Senior Investigator Dr. Geoffrey Fong’s research helped inform the newly proposed tobacco control policy.

When the U.S. Food and Drug Administration (FDA) announced in April 2022 that it was moving forward with a ban on menthol cigarettes, FDA Commissioner Dr. Robert Califf said the ban would help smokers quit, stop young people from starting smoking, and save lives.

He knows that in part because of OICR Senior Investigator Dr. Geoffrey Fong.

Dr. Fong is widely renowned for his research into the impact of policies to curb tobacco smoking — the greatest cause of preventable cancer in Ontario, in Canada and around the world. As Chief Principal Investigator of the International Tobacco Control Policy Evaluation Project (ITC Project) at the University of Waterloo, he led an evaluation of Canada’s recent menthol cigarette ban that was cited by the FDA as it explored a U.S. menthol ban.

Canada became one of the first countries to ban menthol cigarettes when all provinces introduced bans between 2015 and 2018, and then became the first country where a menthol ban has been evaluated on whether it leads smokers to quit.

Smoking kills about 45,000 Canadians every year, and public health authorities including the World Health Organization have long advocated for banning menthols, which have added flavouring and are popular among young smokers, women and some minority groups.

In their initial analysis published in April 2021, Dr. Fong and his ITC Project colleagues showed that banning menthol cigarettes made Canadian menthol smokers significantly more likely to quit than those who smoked non-menthol cigarettes. He presented these findings to colleagues at the FDA. Three weeks later, the FDA announced that it would develop a rule to ban menthol, citing the ITC study.

Now, on the same week of the FDA’s latest announcement, Dr. Fong and colleagues published a new analysis in Tobacco Control that projects the U.S. ban could lead 1.3 million American smokers to quit.

“This is an enormous, landmark decision by the FDA,” says Dr. Fong, who spoke about the decision with several major U.S. news outlets including the New York Times, Washington Post and NBC News. “It’s a major step in tackling the number one preventable cause of cancer and non-communicable diseases.”

This newest study builds on the ITC Project’s previous work by combining ITC data across 7 provinces with data from another project that also evaluated the impact of the menthol ban only in Ontario. Together, they found that 22.3 per cent of menthol smokers quit following the ban, compared to 15 per cent of non-menthol smokers. Applying that 7.3 per cent difference to the more than 18 million menthol smokers in the U.S. gave Dr. Fong and colleagues their 1.3 million estimate.

The menthol ban is likely to have a major impact on the health of Black Americans, who smoke menthols at much higher rates than other Americans and who have been targeted by aggressive menthol tobacco marketing. Dr. Fong’s research estimates that more than 381,000 Black smokers are likely to quit following the ban.

Although the policy has been formally proposed, it may take years before a ban comes into force. The proposal still needs to be finalized and will likely face strong pushback from tobacco companies.

The tobacco industry has a long history of suing countries that try to implement stronger policies, often attempting to discredit the evidence behind those policies. That’s why having comprehensive, population-level studies like Dr. Fong’s is particularly important to the success of these measures.

“Our study is the most complete evaluation of Canada’s menthol cigarette ban,” Dr. Fong said. “I think it can stand up to the challenges that will be coming.”

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