On March 09, 2018, the World Health Organization (WHO) launched new guidance on "Tobacco product regulation: Building laboratory testing capacity51", and a collection of country approaches for regulation of menthol, presented in the publication titled "Case studies for regulatory approaches to tobacco products – Menthol in tobacco products52". This guidance was launched on the occasion of World Conference on Tobacco or Health held in Cape Town, South Africa.

Tobacco product regulation - Building laboratory testing capacity

This guidance provides practical and stepwise approaches to implementing tobacco testing. Such guidance is relevant to a wide range of countries in various settings, even those with inadequate resources to establish a testing facility. Tobacco use is a global health burden. However, despite the devastating effects of tobacco use, only a handful of countries currently regulate tobacco products, including on how the product is made, the contents of the product and emissions from tobacco products during use, to which users and bystanders can be exposed.

This is partly due to the challenges associated with the regulation of tobacco products, highly technical nature of this policy intervention and the difficulties in translating science into regulation. Failure to regulate represents a missed opportunity as tobacco product regulation, in the context of comprehensive control, is a valuable tool that could complement other tried and tested tobacco control interventions, such as raising taxes, smoke-free environments, etc.

The new tobacco laboratory guide is a useful resource for countries, and provides regulators and policymakers with comprehensible information on how to test tobacco products, what products to test, and how to use testing data in a meaningful way to support regulation. Further, it provides a step-by-step guide to developing a testing laboratory, using an existing internal laboratory, contracting an external laboratory, and making use of the available support mechanisms both within WHO and externally.

Case studies for regulatory approaches to tobacco products – Menthol in tobacco products

The publication complements the 2016 advisory note on menthol, published by the WHO Study Group on Tobacco Product Regulation (TobReg), which sets out the available evidence on prevalence and health effects of menthol in tobacco products, as well as evidence-based conclusions and recommendations for policy-makers and regulators on menthol in its various forms.

The new case studies provide practical guidance to countries by describing effective regulatory strategies in tobacco product regulation. This includes lessons learned and challenges encountered in developing and implementing menthol related regulation. The publication offers a description of menthol - a common ingredient in tobacco products and provides governments with a broad overview of regulatory options, which could guide the formulation of effective regulatory strategies for menthol regulation at country level.

Menthol is one of the most widely used and recognizable flavours in tobacco products, with unique cooling properties that help to mask the harshness and irritation of tobacco. Use of menthol-tobacco products is concentrated among the youngest ages in several countries, and these products are associated with:

  • increased experimentation and trial use
  • perceptions of reduced harm
  • higher levels of dependence
  • greater difficulty in quitting

The popularity of menthol tobacco products differs across countries, reflecting product availability, marketing and historical patterns of use. Given strong global evidence that menthol increases attractiveness of tobacco products, efforts to restrict or ban menthol in tobacco products are appropriate even in markets where the use of menthol remains limited. Regulations to date suggest multiple approaches to restricting the use of menthol:

  • a ban on all flavouring agents (including menthol) that increase tobacco product attractiveness;
  • a ban on the use of menthol as a flavouring agent;
  • a ban on all products with a perceived menthol flavour or visible menthol identifiers; or
  • a ban on menthol within a specific category of products (such as small cigars) or specific municipality, based on population evidence (such as high prevalence among youth).

Preliminary evidence indicates that restrictions such as those identified above can successfully reduce menthol- tobacco product use. Regulators should consider the resources necessary to support ongoing evaluation and compliance, and the potential need for public education. Challenges to implementation of such restrictions can include:

  • the availability of adequate surveillance to identify regulatory needs and measure outcomes, including potential unintended consequences;
  • significant industry opposition, particularly in regions where menthol products make up a sizeable portion of the tobacco market; and/or
  • a changing marketplace, including new products or product categories featuring menthol, or introduction of synthetic or other compounds in place of menthol.

Menthol-tobacco products are used disproportionately by the youngest tobacco users across multiple studies and countries. Menthol cigarettes are associated with increased initiation and progression to regular smoking, and both adolescent and adult menthol smokers show greater signs of nicotine dependence and are less likely to successfully quit, compared to non-menthol smokers, with higher rates of relapse. The findings support the conclusion that the use of menthol in tobacco products creates a greater public health burden.

Footnotes

51. http://apps.who.int/iris/bitstream/handle/10665/260418/9789241550246-eng.pdf;jsessionid=3E47B8C353B4595420F1D17A1E9F3D37?sequence=1

52. http://apps.who.int/iris/bitstream/handle/10665/260417/WHO-NMH-PND-18.1-eng.pdf?sequence=1

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