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Objectives: The province of Ontario, Canada banned menthol in cigarettes and other tobacco products effective January 1, 2017 thereby adding to an existing flavor ban. However, there was an exemption for all flavored e-cigarettes, flavored cigars larger than 6 grams, and alcohol flavored cigars without filters over 1.4 grams. In this paper, we examine the association between use of flavored non-cigarette products and self-reported cigarette smoking cessation after the ban. Methods: We recruited current past-30 day cigarette smokers (N = 913) who were 16 years or older and living in Ontario during September-December 2016 and re-contacted January-August 2018. Results: Both daily and occasional pre-ban menthol cigarette smokers were more likely to use flavored cigar products (adjusted relative rate, RR = 1.53, 95% confidence interval, CI = 1.01, 2.31; adjusted RR = 1.57, 95% CI = 1.06, 2.30) after the ban, while occasional pre-ban menthol cigarette smokers were more likely to use other tobacco products (adjusted RR = 1.25, 95% CI = 1.02, 1.53) or flavored other tobacco products (adjusted RR = 1.56, 95% CI = 1.09, 2.24), conditional on prior use. Conclusions: Menthol smokers prior to the ban were more likely to use other tobacco products, or flavored tobacco products, after the ban. These results suggest that comprehensive menthol bans could be more effective without the option of using flavored tobacco or nicotine products as substitutes. [ABSTRACT FROM AUTHOR]

Objectives: Heated tobacco products (such as IQOS) and e-cigarettes have been introduced and advertised in a variety of ways despite inconclusive evidence regarding their safety and benefit for smoking cessation. In this study, we examine the awareness, use, and perceived risk of these products among recent smokers. Methods: In 2017, we conducted an online survey of 727 current and recent smokers in Ontario. We asked participants about their awareness, use, and perceived risk of heated tobacco products and e-cigarettes. Results: Among respondents, 10% were aware of heated tobacco products, and 3% had ever used them. Compared to non-ecigarette users, e-cigarette users were more likely to agree with statements that heated tobacco is less harmful than regular cigarettes, e-cigarette use is less harmful than regular cigarettes, and both products can help smokers stop smoking regular cigarettes. Conclusions: Respondents who used e-cigarettes were more likely to have positive perceptions about heated tobacco and may be more susceptible to the marketing of these products. It is important to monitor the use of multiple nicotine products to inform policies and programming for these products. [ABSTRACT FROM AUTHOR]

Objective: We examined menthol cigarette smokers' reactions to Ontario's menthol cigarette ban. Methods: In April 2017, past-year adult menthol cigarette smokers from Ontario, Canada (N = 67; 64.2% women) participated in an online study. Participants generated statements describing their reactions to the ban. Researchers reviewed statements continuously until reaching content saturation, and then removed duplicate statements. Participants sorted the final 79 statements by content similarity and rated each statement from 1 (Definitely NOT true) to 7 (Definitely true). Multidimensional scaling of sorting data generated a cluster map and mean cluster ratings were compared. Results: Seven statement clusters describing reactions to the menthol ban were generated: thoughts about the ban, perceiving the ban as ineffective, emotional reactions to the ban, smoking non-menthol cigarettes, smoking cessation or reduction, alternative menthol cigarette purchasing behaviors, and alternative tobacco use behaviors. Participants rated the thoughts about the ban cluster highest (most true) and alternative tobacco use behaviors cluster lowest (least true). Participants who smoked menthol cigarettes before the ban every day or most days rated clusters higher than pre-ban occasional or rare menthol smokers. Conclusions: Banning menthol cigarettes resulted in reactions including negative feelings about the ban, smoking cessation attempts, and behaviors to find menthol cigarette alternatives. [ABSTRACT FROM AUTHOR]