Thursday, 5 March 2020

Banning menthol cigarettes doesn't work

I was surprised to learn recently that 17.5 per cent of female smokers in England smoke menthol cigarettes. The rate for both sexes combined is 12.4 per cent, a much higher figure than seen in most countries.

They'd better get ready for May 20th when the EU bans them from sale, unless the British government is going to take back control by then, which seems unlikely.

The EU decided on this piece of 'market harmonisation' despite no member states having banned menthol cigarettes and no member state seriously discussing such a ban. There was never any serious science behind it. They got away with it because menthol smokers are a minority within a minority.

I understand that menthol filter tips will not be banned, so smokers who roll their own should be OK, but for everybody else the only options will be switching to normal cigarettes or buying on the black market. It will be interesting to see how the illicit trade adapts to this new opportunity, not just in Britain but across the EU.

A working paper published last month by the National Bureau of Economic Research, based on real world evidence from Canada, gives us an idea of what we can look forward to. Spoiler: it won't reduce the smoking rate.

It found...
...strong evidence that individuals responded to provincial menthol bans in a variety of ways that are consistent with substitution and evasion. Specifically, the results in the top panel for youths indicate that menthol bans were associated with statistically significant increases of 1.7 percentage points in the likelihood of past 30 day non-menthol cigarette smoking, consistent with the idea that young menthol smokers switched from menthol cigarettes to non-menthol cigarettes in response to the bans. 

It didn't make smokers switch to vaping...

The other possible substitution that the public health literature has identified as a target of concern is e-cigarettes, which we examine in column 2 of Table 5. We find no evidence that provincial menthol bans were associated with statistically or economically meaningful increases in e-cigarette use

But it did drive people to find alternative suppliers...

Finally, the bottom panel of columns 3 and 4 of Table 5 provide strong evidence of another behavioral response to provincial menthol bans: evasion. Specifically, we estimate that menthol bans were associated with statistically significant increases in the likelihood a respondent reports that she purchased cigarettes on or from a First Nations reserve in the past six months, an effect on the order of 4.3 percentage points. This is very large relative to the pre-reform mean and is most consistent with substitution behavior from regulated sources to unregulated sources.

In conclusion:

In the words of former FDA commissioner Scott Gottlieb, “menthol-flavored products represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes.” Our results are not consistent with this broad claim for youths aged 11- 17: banning menthol did not reduce smoking initiation by these youths as measured by the likelihood they smoked 100 cigarettes in their lifetime. We similarly did not find evidence that menthol bans reduced smoking among adults. We also found that the lack of systematic reductions in overall smoking rates is due to two factors: first, youths substituted toward non-menthol cigarettes; and second, adults evaded the new regulation by shifting purchases toward First Nations reserves which are exempt from compliance.

Yet another 'public health' win!

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