Regulating flavours in cigarettes: A call to action

Abstract

Flavoured cigarettes threaten tobacco control efforts by masking the harshness of tobacco smoke, reducing perceptions of harmfulness, and facilitating smoking initiation 1 . Menthol, the most prominent cigarette flavour, has unique sensory properties that can promote addiction through reinforcing the actions of nicotine on the brain 1 . In addition to menthol’s effect on sensory perceptions, recent studies indicate that the cigarette package design of these products may also facilitate use. In particular, innovative crushable filter capsules may enhance the ritual behaviour of cigarette smoking 2 . Differences between menthol and non-mentholated cigarette packaging and labelling have also been observed 3 . Flavoured cigarettes are further used disproportionately by vulnerable populations, including adolescents and young adults, racial/ethnic and sexual minority groups 4–6 . Studies have found that compared to non-flavoured cigarette users, menthol and other flavoured cigarette users are less nicotine dependent, which is a predictor of quit attempts 7 . This is promising in light of tobacco control policies regulating flavours, including menthol, such as the European Tobacco Products Directive (TPD), which went into effect in May 2016 requiring European Union (EU) Member States to ban characterising flavours in cigarettes with a grace period until May 2020 for menthol 8 . Such policies, which have gained momentum in other countries worldwide 1,9 , have created an unprecedented opportunity not to just prevent smoking initiation but to facilitate smokers of flavoured cigarettes to quit. Unfortunately, the maximum impact of policies regulating flavours may not be attained without simultaneous efforts to promote smoking cessation—namely implementation of Article 14 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). In a study of adult smokers in the EU, only a minority of menthol cigarette users responded that they would quit smoking when the TPD ban on menthol came into effect 5 . As the menthol ban in the EU takes effect in May of this year, now more than ever we must prioritize efforts to promote smoking cessation and reduce barriers faced in implementing WHO FCTC Article 14 10 . In light of the scarcity of research in flavour regulations, coupled with a lack of full guidelines of WHO FCTC Article 9 (Regulation of the contents of tobacco products) 11 , it is further critical to identify the best practices for regulating flavours and evaluating their impact to inform future policies in other countries. Tobacco control advocates, researchers and policymakers should be encouraged to initiate or continue the regulation of flavours in cigarettes, evaluate its impact and maximise its implementation through supporting smokers to quit.