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In Canada, where bans on menthol have been implemented in the province of Ontario since January 2017 and across Canada since October 2017, products that can be used to add menthol flavour to non-mentholated tobacco such as flavour cards and menthol drops are available in stores, including the brand ‘Itsa’, which is distributed by a cigar company. These products can easily add menthol flavour by either placing the card or drops with the tobacco or in the package as a way of circumventing the ban. However, in Ontario, it appears that no major cigarette manufacturers had produced or advertised these flavour additives.1 The purpose of this letter is to examine the changes in use of after-market menthol additives after the menthol ban in Ontario. Current (past month) cigarette smokers aged 16+ living in Ontario were surveyed pre-ban …

ObjectivesThe province of Ontario, Canada, banned the use of menthol-flavoured tobacco products as of 1 January 2017. The long-term impact of a menthol ban on smoking behaviour has not been previously evaluated.MethodsPopulation cohort study with baseline survey conducted September–December 2016 and follow-up January–August 2018 among residents of Ontario, Canada, 16 years old and over who reported current smoking (past 30 days) at baseline survey and completed follow-up (n=913) including 187 reporting smoking menthol cigarettes daily, 420 reported smoking menthol cigarettes occasionally, and 306 were non-menthol cigarette smokers. Relative rates of making a quit attempt and being a non-smoker at follow-up were estimated with Poisson regression controlling for smoking and demographic characteristics at baseline.ResultsAt follow-up, 63% of daily menthol smokers reported making a quit attempt since the ban compared with 62% of occasional menthol smokers and 43% of non-menthol smokers (adjusted relative rate (ARR) for daily menthol smokers compared with non-menthol smokers: 1.25; 95% CI 1.03 to 1.50). At follow-up, 24% of daily menthol smokers reported making a quit since the ban compared with 20% of occasional menthol smokers and 14% of non-menthol smokers (ARR for daily menthol smokers compared with non-menthol smokers: 1.62; 95% CI 1.08 to 2.42).ConclusionsThe study found higher rates of quitting among daily and occasional menthol smokers in Ontario 1 year after the implementation of a menthol ban compared with non-menthol smokers. Our findings suggest that restrictions on menthol may lead to substantial improvements in public health.

An unintended consequence of indoor smoking restrictions is the relocation of smoking to building entrances, where non-smokers may be exposed to secondhand smoke, and smoke from outdoor areas may drift through entrances, exposing people inside. Tobacco smoke has been linked to numerous health effects in non-smokers and there is no safe level of secondhand smoke (SHS) exposure. This paper presents data on levels of tobacco smoke inside and outside entrances to office buildings.Real-time air quality monitors were used to simultaneously measure respirable particulate matter (PM(2.5); air pollutant particles with a diameter of 2.5 μg or less) as a marker for tobacco smoke, outside and inside 28 entrances to office buildings in downtown Toronto, Ontario, in May and June 2008. Measurements were taken when smoking was and was not present within 9 m of entrances. Background levels of PM(2.5) were also measured for each session. A mixed model analysis was used to estimate levels of PM(2.5), taking into account repeated measurement errors.Peak levels (10 s averages) of PM(2.5) were as high as 496 μg/m(3) when smoking was present. Mixed model analysis shows that the average outdoor PM(2.5) with smoking was significantly higher than the background level (p0.0001), and significantly and positively associated with the number of lit cigarettes (p0.0001). The average level of PM(2.5) with ≥ 5 lit cigarettes was 2.5 times greater than the average background level.These findings support smoke-free policies at entrances to buildings to protect non-smokers from exposure to tobacco smoke.

Objectives Smoke-free policies not only reduce harm to non-smokers, they may also reduce harm to smokers by decreasing the number of cigarettes smoked and increasing the likelihood of a successful quit attempt. However, little is known about the impact of exposure to smoking on patios on smoking behaviour. Design and participants Smokers from the Ontario Tobacco Survey, a longitudinal population representative cohort of smokers (2005–2011). There were 3460 current smokers who had completed one to six follow-ups and were asked at each follow-up whether or not they had been exposed to smoking on patios in the month. Main outcome measures Generalised estimating equations and survival analysis were used to examine the association between exposure to patio smoking and smoking behaviour changes (making a quit attempt and time to relapse after a quit attempt), controlling for potential confounders. Results Smokers who were exposed to smoking on patios (adjusted incident rate ratio (aIRR) = 0.89; 95% CI 0.81 to 0.97) or had been to a patio (aIRR = 0.86; 95% CI 0.74 to 0.99) were less likely to have made a quit attempt than smokers who had not visited a patio. Smokers who were exposed to smoking on patios were more likely to relapse (adjusted HR=2.40; 95% CI 1.07 to 5.40)) after making a quit attempt than those who visited a patio but were not exposed to smoking. Conclusions Exposure to smoking on patios of a bar or restaurant is associated with a lower likelihood of success in a quit attempt. Instituting smoke-free patio regulations may help smokers avoid relapse after quitting.

Background Tobacco and non-tobacco-based waterpipe smoking has increased exponentially in many countries in recent decades, particularly among youth and young adults. Although tobacco smoking is banned in many indoor public places, waterpipe smoking, ostensibly non-tobacco, continues in Ontario and other jurisdictions where only tobacco smoking is prohibited. This study assessed air quality and exposure in waterpipe cafes using multiple methods and markers. Methods Indoor (n=12) and outdoor (n=5) air quality was assessed in Toronto, Canada waterpipe cafes from 30 August to 11 October 2012. Real-time measurements of air nicotine, fine particulate matter less than 2.5 microns in diameter (PM 2.5 ) and ambient carbon monoxide (CO) were collected in 2 h sessions. Levels of CO in breath were collected in non-smoking field staff before entering and upon leaving venues. Observations of occupant behaviour, environmental changes and venue characteristics were also recorded. Results In indoor venues, mean values were 1419 µg/m 3 for PM 2.5 , 17.7 ppm for ambient CO, and 3.3 µg/m 3 for air nicotine. Levels increased with increasing number of active waterpipes. On outdoor patios, mean values were 80.5 µg/m 3 for PM 2.5 , 0.5 ppm for ambient CO, and 0.6 µg/m 3 for air nicotine. Air quality levels in indoor waterpipe cafes are hazardous for human health. Outdoor waterpipe cafes showed less harmful particulate levels than indoors, but mean PM 2.5 levels (80.5 µg/m 3 ) were still ‘poor’. Conclusions Staff and patrons of waterpipe cafes are exposed to air quality levels considered hazardous to human health. Results support eliminating waterpipe smoking in hospitality venues indoors and out.