Levy David T, Cadham Christopher, Mok Yoonseo, Travis Nargiz, Buszkiewicz James H, Jeon Jihyoun, Fleischer Nancy L, Meza Rafael
Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA.
Department of Health Managment and Policy, University of Michigan, Ann Arbor, MI, USA.
Nicotine Tob Res. 2025 Jan 22;27(2):333-341. doi: 10.1093/ntr/ntae173.
Half of adult cigar users report flavored cigars as their usual brand. The Food and Drug Administration proposed prohibiting "all characterizing flavors in cigars" and "menthol… in cigarettes." We provide evidence on cigar and cigarette transitions and a framework to assess the impact of a U.S. flavored cigar ban.
Using Population Assessment of Tobacco and Health survey waves 1-4, we estimated use patterns and annual transitions among flavored cigars, non-flavored cigars, cigarettes, and among adults aged 18-34 and aged ≥35. We also consider electronic nicotine delivery systems (ENDS)-related transitions. We developed a decision-theoretic framework for examining the impact of a flavored cigar ban alone, and the impact of a flavored cigar with a menthol cigarette ban with and without a non-tobacco flavored ENDS ban.
Cigar users exhibited less stable use than cigarette users, with a large portion of cigar users switching to cigarette use each year. Past studies provide limited information on transitions between cigar and ENDS use. Our policy framework suggests that imposing a flavored cigar ban alone may be partially undermined by the substitution of menthol cigarettes for flavored cigars. While adding a menthol cigarette to a flavored cigar ban is expected to improve public health, a simultaneously implemented ENDS may offset some of the gains.
Our analysis suggests the information necessary to gauge the public health impact of a cigar flavor ban alone and with flavor bans on cigarettes and ENDS. Further research is needed on ENDS vis-a'-vis cigar use, and the impact of enforcement and non-flavor-related policies on flavor ban effectiveness.
Unlike menthol cigarette use and menthol bans, flavored cigar use and flavored cigar bans have received minimal attention. Transitions from cigars, especially dual and flavored use, are generally common compared to cigarettes. Our policy framework suggests important public health impacts. A flavored cigar ban absent a menthol cigarette ban may be partially undermined by the substitution of menthol cigarettes for flavored cigars. Adding a menthol cigarette ban is expected to offset such substitution and improve public health. However, simultaneously adding an ENDS with a flavored cigar and menthol cigarette ban may reduce the public health impact of a menthol cigarette and cigar flavor ban since flavored cigar users would be less able to substitute a lower-risk alternative.
半数成年雪茄使用者表示，调味雪茄是他们常用的品牌。美国食品药品监督管理局提议禁止“雪茄中的所有特征风味”以及“香烟中的薄荷醇……”。我们提供了有关雪茄与香烟转变的证据以及一个框架，以评估美国禁止调味雪茄的影响。
利用烟草与健康人口评估调查的第1至4轮数据，我们估计了调味雪茄、非调味雪茄、香烟的使用模式以及18至34岁和35岁及以上成年人之间的年度转变情况。我们还考虑了与电子尼古丁传送系统（ENDS）相关的转变。我们开发了一个决策理论框架，用于研究单独禁止调味雪茄的影响，以及在有无非烟草风味ENDS禁令的情况下，禁止调味雪茄与薄荷醇香烟的综合影响。
雪茄使用者的使用稳定性低于香烟使用者，每年有很大一部分雪茄使用者转而使用香烟。以往的研究提供的关于雪茄与ENDS使用之间转变的信息有限。我们的政策框架表明，单独实施调味雪茄禁令可能会因薄荷醇香烟替代调味雪茄而部分受到削弱。虽然在调味雪茄禁令中加入薄荷醇香烟禁令有望改善公众健康，但同时实施ENDS禁令可能会抵消一些收益。
我们的分析表明，评估单独禁止雪茄风味以及同时禁止香烟和ENDS风味对公众健康影响所需的信息。关于ENDS与雪茄使用的关系，以及执法和非风味相关政策对风味禁令有效性的影响，还需要进一步研究。
与薄荷醇香烟使用和薄荷醇禁令不同，调味雪茄使用和调味雪茄禁令受到的关注极少。与香烟相比，从雪茄转变，尤其是双重使用和调味使用，通常较为常见。我们的政策框架表明了对公众健康的重要影响。没有薄荷醇香烟禁令的调味雪茄禁令可能会因薄荷醇香烟替代调味雪茄而部分受到削弱。加入薄荷醇香烟禁令有望抵消这种替代并改善公众健康。然而，在禁止调味雪茄和薄荷醇香烟的同时加入ENDS禁令可能会降低薄荷醇香烟和雪茄风味禁令对公众健康的影响，因为调味雪茄使用者将更难替代风险较低的替代品。
