12.6.12 Regulation of flavourings and flavoured tobacco products

 

Flavours are imparted by both the tobacco and the additives in tobacco products. These flavourings not only increase the attractiveness of tobacco products, but some can also increase the addictiveness and toxicity. Regulation of flavour additives may therefore serve to decrease the attractiveness, addictiveness and toxicity of tobacco products. This section describes the regulation of tobacco products that have a characterising flavour (‘flavoured’ tobacco products) as well as regulation affecting all flavouring additives, such as that implemented in Canada.

Menthol is an example of an additive that is predicted to increase the attractiveness and addictiveness of tobacco products (see Section 12.7.2). The regulation of menthol in tobacco is described separately in Section 12.7.7.

12.6.12.1 Aims and approaches to regulating flavourings

Regulation of tobacco product flavours invariably involves regulating the flavouring additives rather than the flavours imparted by the tobacco.

Regulation of flavourings ais recommended to conform with article 9 of the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC): the regulation of the contents of tobacco products. ¹ The WHO Study Group on Tobacco Regulation (TobReg) recommendations for the regulation of flavourings include:

Consider banning the use of flavours, including menthol, in harmful combusted products. …and;

Consider limiting the levels, number of and/or specific flavours allowed in tobacco and nicotine products for which there is evidence of modified or reduced risk, to reduce initiation by young people and support cessation of use of combusted tobacco products. ²

The 2017 partial guidelines for implementing Article 9 of the FCTC recommend prohibiting or restricting ingredients that may be used to increase palatability in tobacco products. ³ Examples of such ingredients are sugars, sweeteners, spices, flavours such as benzaldehyde, maltol, menthol and vanillin.

Some countries have taken a narrow approach to regulating flavours by banning ‘characterising’ flavours. These bans leave room for low levels of flavouring additives in tobacco products, of which are found in most products considered non-flavoured. A drawback to banning ‘characterising’ flavours is the necessity to determine and defend a definition of a ‘characterising’ flavour. The European Union has developed methods and an advisory panel to perform this task. ^{2 , 4}

Other approaches to regulating flavours include a ban on all added flavourings, as well as bans on specific flavours, where there is evidence that they play a sizable role in appealing to young people or specific groups of people or to support cessation. ⁵

Many regulations on flavourings are confined to specific types of products, such as cigarettes. However, unless such legislation covers all products, then exempted products can be more vigorously promoted and gain market share after cigarette flavour regulation has been implemented. An example of this scenario is the increase in flavoured cigar sales after implementation of the flavoured cigarette ban in Canada, described in Section 12.6.12.4.

Waterpipes are often used with strongly flavoured tobacco, which attracts young and new users. ⁶ A systematic review from 2020 recommended a ban on waterpipe molasses with strong characterising flavours or ban on the use of flavourings at any level. ⁷

12.6.12.2 International progress in regulation of flavourings

The World Health Organization (WHO) regularly reports on progress in implementing the articles of the Framework Convention on Tobacco Control (FCTC). Its report from 2021 concluded that there appeared to be a trend in banning characterising flavours of tobacco products. ⁸ Numerous parties to the FCTC have banned characterising flavours. Countries such as Canada, Brazil, Cabo Verde, Mauritania and Senegal have more comprehensive bans of any flavourings in tobacco products (see Table 12.6.12.1). Some countries have also banned flavours in components of tobacco products such as filters, papers and packaging. ⁸

A summary of the international regulations affecting use of flavouring in tobacco products as of September 2023 is presented in Table 12.6.12.1 below. 

Country	Term	Definition and prohibited flavours	Tobacco products	Implementation status
Africa region
Cabo Verde	Substances with flavouring properties	‘Pure substances, extracts, essential oils or balms which have flavoring properties that can confer, intensify, modify, or enhance the taste or smell of the product, including any additives identified as flavoring agents: a) Processing aids to enhance flavoring;’ … ‘Fruits, vegetables, or any products originated from processing fruits and vegetables, except for activated charcoal and starch; h) Sweeteners, artificial sweeteners, honey, molasses, or any other substance other than sugar that can confer a sweet odor or flavor; i) Spices, aromatic herbs, or any substance that can confer their odor or flavor;’	Tobacco products	Implementation scheduled for August 2022.†
Congo	Characterising flavours	Characterising flavour defined as ‘a clearly noticeable smell or taste other than one of tobacco, resulting from an additive or a combination of additives, including but not limited to fruit, spice, herbs, alcohol, candy, vanilla, and others, that is noticeable before or during consumption of the tobacco product’.	Tobacco products	Law introduced 2022. Implementation scheduled for 2022.†
Ethiopia	Characterising flavour	Characterising flavour, ‘flavouring in any of its components or the packaging, wrapping or any technical feature of the product allowing modification of the smell or taste of the product’, …	Tobacco products	Implemented 2015
Mauritania	(Specific) ingredients	Prohibited ingredients include: ‘- Ingredients that can improve the taste of tobacco products.’	‘Tobacco products containing partially or wholly in its composition tobacco leaf.’	Policy restrictions enacted in 2018. †
Mauritius	Characterising flavour	Characterising flavour is defined as ‘(a) means a clearly noticeable smell or taste, other than that of tobacco, resulting from an additive or a combination of additives, including, but not limited to, fruit, spice, herbs, alcohol, candy, menthol or vanilla, which is noticeable before or during the consumption of the tobacco product; and (b) includes a taste or smell which may be activated by the user at the time of consumption’.	Cigarettes, RYO, bidis, cigars, cigarillos, smokeless tobacco, e-cigarettes, waterpipe tobacco, heated tobacco products, cigarette papers, tubes or filters.	Regulations introduced 2022.†
Niger	Flavour (except menthol)	Flavour is defined as ‘a taste or smell, other than that of tobacco, derived from an additive or combination of natural or artificial additives, especially fruit, spices, herbs, alcohol, confectionery, chocolate or vanilla; identifiable before or during the consumption of a tobacco product with the exception of menthol’.	Tobacco products	Policy enacted in 2017, not yet in effect as of 2020. †
Nigeria	Characterising flavour	Characterising flavour is defined as ‘a clearly noticeable smell or taste other than one of tobacco, resulting from an additive or a combination of additives, including, but not limited to fruit, spice, herbs, alcohol, candy, menthol or vanilla which is noticeable before or during the consumption of the tobacco’.	Cigarettes	Regulations introduced in 2018. †
Senegal	Characteristic aromatic agents	Characteristic aromatic agent is defined as ‘a taste or scent, other than that of the tobacco, coming from an additive or a combination of natural or artificial additives, particularly those derived from fruits, spices, aromatic plants, alcohol, sweetening elements, menthol, chocolate or vanilla, and which is identifiable prior to or during the consumption of the tobacco product’.	Tobacco product	Laws passed in 2017 and have been implemented.
Sierra Leone	Characterising flavours	Prohibited are tobacco products with characterising flavours.	Tobacco, tobacco products and other nicotine products	Law passed in 2022.†
Uganda	Flavours	The regulations prohibit: (a) flavoured tobacco product (defined as ‘a tobacco product which has a taste or smell, other than the taste or smell of tobacco, such as fruit, spice, herb, alcohol, candy, menthol, mint, chocolate or vanilla, and includes a taste or smell that is activated by the consumer at the point of consumption’; (b) a tobacco product that has any technical feature that allows the release or modification of the smell or taste of the tobacco product or the smoke intensity of the tobacco product by the consumer; (c) a tobacco product that has flavour delivering mechanisms including filter flavour capsules, granules and flavour threads	Tobacco products	Implemented in 2020.
Americas region
Country	Term	Definition and prohibited flavours	Tobacco products	Implementation status
Antigua and Barbuda	Characterising flavours	Characterising flavour is defined as ‘means a taste or smell, other than one of tobacco, resulting from a natural or artificial additive or a combination of additives, which is noticeable before or during the consumption of the tobacco product.’	Tobacco products	Laws introduced 2018. †
Brazil	Additives Substances with flavouring properties	Prohibited additives include: ‘ additives: I – synthetic and natural substances in any form (pure substances, extracts, oils, distillates, balms, among others), with flavoring properties that can impart, intensify, modify or enhance the flavor of the product, including additives identified as flavoring agents: a) by the Joint FAO/WHO Expert Committee on Food Additives - JECFA; or b) by the Flavor and Extract Manufacturers Association - FEMA.”	‘Tobacco products containing partially or wholly in its composition tobacco leaf.’	Law passed in 2012. Not implemented yet.
Chile	Details not available			Bill successful passed senate but has not yet been implemented.
Canada	Flavours Additives that have flavouring properties	Flavour is not defined, though the term ‘flavours’ is used in the description of prohibited additives. ‘Additives that have flavouring properties or that enhance flavour, including –       additives identified as flavouring agents by the Joint FAO/WHO Expert Committee on Food Additives in the Committee’s evaluations, as published from time to time in the WHO Technical Report Series –       additives identified as flavouring substances by the Flavor and Extract Manufacturers Association (FEMA) Expert Panel in its lists of GRAS (Generally Recognized as Safe) flavouring substances referred to as “GRAS 3” to “GRAS 24” and subsequent GRAS lists, as published from time to time, if any’.	Cigarettes, Cigars (<6 g), little cigars, blunt wraps	Flavour ban (excluding menthol) implemented in 2009. Amendment to include menthol implemented in 2018.
US	Characterising flavour (not including menthol or tobacco flavour)	The Act prohibits any ‘constituent (including a smoke constituent) or additive, an artificial or natural flavor (other than tobacco or menthol) or an herb or spice, including strawberry, grape, orange, clove, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee, that is a characterizing flavor of the tobacco product or tobacco smoke.’	Cigarettes, roll-your-own tobacco	Implemented in 2009.
	Characterising flavours (other than tobacco)		Cigars and their components and parts	Proposed, not yet implemented.
	Menthol as a characterising flavour	The proposal prohibits as a constituent (including a smoke constituent) or additive, menthol that is a characterizing flavour of the tobacco product or tobacco smoke.	Cigarettes any of their components or parts (including the tobacco, filter, wrapper, or paper, as applicable)	Proposed, not yet implemented.
Within US	As of July 2023, there were over 370 localities in the US that had passed restrictions on sales of flavoured tobacco products, including the states of California, Massachusetts, New Jersey, New York and Rhode Island.
Eastern Mediterranean region
Country	Term	Definition and prohibited flavours	Tobacco products	Implementation status
Jordan	Additives	‘The additives used in manufacturing tobacco (combination) must be of the additives permitted in the Flavor and Extract Manufacturers Association, Generally Recognized As Safe list, FEMA GRAS.’	Cigarettes	Law introduced in 2012.†
Europe region
Country	Term	Definition and prohibited flavours	Tobacco products	Implementation status
European Union (27 member states)	Characterising flavour	Characterising flavour is defined as ‘clearly noticeable smell or taste other than one of tobacco, resulting from an additive or a combination of additives, including, but not limited to, fruit, spice, herbs, alcohol, candy, menthol or vanilla, which is noticeable before or during the consumption of the tobacco product’.	Cigarettes, roll-your-own, in filters, papers, packages, capsules or any technical features allowing modification of the smell or taste of the tobacco products concerned	Fully implemented in 2020.
Finland	Characterising flavours or aroma	Characterising flavour or aroma defined as ‘a smell or taste other than one of tobacco, resulting from an additive or a combination of additives, which is clearly noticeable in a tobacco product, nicotine-containing liquid or nicotine-free liquid intended for vaporisation before or during its consumption’.	Cigarettes and RYO (characterising flavour); tobacco products (additives)	Legislation took effect in 2022 with implementation at the retailer level required by April 2023.†
Germany	Characterising flavour	‘Characterising flavour’ means a clearly noticeable smell or taste other than one of tobacco, resulting from an additive or a combination of additives, including, but not limited to, fruit, spice, herbs, alcohol, candy, menthol or vanilla, which is noticeable before or during the consumption of the tobacco product.	Cigarettes and all smoking tobacco products (such as cigarillos or hookah tobacco)	Implemented 2020
Hungary	Any amount of menthol in cigarettes	Not specified		Plans for ban announced in 2021.
Moldova	Characteristic flavours	Characteristic flavour defined as ‘a clearly noticeable smell or taste other than one of tobacco, resulting from an additive or a combination of additives, including, but not limited to, fruit, spice, herbs, alcohol, candy, menthol or vanilla, which is noticeable before or during the consumption of the tobacco product.’	Cigarettes (including capsules) and roll-your-own tobacco	Scheduled to be implemented in 2020. †
Türkiye (formerly Turkey)	Characteristic flavours	Characteristic flavour is defined as ‘the scent or flavor noticed before or during the use of tobacco products that can be distinguished from the tobacco’s own flavor originating from an additive such as but not limited to fruit, spices, herbs, alcohol, sugar, menthol or vanilla’.	Cigarettes (including capsules) and rolling tobacco	Legislated enacted in 2019, which implementation at the retailer level require by 2020. †
Ukraine	Characteristic taste and flavour	Characteristic taste and flavour is defined as “a clearly perceptible smell or taste other than the smell or taste of tobacco resulting from the introduction of an additive or combination of additives, including but not limited to fruit, spices, herbs, alcohol, candy, menthol or vanilla that can be recognized before or during the use of a tobacco product.	Cigarettes and RYO tobacco.	Scheduled to be implemented July 2023. †
United Kingdom	Characterising flavours (including menthol)	Characterising flavour is defined as ‘a smell or taste other than one of tobacco which— (a) is clearly noticeable before or during consumption of the product; and (b) results from an additive or a combination of additives, including, but not limited to, fruit, spice, herbs, alcohol, candy, menthol or vanilla’.   Filters, papers, packages, capsules or any technical features allowing modification of the smell, taste or smoke intensity of the tobacco product are banned.	Cigarettes, RYO, filters, papers, packages, capsules etc.	Implemented in 2020
South-east Asia region
Singapore	Fruit-flavoured shisha tobacco	Banned is “Shisha tobacco, that is, any mixture containing tobacco intended for smoking in a water pipe, whether or not containing glycerol, aromatic oils, aromatic extracts, molasses or sugar, and whether or not flavoured with fruit”	Waterpipe tobacco only	Legislated in 2014
Sri Lanka	Flavours, colours and sweetening	‘Flavoured, coloured or sweetened’ cigarettes are prohibited.	Cigarettes	Introduced in 2016. †

European Union

The sale of tobacco products with a characterising flavour was banned in the European Union (EU) in the second Tobacco Products Directive (TPD2) of 2014. ⁵² Flavourings are also banned in any component including filters, papers, packages, capsules or any technical features allowing modification of the smell or taste of the tobacco products concerned or their smoke intensity. EU member states were required to incorporate the TPD into their national legislation by May 2016. However, these bans were not immediately implemented. TPD2 went into effect in May 2016 in the 27 member states of the EU, but a transition period was granted until 2017, with menthol cigarettes able to be sold until 2020.

The term ‘characterising flavour’ was defined by TPD2 as a smell or taste other than one of tobacco which is (1) clearly noticeable before or during consumption of the product; and (2) results from an additive or a combination of additives, including, but not limited to, fruit, spice, herbs, alcohol, candy, menthol or vanilla. ⁵² The EU has established methods for determining whether a flavour is characterising, by using sensory panels and chemical analysis. ² An independent advisory panel issues opinions on whether specific products have a characterising flavour according to these methods. ⁴

The EU ban on sales of products with characterising flavours has only been implemented for cigarettes and roll-your-own tobacco but not for other types of products. ⁵³

Some member states of the EU have implemented wider bans than the TPD2 flavour ban for cigarettes and roll-your-own tobacco. In 2022, the Tobacco Act of Finland was revised banning tobacco flavouring products such as flavour cards to prevent consumers from using these to flavour unflavoured tobacco products. ⁴⁰ Characteristic flavours (with the exemption of menthol) in tobacco products were banned earlier in Germany, since May 2016. The legislation was subsequently amended to ban specified additives (including menthol), which came into force in May 2020. ⁴⁴

United States

The US is not a party to the FCTC, but does regulate the contents of tobacco products. The Family Smoking Prevention and Tobacco Control Act of 2009 provided the authority to the Food and Drug Administration (FDA) to regulate tobacco products, allowing a ban on tobacco products that contain ‘characterising flavours’. The FDA subsequently prohibited the sale of cigarettes with a characterising flavour, with the exception of tobacco and menthol flavours in 2009. ¹⁴ Limitations on the 2009 flavouring ban include the lack of a ban on any other tobacco product with a characterising flavour and the lack of regulation of mentholated cigarettes. There is considerable effort underway to widen these regulations, as described below.

The FDA describes a cigarette with a characterising flavour as: ²

… a cigarette or any of its component parts (including the tobacco, filter, or paper) from containing as a constituent (including a smoke constituent) or additive, an artificial or natural flavour (other than tobacco or menthol) or an herb or spice, including strawberry, grape, orange, clove, cinnamon, pineapple, vanilla, coconut, liquorice, cocoa, chocolate, cherry, or coffee, that is a characterising flavour of the tobacco product or tobacco smoke.

Individual states and localities in the US have enacted their own bans on flavoured products that widen the federal ban. Over 160 cities and towns across the state of Massachusetts introduced regulations restricting the sales of flavoured tobacco products. ⁵⁴ The state of Massachusetts has banned all flavoured products, including e-cigarettes, in 2019, which was implemented in 2020. ⁵⁵ A number of states also have restrictions on flavours in e-cigarettes. ³³ Over 370 localities in the US have some type of restrictions on the sales of flavoured tobacco products. ⁵⁶ Most of these are in Massachusetts, California and Minnesota. The state of California passed legislation for a flavoured tobacco product restriction in 2020, however the tobacco industry successfully delayed implementation. The ban was finally implemented after legislation was upheld in a referendum in November 2022. ⁵⁷

In April 2021, the FDA in the US announced its commitment to a ban all characterising flavours in cigars, as well as ban menthol flavours in cigarettes (see Section 12.7.7.2). ³⁴ In April 2022, the FDA proposed rules for prohibition of all characterising flavours (other than tobacco) in cigars. The implementation date is not yet determined. ³⁴

The US House of Representatives passed a bill for the Protecting American Lungs and Reversing the Youth Tobacco Epidemic Act in February 2020. If enacted, this legislation would (among other aims): ^{58 , 59}

• prohibit flavours other than tobacco in a tobacco product, and
• prohibit the use of flavoured products in an electronic nicotine delivery system, except in specified circumstances.

However, the bill must be passed by the Senate, where it will face a difficult battle. ⁶⁰

Australia

The promotion and sale of fruit and confectionary flavoured cigarettes have been prohibited for some time in all states and territories in Australia, however no other flavours had been banned. Legislation  passed in Australia at the end of 2023 aims to prevent the use of additives in tobacco products, including any flavourings and menthol. ⁶¹

Canada

The Tobacco Act in Canada was amended to ban the sale or import of cigarettes, little cigars and blunt wraps in 2009 containing flavours, coming into effect on 5 ^th July 2010. ³⁰ This act (bill C-32) banned any flavourings, not just characterising flavours (see Table 12.6.12.1). ²⁷ The ban included additives identified as flavouring agents by the Joint FAO/WHO Expert Committee on Food Additives in the Committee’s evaluations, and by the Flavor and Extract Manufacturers Association (FEMA) Expert Panel in its lists of GRAS flavours (Generally Recognized as Safe). ²⁷ Exempt from the bill were menthol flavour and other types of tobacco products. A 2015 amendment to the Canadian Tobacco Act extended the flavour ban to most cigars (specifically: little cigars, cigars that have tipping paper, cigars that have a wrapper that is not fitted in spiral form and cigars weighing more than 1.4 g but less than 6 g, excluding the weight of any mouthpiece or tip). Further amendments widened these regulations to include cloves and menthol in these bans as of 2017 (discussed in Section 12.7.7.2). ¹⁴ Flavours are also prohibited in components of cigarettes, such as the paper and filters.

Brazil

The Brazilian Health Regulatory Agency passed a regulation (RDC 14/2012) to ban the addition of substances that enhance the flavour and taste of tobacco products that make them more attractive to users. Brazil was therefore the first country in the world to pass a law banning flavours in tobacco products. However, this ban has not been implemented, as it is still being challenged by tobacco and tobacco-related industry groups. ^{14 , 25}

The RDC 14/2012 regulation specifically prohibits the sale or import of tobacco products with additives that are:

“…synthetic and natural substances in any form (pure substances, extracts, oils, distillates, balms, among others), with flavoring properties that can impart, intensify, modify or enhance the flavor of the product…” ⁶²

"seasonings, herbs and spices or any substance that can impart a flavor of seasonings, herbs and spices." ⁶²

Examples of these flavours in the regulations include fruits, vegetables, extracts of processed fruits or vegetables (except activated charcoal and amides), sweeteners, honey, molasses, seasonings, herbs and spices. ⁶²

Other countries

Three other countries have passed legislation to ban flavourings that are broader than bans on characterising flavours. Cabo Verde has banned substances that have flavouring properties and any additives identified as flavouring agents. ¹⁰ Mauritania has banned ingredients that can improve the taste of tobacco, enacted in 2018. ¹³ Senegal has banned “any aromatic agent in a component or technical feature that makes it possible to modify the scent or flavor of a tobacco product…”. ¹⁸

Despite facing a legal challenge from British American Tobacco, Uganda (BATU) in May 2019, the country successfully passed Tobacco Control Regulations in August 2019. ¹⁴ A directive was issued in Ethiopia to manufacturing, import, distribution, and sale of flavoured tobacco products of any kind from late 2015. ⁶³ This makes it illegal to import, wholesale, distribute, sell or offer for sale any flavoured tobacco product in Ethiopia.

Singapore has banned flavours in waterpipe tobacco, ¹⁴ making it one of very few Asian countries to do so.

The Ministry of Health in Chile attempted to ban menthol tobacco products in 2013 but Chile’s autonomous Office of the Comptroller General ruled that the Ministry had failed to demonstrate that menthol directly increases addiction, harm or risk. A new bill was successful in 2015 after arguing that menthol and other distinctive cigarette flavours were associated with high levels of use by Chilean youth. Although the new bill successfully passed in Chile’s Senate, as of 2020, the law had not yet been implemented. ²⁶

The 2014 TPD2 ban on flavoured and menthol cigarettes included the United Kingdom (UK), until it left the European Union at the end of 2020. The flavour ban was transposed into UK law with any future amendments to be made by the UK government ³⁹ and enacted in 2020.

As of October 2023, countries that have introduced legislation to regulate flavours in tobacco products include ten African nations, five nations from the Americas, the 27 European Union states and four other nations, the United Kingdom and Sri Lanka. Aside from these countries mentioned above and in Table 12.6.12.1, a number of countries have banned the use of some flavours that are known to be poisonous, such as bitter almond oil and coumarin. These countries are Belarus, Kazakhstan, Kyrgyzstan, Oman, Qatar, Russia, Saudi Arabia and the United Arab Emirates. ⁹   

12.6.12.3 Evidence for the effects of flavour regulation

European Union

Sales of cigarettes and roll-your-own tobacco with characterising flavours are banned in the EU. Longitudinal survey data (June to December 2016 to 2018) from eight EU countries found that 11% of people who smoked products that are now banned continued to smoke them, while 62% changed to using unflavoured cigarettes and 5% to menthol cigarettes. Almost nine percent of the smokers who previously used now-banned flavoured products had quit by 2018. ⁶⁴ The prevalence of use of non-menthol flavoured cigarettes fell by an estimated 1.3% between 2016 and 2018. However, this decline in smoking of products with a characterising flavour was primarily caused by a shift to use of non-flavoured products rather than to cessation. Over the same time period, 11.2% of smokers of non-flavoured cigarettes quit smoking compared to 8.6% of smokers of flavoured cigarettes and 14% of menthol smokers. ⁶⁴

United States

There is evidence that the 2009 ban on the sale of cigarettes and roll-your-own tobacco with characterising flavours was associated with a reduction in smoking in younger people, as well as a shift to alternative flavoured products that are not covered by the ban.

An analysis of data from the National Survey on Drug Use and Health over the period 2002–2017 predicted a decrease in youth and young adult cigarette smoking. ⁶⁵ In 2017, the predicted probability of cigarette use in youth (12–17 years) was reduced by 43%, and reduced by 27% in young adults (18–24 years), compared to the predicted probability in absence of the ban. There was no reduction in the predicted probability of smoking for people 50 years and over. ⁶⁵

Data from the National Youth Tobacco Survey of middle and high-schoolers over the period 1999–2013 showed a 17% decrease in the probability of being a cigarette smoker after the 2009 characterising flavour ban. ⁶⁶ This study also showed an increase in the use of menthol cigarettes, cigars and pipes, indicating a switching effect to other flavoured products. Despite evidence of switching to other types of tobacco, overall there was a 6% reduction in the probability of using any tobacco product by middle and high-schoolers. ⁶⁶

The characterising flavour ban for most tobacco products in New York City, which came into effect in 2010, was associated with teenagers having a 37% lower odds of ever trying flavoured tobacco products and a 28% lower odds of using any type of tobacco product in 2013 compared to 2010. ⁶⁷

While the state of Massachusetts banned sales of all flavoured products in 2020, some individual counties in this state had already implemented flavour restrictions prior to the 2020 statewide ban. ^{54 , 68} The strength of flavour regulations differed over various counties in Massachusetts, and those counties with greater implementation of flavoured tobacco restrictions had lower cigarette use among adolescents. ⁶⁸ The statewide flavour ban in Massachusetts banned characterising flavours, including menthol, in all tobacco products. This ban was associated with a statistically significant 33% decrease in all the sales of all cigarettes, measured from 2017 to 2021. ⁵⁵ There was a corresponding increase in sales of nicotine replacement lozenges and gum. ⁶⁹ This ban did not significantly affect cross-border sales in neighbouring states where flavoured and menthol cigarettes were sold. ^{70 , 71}

A comprehensive flavour ban in San Francisco applied to all products, all retailers and all flavours, including menthol. Two studies have evaluated the outcomes of this ban with differing results. In 2020, a survey of 247 people who previously used tobacco products found small reductions in the proportion of people aged 18–34 years who used flavoured products, but the ban was not supported by 66% of people and non-compliance was reported, where flavoured products remained easy to obtain despite the ban. ⁷² This increase in cigarette smoking may have been influenced by the recent outbreak of EVALI among e-cigarette users (a respiratory illness linked to vaping—see Section 18.6.5). However, a later study of weekly retail sales data (July 2015 through December 2019) showed that the predicted average weekly flavoured tobacco sales fell by 96% from before the policy to after enforcement. In the neighbouring Californian town of San Jose the average weekly flavoured tobacco sales did not fall, and it fell by only 10% in San Diego (500 miles further south) over the same time period. ⁷³

Canada

Unlike the European Union and the United States, Canada’s 2009 flavour ban included any flavouring additive, not just characterising flavours. The federal legislation banned sales of cigarettes, little cigars (1.4 g or less) and blunt wraps with any flavouring additives, aside from menthol. ¹⁴

After coming into effect in July 2010, these laws had immediate effects, particularly on the use of cigars. ^{30 , 74 , 75} In the time period of 2008 to 2009, 17.5% of people in the Canadian Student Tobacco, Alcohol and Drugs Survey report cigar use in the past 30 days. This proportion dropped in each successive survey (every two years) to 4.9% on 2018 and 2019, nine years after the ban came into effect. ³⁰ Reported use of little cigars reportedly declined after the ban, (by December 2011) as well as a net reduction in all cigar use by people aged 15 to 24 years. ⁷⁵ Past-30 day use of little cigars dropped from 13.7% to 9.5% for males and from 5.3% to 3.3% for females in this age group. ⁷⁵

To assess the effects of the ban on cigar sales, the wholesale quarterly data for cigar sales were analysed from 2004 to 2016. ⁷⁴ After the flavour ban there was an overall decline in sales of all cigars by 49.6 million units. Sales of flavoured cigars fell by 59 million units. Although there was an overall decline in cigar sales, a slight increase was noted (9.6 million units), in the sale of cigars with other descriptors, such as colours and other ambiguous terms. ⁷⁴

After the Canadian flavour ban, there was no credible indication of an increase in illicit tobacco sales. ³⁰ The number of seized illicit cigarettes in the province of Nova Scotia decreased between 2007-08 (prior to the ban) and 2017-18 (after the ban). ⁷⁶

Singapore

Singapore is a country with high prevalence of use of flavoured or menthol tobacco products and a ban on fruity flavours only in waterpipe tobacco. ¹⁴ A flavour ban in Singapore is predicted to decrease total smoking rates, but would be more effective if all flavours are included. ⁷⁷ A modelling study predicts that a partial ban (excluding menthol and clove flavours that are popular in Singapore ^{78 , 79} ) would stabilise smoking rates at 12.5%, avoiding a predicted increase to 15.2% in 50 years without a ban. A full ban, that includes menthol and clove flavours, was predicted to decrease smoking prevalence to 10.6% over the next 50 years. ⁷⁷

12.6.12.4 Tobacco industry responses to and unintended consequences of flavour regulation

United States

Unintended consequences of the US flavour ban include a rise in use of other flavoured products such as flavoured cigars, e-cigarettes, smokeless tobacco and waterpipes, as well as a shift towards using exempted mentholated products on the market. ^{34 , 80} Under the 2009 flavoured cigarette ban the sale of kreteks, which are clove-flavoured cigarettes from Indonesia, was no longer permitted. In response, one kretek company started production of a clove flavoured cigar. These cigars are now sold in the US and have increased considerably in popularity since the ban in 2009. ⁸¹ The rise in popularity of alternative tobacco products with characterising flavours indicates that flavour regulation would be more effective if it covered a wider range of tobacco product types.

Canada

Banning flavoured little cigars was an important step for tobacco regulators in Canada. These products appear similar to cigarettes as they are a similar size and contain a filter. Sales of little cigars had risen considerably from 2001 to 2008 with flavoured products being most popular. A substantial proportion of young smokers used flavoured little cigars in 2008. To ensure the 2009 amendment banning flavours included little cigars, these products (in a wide variety of flavours and colourful packaging) were shown to elected representatives who were mostly unaware of their existence on the market. ^{30 , 82} The original legislation in 2009 banned flavoured little cigars of 1.4 g and smaller. Very soon after the amendment was implemented, manufacturers increased the size of their products to circumvent the ban. This loophole was addressed by the 2015 amendment that widened the regulation to most cigars. ⁸²

Brazil

Tobacco companies used a range of tactics to challenge RDC 14/2012 and have successfully delayed this regulation, despite none of their arguments having a sound scientific basis. ²⁵ Their challenges have included instigating demonstrations by tobacco farming front groups, media articles, litigation, lobbying, and industry-commissioned studies questioning the rationales for legislation. ²⁶ Industry claims have included a potential risk in the illicit tobacco market, a loss of farmers’ jobs, the World Health Organization acting beyond its mandate, prevention of growing Burley tobacco, a lack of evidence that a ban would reduce smoking, and that such a ban is illegal. ²⁵

References 

1. World Health Organization. WHO framework convention on tobacco control. Geneva: WHO, 2003. Available from: https://fctc.who.int/who-fctc/overview.

2. World Health Organization. Report on the scientific basis of tobacco product regulation: Seventh report of a WHO study group. Geneva: WHO, 2019. Available from: https://www.who.int/publications/i/item/who-study-group-on-tobacco-product-regulation-report-on-the-scientific-basis-of-tobacco-product-regulation-seventh-report-of-a-who-study-group.

3. World Health Organization. Partial guidelines for implementation of articles 9 and 10 of the WHO framework convention on tobacco control.  2017. Available from: https://fctc.who.int/publications/m/item/regulation-of-the-contents-of-tobacco-products-and-regulation-of-tobacco-product-disclosures.

4. European Commission. Independent advisory panel on characterising flavours in tobacco products.  Available from: https://health.ec.europa.eu/tobacco/product-regulation/determination-characterising-flavours-tobacco-products/independent-advisory-panel-characterising-flavours-tobacco-products_en.

5. World Health Organization. The scientific basis for product regulation. Technical Report Series, 945.Geneva: World Health Organisation, 2007. Available from: https://www.who.int/publications/i/item/the-scientific-basis-of-tobacco-product-regulation-report-of-a-who-study-group.

6. Minaker LM, Shuh A, Burkhalter RJ, and Manske SR. Hookah use prevalence, predictors, and perceptions among Canadian youth: Findings from the 2012/2013 youth smoking survey. Cancer Causes Control, 2015; 26(6):831-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25783457

7. Kienhuis AS and Talhout R. Options for waterpipe product regulation: A systematic review on product characteristics that affect attractiveness, addictiveness and toxicity of waterpipe use. Tobacco Induced Diseases, 2020; 18:69. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32934615

8. World Health Organization. 2021 global progress report on implementation of the who framework convention on tobacco control. Geneva: WHO, 2022. Available from: https://fctc.who.int/publications/i/item/9789240041769.

9. Tobacco control laws. Legislation. Find legislation from 212 countries and FCTC analysis of 136 countries.  Available from: https://www.tobaccocontrollaws.org/legislation.

10. Republic of Cape Verde. Law no. 8/x/2022 defining the general regime for the prevention and control of smoking, 2022. Available from: https://www.tobaccocontrollaws.org/legislation/cabo-verde/cigarette-contents.

11. Republic of the Congo. Order no. 2853 of May 31, 2022 banning the manufacture, import, distribution, possession, sale or giveaway of flavor capsule cigarettes, cigarettes with characterizing flavors, and shisha, 2022, Official Gazette of the Republic of the Congo. Available from: https://www.tobaccocontrollaws.org/legislation/congo/cigarette-contents?row=1224817.

12. Tobacco Control Directive. No 28/2015. Ethiopian food, medicine and healthcare administration and control authority.  2015. Available from: https://www.tobaccocontrollaws.org/legislation/ethiopia/laws

13. Islamic Republic of Mauritania. Law no. 2018-020 concerning the production, importation, distribution, sale, advertising, promotion and tobacco consumption and its products, 2018. Available from: https://www.tobaccocontrollaws.org/legislation/mauritania/laws.

14. Erinoso O, Clegg Smith K, Iacobelli M, Saraf S, Welding K, et al. Global review of tobacco product flavour policies. Tobacco Control, 2020; 30(4):373-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32414867

15. Public health (restrictions on tobacco products) regulations 2022. Available from: https://www.tobaccocontrollaws.org/legislation/mauritius/cigarette-contents?row=1226187.

16. Republic of Niger. Ministry of trade and private sector promotion order no. 082 of october 9, 2017. Prohibiting the import, distribution and sale of tobacco products containing flavors. Available from: https://www.tobaccocontrollaws.org/legislation/niger/cigarette-contents.

17. Nigerian industrial standard (NIS) 463:2018, standard for tobacco and tobacco products - specifications for cigarettes, 2018. Available from: https://www.tobaccocontrollaws.org/legislation/nigeria/cigarette-contents?row=1226402.

18. Republic of Senegal Decree. No. 2016- 1008 concerning the implementation of law no. 2014-14 manufacture, packaging, labeling, sale and use of tobacco. Available from: https://www.tobaccocontrollaws.org/legislation/senegal/cigarette-contents.

19. Tobacco and nicotine control act, 2022, 2023. Available from: https://www.tobaccocontrollaws.org/legislation/sierra-leone/cigarette-contents?row=1331056.

20. Tobacco control regulations (s.I. 2019 no.66), 2019: The Uganda Gazelle Available from: https://www.tobaccocontrollaws.org/legislation/uganda/cigarette-contents.

21. Antigua and Barbuda tobacco control act 2018, 2018, The Official Gazette Vol. XXXVIII No.No. 69. Available from: https://www.tobaccocontrollaws.org/legislation/antigua-and-barbuda/cigarette-contents?row=1240029.

22. Agência Nacional De Vigilância Sanitária (ANVISA – National Health Surveillance Agency). Collegiate directorate resolution- rdc n° 14. Diário oficial da união – section 1 - n° 53 (translated).  Available from: https://docs.bvsalud.org/leisref/2018/08/1497/bra_2012_w_anvisa_resolution_rdc_14_en.pdf

23. Tobacco Control Laws. Legislation by country: Brazil. Regulated contents in cigarettes.  2019. Available from: https://www.tobaccocontrollaws.org/legislation/country/brazil/cd-regulated.

24. Kyriakos CN, Fong GT, de Abreu Perez C, Szklo AS, Driezen P, et al. Brazilian smokers are ready for the ban on flavour additives in tobacco to be implemented. Preventive Medicine, 2022; 160:107074. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35550839

25. Oliveira da Silva AL, Bialous SA, Albertassi PGD, Arquete D, Fernandes A, et al. The taste of smoke: Tobacco industry strategies to prevent the prohibition of additives in tobacco products in Brazil. Tobacco Control, 2019; 28(e2):e92-e101. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31152115

26. Tobacco Tactics. Flavoured and menthol tobacco.  2022. Available from: https://tobaccotactics.org/wiki/flavoured-and-menthol-tobacco/#:~:text=The%20Ministry%20of%20Health%20in,an%20existing%20law%20in%202013.

27. Parliament of Canada. Bill c-32 an act to amend the tobacco act, chapter 27 of the statutes of Canada, 2009. Available from: http://www.parl.ca/DocumentViewer/en/40-2/bill/C-32/royal-assent.

28. Government of Canada. Order amending the schedule to the tobacco act (menthol). Canada Gazette, 2017. Available from: https://canadagazette.gc.ca/rp-pr/p2/2017/2017-04-05/html/sor-dors45-eng.html.

29. World Health Organization (WHO). Case studies for regulatory approaches to tobacco products: Menthol in tobacco products. WHO/NMH/PND, 18.1 Licence: CC BY-NC-SA 3.0 IGO. 2018. Available from: https://www.who.int/publications/i/item/case-studies-for-regulatory-approaches-to-tobacco-products-menthol-in-tobacco-products.

30. Chaiton MO, Cunningham R, Hagen L, Dubray J, and Borland T. Taking global leadership in banning menthol and other flavours in tobacco: Canada's experience. Tobacco Control, 2022; 31(2):202-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35241589

31. Flavour bans on tobacco products in Canada and selected other jurisdictions. Regulatory update: Physicians for a Smoke-Free Canada, 2020. Available from: https://www.smoke-free.ca/SUAP/2020/Menthol%20bans.pdf.

32. U.S. FDA. Section 907 of the federal food, drug, and cosmetic act - tobacco product standards.  2018. Available from: https://www.fda.gov/TobaccoProducts/Labeling/RulesRegulationsGuidance/ucm263053.htm

33. Bach L. States & localities that have restricted the sale of flavored tobacco products. . Campaign for Tobacco-Free Kids, 2022. Available from: https://www.tobaccofreekids.org/assets/factsheets/0398.pdf.

34. Food & Drug Administration. FDA commits to evidence-based actions aimed at saving lives and preventing future generations of smokers.  2021. Available from: https://www.fda.gov/news-events/press-announcements/fda-commits-evidence-based-actions-aimed-saving-lives-and-preventing-future-generations-smokers.

35. FDA proposes rules prohibiting menthol cigarettes and flavored cigars to prevent youth initiation, significantly reduce tobacco-related disease and death. Food and Drug Administration, 2022. Available from: https://www.fda.gov/news-events/press-announcements/fda-proposes-rules-prohibiting-menthol-cigarettes-and-flavored-cigars-prevent-youth-initiation

36. Food & Drug Administration. Tobacco product standard for menthol in cigarettes.  2022. Available from: https://public-inspection.federalregister.gov/2022-08994.pdf.

37. Jordan Standards and Metrology Organization. Technical regulation js 446:2012 (5th ed.), tobacco and tobacco products - cigarettes, 2012. Available from: https://www.tobaccocontrollaws.org/legislation/jordan/cigarette-contents?row=1225843.

38. European Union. Directive 2014/40/eu of the European Parliament and of the council, in (April):1-382014, Official Journal of the European Union. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32014L0040.

39. Tobacco Tactics. Menthol cigarettes: Industry interference in the EU and UK.  2021. Available from: https://tobaccotactics.org/wiki/menthol-interference-eu-uk/.

40. Finland tightens tobacco laws. Tobacco reporter, 2022. Available from: https://tobaccoreporter.com/2022/05/03/finland-tightens-tobacco-laws/.

41. Ministry of Social Affairs and Health. Tobacco act (no. 549/2016; amendments up to 1374/2016 included). Available from: https://www.tobaccocontrollaws.org/legislation/finland/cigarette-contents?row=1225255.

42. Verordnung über tabakerzeugnisse und verwandte erzeugnisse (tabakerzeugnisverordnung - tabakerzv), 2016. Available from: https://assets.tobaccocontrollaws.org/uploads/legislation/Germany/Germany-Tobacco-Products-Ordinance-2016-national.pdf.

43. German Federal Institute for Risk Assessment. No more menthol in cigarettes and smoking tobacco.  2020. Available from: https://www.bfr.bund.de/en/press_information/2020/19/no_more_menthol_in_cigarettes_and_smoking_tobacco-246948.html.

44. Bundesverband der Tabakwirtschaft und neuartiger Erzeugnisse. Ingredients.  Available from: https://www.bvte.de/en/themes/ingredients.html

45. Ciurcanu A and Cerantola A. Japan tobacco international making a mint by circumventing menthol cigarette ban. Organised Crime and Corruption Reporting Project (OCCRP),  2021. Available from: https://www.occrp.org/en/investigations/japan-tobacco-international-making-a-mint-by-circumventing-menthol-cigarette-ban

46. Republic of Moldova. Law no. 278 dated 12/14/2007 concerning tobacco control* amended lp97 dated 7/26/19, og 256-259/ 8/16/19 art. 350; effective date: 1/1/20. Available from: https://assets.tobaccocontrollaws.org/uploads/legislation/Moldova/Moldova-TC-Law-as-amended.pdf

47. Tobacco Control Legal Consortium. How other countries regulate flavored tobacco products.  2015. Available from: https://www.publichealthlawcenter.org/sites/default/files/resources/tclc-fs-global-flavored-regs-2015.pdf.

48. Regulation on the procedures and principles related to the production methods, labeling and surveillance of tobacco products. Available from: https://www.tobaccocontrollaws.org/legislation/turkey/cigarette-contents.

49. Tobacco and related products regulations 2016 (s.I. 2016 no. 507). Available from: https://www.tobaccocontrollaws.org/legislation/england/cigarette-contents.

50. Singapore Statutes Online. Tobacco (control of advertisements and sale) act (prohibited tobacco products) regulations 2014. Singapore Government, 2014. Available from: https://sso.agc.gov.sg/SL/TCASA1993-S769-2014?DocDate=20180131.

51. The Gazette of the Democratic Socialist Republic of Sri Lanka. Prohibited tobacco products regulations, no. 1 of 2016, 2016. Available from: https://www.tobaccocontrollaws.org/legislation/sri-lanka/cigarette-contents?row=1227153.

52. European Commission. Directive 2014/40/eu of the european parliament and of the council of 3 april 2014 on the approximation of the laws, regulations and administrative provisions of the member states concerning the manufacture, presentation and sale of tobacco and related products and repealing directive 2001/37/ec., Document 32014L0040.Brussels, Belgium: European Commission, 2014. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex:32014L0040.

53. European Network for Smoking and Tobacco Prevention. Ban on menthol cigarettes: European union member states shall prohibit the placing on the market of tobacco products with a characterising flavour. Tobacco Prevention & Cessation, 2020; 6:40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33083673

54. Campaign for tobacco Free Kids. Impact of restricting the sale of flavored tobacco products: The Massachusetts experience.  2023. Available from: https://assets.tobaccofreekids.org/factsheets/0421.pdf.

55. Asare S, Majmundar A, Westmaas JL, Bandi P, Xue Z, et al. Association of cigarette sales with comprehensive menthol flavor ban in Massachusetts. JAMA Internal Medicine, 2022; 182(2):231-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34982100

56. Campaign for Tobacco Free Kids. States and localities that have restricted the sale of flavored tobacco products.  2022. Available from: https://assets.tobaccofreekids.org/factsheets/0398.pdf.

57. Ballotpedia. California proposition 31, flavored tobacco products ban referendum (2022).  2022. Available from: https://ballotpedia.org/California_Proposition_31,_Flavored_Tobacco_Products_Ban_Referendum_(2022).

58. Myers ML. Big win for kids: U.S. House approves bill to reverse youth e-cigarette epidemic, prohibit flavored tobacco products. Campaign for Tobacco-Free Kids, 2020. Available from: https://www.tobaccofreekids.org/press-releases/2020_02_28_pallone.

59. Congress.gov. H.R.2339 - protecting american lungs and reversing the youth tobacco epidemic act of 2020.  2022. Available from: https://www.congress.gov/bill/116th-congress/house-bill/2339.

60. Gee RE. Shortcomings of the food and drug administration guidance addressed by congress 2020 hr 2339. American Journal of Public Health, 2020; 110(6):776-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32374703

61. Australian Government Department of Health and Aged Care. Ten years of world-leading reforms and reigniting the fight against tobacco addiction. Canberra, Australia: Australian Government, 2022. Available from: https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/ten-years-of-world-leading-reforms-and-reigniting-the-fight-against-tobacco-addiction.

62. Agência Nacional de Vigilância Sanitária. Resolution - rdc nº 14, of March 15, 2012. Tobacco Control Laws, 2012. Available from: https://assets.tobaccocontrollaws.org/uploads/legislation/Brazil/Brazil-RDC-No.-142012.pdf.

63. Ethiopian Food Medicine and Healthcare Administration and Control Authority. Tobacco control directive.  2015. Available from: https://assets.tobaccocontrollaws.org/uploads/legislation/Ethiopia/Ethiopia-Tobacco-Ctrl.-Dir.-No.-282015-native.pdf.

64. Zatonski M, Herbec A, Zatonski W, Janik-Koncewicz K, Driezen P, et al. Cessation behaviours among smokers of menthol and flavoured cigarettes following the implementation of the EU tobacco products directive: Findings from the eurest-plus itc europe surveys. European Journal of Public Health, 2020; 30(Suppl_3):iii34-iii7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32918816

65. Rossheim ME, Livingston MD, Krall JR, Barnett TE, Thombs DL, et al. Cigarette use before and after the 2009 flavored cigarette ban. Journal of Adolescent Health, 2020; 67(3):432-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32674967

66. Courtemanche CJ, Palmer MK, and Pesko MF. Influence of the flavored cigarette ban on adolescent tobacco use. American Journal of Preventive Medicine, 2017; 52(5):e139-e46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28081999

67. Farley SM and Johns M. New York City flavoured tobacco product sales ban evaluation. Tobacco Control, 2017; 26(1):78-84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26872486

68. Hawkins SS, Kruzik C, O'Brien M, and Levine Coley R. Flavoured tobacco product restrictions in Massachusetts associated with reductions in adolescent cigarette and e-cigarette use. Tobacco Control, 2022; 31(4):576-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33504582

69. Asare S, Xue Z, Bandi P, Westmaas JL, Jemal A, et al. Association of nicotine replacement therapy product sales with menthol cigarette sales restriction in Massachusetts. Tobacco Control, 2023. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37160349

70. Ali FRM, King BA, Seaman EL, Vallone D, and Schillo B. Impact of Massachusetts law prohibiting flavored tobacco products sales on cross-border cigarette sales. PloS One, 2022; 17(9):e0274022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36099316

71. Kingsley M, McGinnes H, Song G, Doane J, and Henley P. Impact of Massachusetts' statewide sales restriction on flavored and menthol tobacco products on tobacco sales in Massachusetts and surrounding states, June 2020. American Journal of Public Health, 2022; 112(8):1147-50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35830660

72. Yang Y, Lindblom EN, Salloum RG, and Ward KD. The impact of a comprehensive tobacco product flavor ban in San Francisco among young adults. Addictive behaviors reports, 2020; 11:100273. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32368612

73. Gammon DG, Rogers T, Gaber J, Nonnemaker JM, Feld AL, et al. Implementation of a comprehensive flavoured tobacco product sales restriction and retail tobacco sales. Tobacco Control, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34088881

74. Chaiton MO, Schwartz R, Tremblay G, and Nugent R. Association of flavoured cigar regulations with wholesale tobacco volumes in Canada: An interrupted time series analysis. Tobacco Control, 2019; 28(4):457-61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30135113

75. Nguyen HV and Grootendorst P. Intended and unintended effects of restrictions on the sale of cigarillos to youth: Evidence from Canada. Tobacco Control, 2015; 24(4):382-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24610053

76. Stoklosa M. No surge in illicit cigarettes after implementation of menthol ban in Nova Scotia. Tobacco Control, 2019; 28(6):702-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30309981

77. Zeng Z, Cook AR, Chen JI, and van der Eijk Y. Evaluating the public health impact of partial and full tobacco flavour bans: A simulation study. The Lancet Regional Health – Western Pacific, 2022; 21:100414. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35252911

78. Soeparna (The Jakarta Post) I. An unseen threat to 'kretek', symbol of culture and history. The Jakarta Post, 2016. Available from: https://www.thejakartapost.com/academia/2016/08/01/an-unseen-threat-to-kretek-symbol-of-culture-and-history.html.

79. van der Eijk Y, Lee JK, and P ML. How menthol is key to the tobacco industry's strategy of recruiting and retaining young smokers in Singapore. Journal of Adolescent Health, 2019; 64(3):347-54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30392860

80. Corey CG, Ambrose BK, Apelberg BJ, and King BA. Flavored tobacco product use among middle and high school students--United States, 2014. The Morbidity and Mortality Weekly Report, 2015; 64(38):1066-70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26421418

81. Delnevo CD and Hrywna M. Clove cigar sales following the US flavoured cigarette ban. Tobacco Control, 2015; 24(e4):e246-50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24652459

82. Lencucha R, Ruckert A, Labonte R, and Drope J. Opening windows and closing gaps: A case analysis of Canada's 2009 tobacco additives ban and its policy lessons. BMC Public Health, 2018; 18(1):1321. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30486817