Flavored Tobacco
(Re)Move the Mint: The Case for Banning Menthol and other flavored tobacco
STACEY GAGOSIAN | DIRECTOR, PUBLIC POLICY | SEPTEMBER 16, 2016
Disclosures and Acknowledgements
Disclosures • I have no disclosures or financial relationships to report
Acknowledgements • Andrea Villanti, PhD, MPH, CHES
Overview • Flavored tobacco, including menthol cigarettes, impacts tobacco initiation, escalation and cessation • The evidence shows that the presence of menthol cigarettes slows progress in tobacco control • There is urgency to act now on menthol • Action on flavors, especially menthol, is a bold policy move that can have significant impact on public health
The Tobacco Control Act
Flavored cigarettes banned – sept. 2009
Flavors play a strong role in tobacco use
Past 30-day tobacco use among high school students 20%
21.7%
19.7%
19.5% 17.7%
Any Combustible Use (NYTS)
15.8% 15%
14.0%
Prevalence
12.7%
13.4%
Cigarettes (NYTS)
9.2%
10%
E-Cigarettes (NYTS)
4.5%
5%
4.4%
2.8% 1.5% 0%
0.1% 2011
0.2% 2012
Exclusive E-Cigarette Use (NYTS) 0.6% 2013
2014 7
Source: National Youth Tobacco Survey, 2011 - 2014.
A Spoonful of Sugar…
Photo Source: http://www.dailymail.co.uk/h ealth/article-1058406/Aspoonful-sugar-reallyDOES-help-medicine-sayscientists.html
Flavored Tobacco 2014 NYTS:
Source: C.G. Corey, B.K. Ambrose, B.J. Apelberg, B.A. King; Flavored tobacco product use among middle and high school students—United States, 2014; MMWR. Morbidity and Mortality Weekly Report, 64 (38) (2015), pp. 1066–1070
Flavored Tobacco Proportion of Flavored tobacco use among Past 30-day Youth Tobacco users
Proportion of Ever users reporting first product used was flavored 100 90 80 70 60 50 40 30 20 10 0
100 90 80 70 60 50 40 30 20 10 0
Ever-Users
80% used flavored products
Past 30-day users
79.8% used flavored products
Source: B.K. Ambrose, H.R. Day, B. Rostron, et al. Flavored tobacco product use among US youth aged 12–17 years, 2013–2014. Journal of the American Medical Association, 314 (17) (2015), pp. 1871–1873
Past 30-day regular and flavored little cigar prevalence Flavored Little Cigars
14
Regular Little Cigars 11.9
12
11.4
Percent %
10 7.8
8
7
6.9
6.1 6 4.4
4.1 4
4.1 3.3
3.8
2.5 2 0
8th Grade 10th Grade 12th Grade
2014
8th Grade 10th Grade 12th Grade
2015 11
Source: Monitoring the Future, 2015
Flavors Are a Reason Youth Use Tobacco
12
Flavored Tobacco
Flavored Tobacco
8,000 flavors of ENDS
Menthol is slowing progress in tobacco control : The Evidence
Progress has been made with Cigarettes Current smoking prevalence among all U.S. Adults, 2015: 15.1%
Current smoking prevalence among all U.S. 12th Graders, 2015: 11.4%
45
Prevalence of past 30-day cigarette use
45
40 Prevalence of current smoking (%)
40
35
35 30
30
25
25
20 15
20
10
15
5
10
0
5 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Year
Source: National Health Interview Survey. http://www.cdc.gov/tobacco/data_statistics/index.htm
1975 1980 1985 1990 1995 2000 2005 2010 2015
Year Source: Monitoring the Future. http://monitoringthefuture.org/pressreleases/15Ecigtbl.pdf
Cigarette smoking is still a major problem The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products. • Smoking accounts for 480,000 deaths annually in the U.S. • ~1,300 smoking-related deaths per day • 5.6 million of today’s youth expected to die prematurely from smoking U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. January 2014.
Menthol use Proportion of Flavored tobacco use among Past 30-day Youth Tobacco users
Proportion of Ever users reporting first product used was flavored 100 90 80 70 60 50 40 30 20 10 0
100 90 80 70 60 50 40 30 20 10 0
Ever-Users
50% of ever cigarettes users used a menthol cigarette the first time they tried smoking
Past 30-day users
59.8% of current smokers were using menthol cigarettes
Source: B.K. Ambrose, H.R. Day, B. Rostron, et al. Flavored tobacco product use among US youth aged 12–17 years, 2013–2014. Journal of the American Medical Association, 314 (17) (2015), pp. 1871–1873
Youth and Young Adults are More Likely to Use Menthol 70
Prevalence (%)
60 50 40 30 20 10 0 12-17
18-25
26-34 35-49 50+ Age group Adjusted prevalence of use of menthol cigarettes among past 30-day smokers – United States, 2008-2010 Giovino GA, et al. Tob Control. 2015;24(1):28-37.
Menthol cigarette use is high in Black smokers across all ages
Prevalence (%)
Blacks
Overall
100 90 80 70 60 50 40 30 20 10 0 12-17
18-25
26-34 Age
Giovino GA, et al. Tob Control. 2015;24(1):28-37.
35-49
50+
Youth and Young Adult Menthol Use Over Time • Non-menthol cigarette use declined in all age groups from 20042010 • Menthol cigarette use remained constant in adolescents and adults ages 26+ from 2004-2010.
Giovino GA, et al. Tob Control. 2015;24(1):28-37.
• Menthol cigarette use increased in young adults ages 18-25 during this time.
Cigarette consumption in the U.S.
Delnevo CD, et al. Tob Control. 2014;23(e2):e154-155.
Menthol Cigarettes increase escalation to regular smoking Initiation with menthol cigarettes was associated with … • 80% increased odds of escalating to established smoking • Higher levels of nicotine dependence
Source: Nonnemaker J et al. Addiction. 2013;108(1):171-178.
Current menthol cigarette use … Nearly doubled the odds of increased smoking behavior in a national sample of young adults.
Source: Delnevo CD, et al. Tob Control. 2015; Epub ahead of print, August 4.
Effect of menthol cigarettes on smoking cessation •
Menthol smokers are more likely to make quit attempts, but less likely to quit successfully.
•
Quit success in the past 5 years was further eroded among mentholsmoking Blacks and young adults.
Source: Levy DT, et al. Am J Public Health. Jul 2011;101(7):1241-1247.
•
Adult menthol smokers were: • Less likely to quit successfully (short-term or long-term) • This was more pronounced among Black and Puerto Rican smokers
Source: Delnevo CD, et al. Am J Prev Med. 2011;41(4):357-365.
Scientific reviews support action on menthol in cigarettes • TPSAC Report on menthol (March 2011) • FDA Preliminary Scientific Evaluation (August 2011) • FDA Reference Addendum (July 2013) • Truth Initiative reviews (2010, 2013, and coming in 2017) “Removal of menthol cigarettes from the marketplace would benefit public health in the United States.” - TPSAC Report, 2011 2 5
Summary: Menthol’s impact on smoking rates
What’s the Urgency?
Why action on menthol now?
Reynolds American Inc. on Tuesday reported a 42% increase in firstquarter sales, driven by last year’s $25 billion acquisition of Lorillard Inc. and its Newport cigarette brand.
Menthol gaining market share
“Newport… has been the only major brand consistently gaining share of the shrinking cigarette market over the past decade. Its minty, menthol style has gained in popularity among millennials, who have shown a preference for more flavorful options.” “Reynolds earmarked about $50 million this year to promote the brand at events and bars, according to a former executive who worked on Newport. It also is peddling the brand through a 2,300person sales force—nearly double the size of Lorillard’s.” Newport’s rate of market share growth has nearly doubled over the past year to approximately one half of a share point, and its U.S. market share has increased to 13.9% from 13.4% last June, according to Reynolds.
Menthol cigarettes and population health Table 1. Smoking-attributable deaths and deaths averted if menthol is banned under three scenarios (10%, 20% and 30% change in initiation and cessation), projected from 2010-2050: Total population and African American population
2010
2020
2030
2040
2050
TOTAL SADs
TOTAL DEATHS AVERTED
Total population Status quo
386,732 410,809 399,028 342,472 272,424 1,811,465
10% change
386,732 406,046 388,347 331,117 262,574 1,488,358
323,107
20% change
386,732 402,568 382,621 326,799 259,002 1,333,311
478,154
30% change
386,732 399,091 376,893 322,478 255,424 1,178,214
633,252
African Americans Status quo
53,836 57,056 53,382 45,022 37,475
246,771
10% change
53,836 55,234 50,086 42,175 35,320
155,027
91,744
20% change
53,836 53,706 47,562 40,044 33,340
82,306
164,465
30% change
53,836 52,177 45,036 37,908 31,347
9,454
237,317
Source: Levy DT, et al. Am J Public Health. 2011;101(7):1236-1240.
Thank you
[email protected]
STACEY GAGOSIAN | DIRECTOR, PUBLIC POLICY | SEPTEMBER 16, 2016
Disclosures and Acknowledgements
Disclosures • I have no disclosures or financial relationships to report
Acknowledgements • Andrea Villanti, PhD, MPH, CHES
Overview • Flavored tobacco, including menthol cigarettes, impacts tobacco initiation, escalation and cessation • The evidence shows that the presence of menthol cigarettes slows progress in tobacco control • There is urgency to act now on menthol • Action on flavors, especially menthol, is a bold policy move that can have significant impact on public health
The Tobacco Control Act
Flavored cigarettes banned – sept. 2009
Flavors play a strong role in tobacco use
Past 30-day tobacco use among high school students 20%
21.7%
19.7%
19.5% 17.7%
Any Combustible Use (NYTS)
15.8% 15%
14.0%
Prevalence
12.7%
13.4%
Cigarettes (NYTS)
9.2%
10%
E-Cigarettes (NYTS)
4.5%
5%
4.4%
2.8% 1.5% 0%
0.1% 2011
0.2% 2012
Exclusive E-Cigarette Use (NYTS) 0.6% 2013
2014 7
Source: National Youth Tobacco Survey, 2011 - 2014.
A Spoonful of Sugar…
Photo Source: http://www.dailymail.co.uk/h ealth/article-1058406/Aspoonful-sugar-reallyDOES-help-medicine-sayscientists.html
Flavored Tobacco 2014 NYTS:
Source: C.G. Corey, B.K. Ambrose, B.J. Apelberg, B.A. King; Flavored tobacco product use among middle and high school students—United States, 2014; MMWR. Morbidity and Mortality Weekly Report, 64 (38) (2015), pp. 1066–1070
Flavored Tobacco Proportion of Flavored tobacco use among Past 30-day Youth Tobacco users
Proportion of Ever users reporting first product used was flavored 100 90 80 70 60 50 40 30 20 10 0
100 90 80 70 60 50 40 30 20 10 0
Ever-Users
80% used flavored products
Past 30-day users
79.8% used flavored products
Source: B.K. Ambrose, H.R. Day, B. Rostron, et al. Flavored tobacco product use among US youth aged 12–17 years, 2013–2014. Journal of the American Medical Association, 314 (17) (2015), pp. 1871–1873
Past 30-day regular and flavored little cigar prevalence Flavored Little Cigars
14
Regular Little Cigars 11.9
12
11.4
Percent %
10 7.8
8
7
6.9
6.1 6 4.4
4.1 4
4.1 3.3
3.8
2.5 2 0
8th Grade 10th Grade 12th Grade
2014
8th Grade 10th Grade 12th Grade
2015 11
Source: Monitoring the Future, 2015
Flavors Are a Reason Youth Use Tobacco
12
Flavored Tobacco
Flavored Tobacco
8,000 flavors of ENDS
Menthol is slowing progress in tobacco control : The Evidence
Progress has been made with Cigarettes Current smoking prevalence among all U.S. Adults, 2015: 15.1%
Current smoking prevalence among all U.S. 12th Graders, 2015: 11.4%
45
Prevalence of past 30-day cigarette use
45
40 Prevalence of current smoking (%)
40
35
35 30
30
25
25
20 15
20
10
15
5
10
0
5 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Year
Source: National Health Interview Survey. http://www.cdc.gov/tobacco/data_statistics/index.htm
1975 1980 1985 1990 1995 2000 2005 2010 2015
Year Source: Monitoring the Future. http://monitoringthefuture.org/pressreleases/15Ecigtbl.pdf
Cigarette smoking is still a major problem The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products. • Smoking accounts for 480,000 deaths annually in the U.S. • ~1,300 smoking-related deaths per day • 5.6 million of today’s youth expected to die prematurely from smoking U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. January 2014.
Menthol use Proportion of Flavored tobacco use among Past 30-day Youth Tobacco users
Proportion of Ever users reporting first product used was flavored 100 90 80 70 60 50 40 30 20 10 0
100 90 80 70 60 50 40 30 20 10 0
Ever-Users
50% of ever cigarettes users used a menthol cigarette the first time they tried smoking
Past 30-day users
59.8% of current smokers were using menthol cigarettes
Source: B.K. Ambrose, H.R. Day, B. Rostron, et al. Flavored tobacco product use among US youth aged 12–17 years, 2013–2014. Journal of the American Medical Association, 314 (17) (2015), pp. 1871–1873
Youth and Young Adults are More Likely to Use Menthol 70
Prevalence (%)
60 50 40 30 20 10 0 12-17
18-25
26-34 35-49 50+ Age group Adjusted prevalence of use of menthol cigarettes among past 30-day smokers – United States, 2008-2010 Giovino GA, et al. Tob Control. 2015;24(1):28-37.
Menthol cigarette use is high in Black smokers across all ages
Prevalence (%)
Blacks
Overall
100 90 80 70 60 50 40 30 20 10 0 12-17
18-25
26-34 Age
Giovino GA, et al. Tob Control. 2015;24(1):28-37.
35-49
50+
Youth and Young Adult Menthol Use Over Time • Non-menthol cigarette use declined in all age groups from 20042010 • Menthol cigarette use remained constant in adolescents and adults ages 26+ from 2004-2010.
Giovino GA, et al. Tob Control. 2015;24(1):28-37.
• Menthol cigarette use increased in young adults ages 18-25 during this time.
Cigarette consumption in the U.S.
Delnevo CD, et al. Tob Control. 2014;23(e2):e154-155.
Menthol Cigarettes increase escalation to regular smoking Initiation with menthol cigarettes was associated with … • 80% increased odds of escalating to established smoking • Higher levels of nicotine dependence
Source: Nonnemaker J et al. Addiction. 2013;108(1):171-178.
Current menthol cigarette use … Nearly doubled the odds of increased smoking behavior in a national sample of young adults.
Source: Delnevo CD, et al. Tob Control. 2015; Epub ahead of print, August 4.
Effect of menthol cigarettes on smoking cessation •
Menthol smokers are more likely to make quit attempts, but less likely to quit successfully.
•
Quit success in the past 5 years was further eroded among mentholsmoking Blacks and young adults.
Source: Levy DT, et al. Am J Public Health. Jul 2011;101(7):1241-1247.
•
Adult menthol smokers were: • Less likely to quit successfully (short-term or long-term) • This was more pronounced among Black and Puerto Rican smokers
Source: Delnevo CD, et al. Am J Prev Med. 2011;41(4):357-365.
Scientific reviews support action on menthol in cigarettes • TPSAC Report on menthol (March 2011) • FDA Preliminary Scientific Evaluation (August 2011) • FDA Reference Addendum (July 2013) • Truth Initiative reviews (2010, 2013, and coming in 2017) “Removal of menthol cigarettes from the marketplace would benefit public health in the United States.” - TPSAC Report, 2011 2 5
Summary: Menthol’s impact on smoking rates
What’s the Urgency?
Why action on menthol now?
Reynolds American Inc. on Tuesday reported a 42% increase in firstquarter sales, driven by last year’s $25 billion acquisition of Lorillard Inc. and its Newport cigarette brand.
Menthol gaining market share
“Newport… has been the only major brand consistently gaining share of the shrinking cigarette market over the past decade. Its minty, menthol style has gained in popularity among millennials, who have shown a preference for more flavorful options.” “Reynolds earmarked about $50 million this year to promote the brand at events and bars, according to a former executive who worked on Newport. It also is peddling the brand through a 2,300person sales force—nearly double the size of Lorillard’s.” Newport’s rate of market share growth has nearly doubled over the past year to approximately one half of a share point, and its U.S. market share has increased to 13.9% from 13.4% last June, according to Reynolds.
Menthol cigarettes and population health Table 1. Smoking-attributable deaths and deaths averted if menthol is banned under three scenarios (10%, 20% and 30% change in initiation and cessation), projected from 2010-2050: Total population and African American population
2010
2020
2030
2040
2050
TOTAL SADs
TOTAL DEATHS AVERTED
Total population Status quo
386,732 410,809 399,028 342,472 272,424 1,811,465
10% change
386,732 406,046 388,347 331,117 262,574 1,488,358
323,107
20% change
386,732 402,568 382,621 326,799 259,002 1,333,311
478,154
30% change
386,732 399,091 376,893 322,478 255,424 1,178,214
633,252
African Americans Status quo
53,836 57,056 53,382 45,022 37,475
246,771
10% change
53,836 55,234 50,086 42,175 35,320
155,027
91,744
20% change
53,836 53,706 47,562 40,044 33,340
82,306
164,465
30% change
53,836 52,177 45,036 37,908 31,347
9,454
237,317
Source: Levy DT, et al. Am J Public Health. 2011;101(7):1236-1240.
Thank you
[email protected]
