- 1 Key messages and recommendations
- 2 Background
- 3 Filter design features
- 4 Flavourings
- 5 Article 9 of the WHO FCTC
- 6 International developments
- 7 Key messages and recommendations
- 8 References
Key messages and recommendations
Cancer Council Australia recommends that the Commonwealth Government introduce legislation prohibiting the sale and importation of:
Smoking is the leading cause of preventable death in Australia. Nicotine is considered the primary addictive component in tobacco products. However, recent studies indicate that the use of flavourings, including menthol, and masking agents increase the attractiveness of tobacco products by disguising the harsh taste and unpleasant odour of tobacco and may increase the addictiveness of nicotine. Similarly, various cigarette design features are often used to increase the palatability of cigarettes, making them more attractive and creating a misleading perception of reduced harm.
The 2012 National Tobacco Strategy, endorsed by all Australian governments, recommended that Australia commission research to examine the effects of flavouring, including menthol, and masking agents in increasing the palatability of tobacco products and the impact of these substances on smoking behaviours (particularly smoking initiation and uptake) and identify best practice approaches to regulation and to continue to participate in international efforts to increase tobacco product regulation. In addition, Article 9 of the WHO Framework Convention on Tobacco Control (‘FCTC’) requires parties to regulate the contents and emissions of tobacco products. The Partial Guidelines for Implementation of Article 9 and 10 specifically recommend that parties to the FCTC prohibit or restrict ingredients that may be used to increase the palatability of tobacco products, and regulate design features that increase the attractiveness of tobacco products.
While most Australian jurisdictions have adopted legislation banning the sale of certain tobacco products with distinctively fruity, sweet or confectionary-like flavours or scents which appeal to young people, the composition of tobacco products otherwise remains largely unregulated in Australia. This leaves tobacco companies considerable scope to manipulate products in order to maximise their attractiveness to new smokers, and make it more difficult for smokers to quit.
The “Mid-point review of the National Tobacco Strategy” found that the Commonwealth has conducted some research to explore potential regulatory options relevant to Articles 9 and 10. As no action has been taken to implement any measures, the review recommended that the Commonwealth finalise the development of options for legislation and associated regulation to remove flavourings, including menthol, and masking agents.
Further regulation of tobacco product ingredients and design features may help to reduce tobacco-related disease and premature death. Reducing the palatability and appeal of tobacco products deters young people from taking up smoking and makes it easier for smokers to quit. In particular, prohibiting the use of flavourings, including menthol, and masking agents that increase the palatability and appeal of tobacco products can reduce the prevalence of tobacco use. Research also indicates that prohibiting filter ventilation and other filter design features (such as the inclusion of flavour capsules inside cigarette filters) would be likely to have the same effect.
Cancer Council Australia recommends that the Commonwealth Government introduce comprehensive legislation banning the sale and importation of:
- All tobacco products and other products intended for smoking (such as cigarette and cigar papers) that possess flavourings, including menthol, and masking agents.
- All tobacco products with filter design features that are likely to have the effect of making the product more palatable or appealing.
Filter design features
For decades, tobacco companies have used various design features in cigarette filters to improve cigarette palatability and create a perception of reduced harm. Two key design features currently employed are filter ventilation, and the inclusion of flavour ‘capsules’ in cigarette filters.
Filter ventilation is the inclusion of tiny vent holes in the tipping paper enclosing the cigarette filter, which dilute the smoke inhaled by the smoker, thereby reducing its harshness and strength of taste (see figure 1). The majority of cigarettes available for sale in Australia are ventilated.
Filter ventilation creates a perception of reduced harm by reducing some of the unpleasant sensations of smoking. However, there is compelling evidence that filter ventilation has no positive impact on the health consequences of smoking. Smokers adjust the manner in which they smoke ventilated cigarettes to compensate for the diluted smoke. Research shows that ventilated filters cause smokers to take larger or more frequent puffs. Ventilated filters make it much easier for smokers to inhale smoke as the ventilation reduces resistance to drawing on a cigarette. Many smokers also block filter holes with their fingers or lips to prevent smoke being diluted.
Filter ventilation plays a key role in misleading consumers. The increased palatability and perception of reduced harm caused by filter ventilation is ultimately likely to discourage smokers from quitting. Research suggests that smokers form judgements about harmfulness based on their experience while smoking. The more harsh and irritating a cigarette, the more harmful it is perceived to be (and the more motivated the smoker is to quit).
Furthermore, research strongly suggests that filter ventilation has contributed to a rise in lung cancers among smokers since its introduction in the mid-1960’s. Taking larger and more frequent puffs results in the inhalation of more toxicants into deeper parts of the lungs. Filter ventilation also causes the cigarette to burn down more slowly resulting in the production of more toxic constituents. The slower burn time also results in an increase in the size of smoke particles and larger particles are able to carry more toxic constituents. Filter ventilation results in a decrease in air flow through the burning tip of the cigarette. This means that the coal burns at a lower temperature, which in turn results in incomplete combustion and an increase in toxic constituents.
Filter ventilation therefore not only creates a perception of reduced harm by improving cigarette palatability, but also appears to have contributed to the rise in lung cancer by increasing the toxicant yield of cigarettes.
For this reason, Cancer Council Australia recommends that the Commonwealth Government introduce legislation banning the sale or importation of filter ventilated cigarettes in Australia.
Flavour capsules: Making smoking a novelty
In addition to filter ventilation, tobacco companies have more recently begun producing cigarettes with flavour ‘capsules’ embedded in the cigarette filter. The capsules (about 3.5 - 4 mm in diameter) are filled with a flavouring solution, and can be ‘crushed’ by the smoker at any time while smoking to release a burst of flavour. Flavour capsules generally contain menthol, but can also include other common tobacco flavourings (such as sugars and cloves).
Cigarettes containing flavour capsules were initially introduced in Australia in the lead up to the implementation of plain packaging laws in 2012. For a short period, tobacco companies were therefore able to use package designs to inform consumers about these new products. Since the implementation of plain packaging, flavour capsules appear to be increasing in popularity and tend to appeal to younger smokers. They appear to be used by tobacco companies as a marketing tool, and continue to be promoted through the use of fresh-sounding variant names such as ‘Crush Blue’, ‘Crush Sky’ and ‘Ice Blast’.
Tobacco industry documents indicate that flavour capsules help to prevent ‘volatilisation’ (i.e. gaseous loss) of flavouring agents, as the capsule prevents the flavour from being absorbed by surrounding filter material. This results in the cigarette retaining a fuller flavour, thereby making the act of smoking more pleasant than when flavouring agents are added directly to the tobacco or cigarette paper. This tendency to be easier to smoke, (along with the obvious ‘novelty’ factor) may explain why cigarettes containing flavour capsules are more popular among younger smokers. Alarmingly, data from a 2014 survey of Australian secondary school students reveals that 52% of past-month smokers reported having used cigarettes containing menthol flavoured capsules. The high prevalence of use among younger smokers suggests that flavour capsules represent an important innovation for the future of the tobacco industry. In particular, flavoured capsules may be intended to generate more interest in menthol and other flavoured tobacco products among younger smokers.
Cancer Council Australia recommends that Commonwealth and State/Territory governments also take action to ban the sale or importation of tobacco products with filter innovations such as flavour capsules in Australia.
Existing legislation regarding flavoured tobacco products in Australia
At the Australian Health Minister’s Conference on 18 April 2008, Australia’s Health Ministers agreed to ban the sale of flavoured cigarettes across Australia. Following the meeting, most Australian jurisdictions adopted legislation which has the effect of prohibiting the sale of certain tobacco products possessing fruity, sweet or confectionary-like characters.
The relevant legislation in each State and Territory is outlined in Table 1.
Table 1: Summary of State/Territory legislation banning tobacco products with overtly fruity or confectionary-like flavours
|Jurisdiction||Comprehensive ban on overtly fruity/confectionary flavoured smoking products||Details of ban|
|ACT||✖||Partial ban only - Minister has the power to ban a smoking product that has a ‘distinctive fruity, sweet or confectionary-like character’ if ‘the nature of the product, or the product’s packaging, may be attractive to children.’ A number of specific products have been declared banned (see Tobacco and Other Smoking Products Act 1927 (ACT), s 21). However, flavoured products not specifically mentioned in the relevant ban order can be legally sold. In addition, the Ministerial power only extends to products containing tobacco (as well as herbal products and personal vaporisers). Flavoured cigarette papers and cigar wraps can therefore be legally sold.|
|NT||✔||No legislative ban in place, however the sale of fruity or confectionery flavoured cigarettes and cigarette papers is prohibited by way of a condition imposed on all tobacco retail licenses. It is an offence for the holder of a tobacco retail license to breach the conditions of that license (see Tobacco Control Act (NT), s 30).|
|NSW||✖||Partial ban only - Minister has the power to ban tobacco products that possess a ‘distinctive fruity, sweet or confectionery-like character that might encourage a minor to smoke.’ A number of specific products have been declared banned (see Public Health (Tobacco) Act 2008 (NSW), s 29). However, flavoured tobacco products not specifically mentioned in the relevant ban order can be legally sold. In addition, the Ministerial power only extends to products containing tobacco. Flavoured cigarette papers and cigar wraps can therefore be legally sold.|
|QLD||✖||Partial ban only - Sale of all cigarettes that are ‘confectionary-flavoured or fruit-flavoured’ is prohibited (see Tobacco and other Smoking Products Act 1998 (QLD), s 26ZT). However, flavoured cigarette papers or cigar wraps are not covered by the prohibition.|
|SA||✖||Partial ban only - Minister has the power to ban tobacco products that ‘possess a distinctive fruity, sweet or confectionary-like character’ if ‘the nature of the products, or the way they are advertised, might encourage young people to smoke’. A number of specific products have been declared banned (see Tobacco Products Regulation Act 1997 (SA), s 34A). However, flavoured tobacco products not specifically mentioned in the relevant ban order can be legally sold.|
|TAS||✔||Sale, supply or display of tobacco products that are confectionery-flavoured or confectionery-scented, or fruit-flavoured or fruit-scented is prohibited. Sale, supply or display of cigarette papers that are confectionery-flavoured or confectionery-scented, or fruit-flavoured or fruit-scented is also prohibited (see Public Health Act 1997 (TAS), s 68A(c)-(e)).|
|VIC||✖||Partial ban only - Minister has the power to ban tobacco products (or a class of tobacco products) which ‘possess a distinctive fruity, sweet or confectionery-like character’. All brands or types of cigarette papers, cigar wraps, cigarillo wraps and cigarillos that ‘possess a distinctive fruity, sweet or confectionary-like flavour or scent’ have been banned.
In addition, a number of specific cigarette products have been declared banned. However, flavoured cigarette products not specifically mentioned in the relevant ban order can be legally sold.
|WA||✖||No ban in place.|
Why should existing bans be widened?
It is important to note that menthol flavoured tobacco products and other overtly flavoured products (such as liqueur or coffee flavoured products) which aren’t considered ‘fruity, sweet or confectionary-like’ fall outside the scope of the above bans.
In addition, in many jurisdictions, the existing bans are not sufficiently broad to capture all fruity, sweet or confectionary flavoured tobacco products. For example, in Victoria, New South Wales, the ACT and South Australia, the ban orders currently in place relating to tobacco products simply list specific products which are prohibited for sale. Fruity, sweet or confectionary-like tobacco products that are not specifically mentioned (such as those introduced to the market after the ban order was made) can therefore be legally sold.
In other jurisdictions, the power to ban fruity, sweet or confectionary flavoured products extends only to products containing tobacco. This means that all flavoured cigarette papers and cigar wraps can continue to be sold.
The inconsistent approach across jurisdictions is problematic, as products can be obtained across Australia via online sales.
There is public support for more comprehensive regulation of flavouring additives in tobacco products. The 2013 National Drug Strategy Household Survey showed that 78.8% of adults would support measures banning all flavouring additives in order to make tobacco products less attractive. In addition, another Australian study found that 80% of smokers in WA were in favour of government regulations banning the use of flavourings and additives that mask the harshness of cigarette smoke.
Research suggests that flavourings not captured by the existing bans play a role in enhancing the appeal of tobacco products, and encouraging smoking uptake. Extensive research has been undertaken regarding the impact of menthol in particular. Menthol flavoured cigarettes, initially marketed as ‘healthy’, have been produced by tobacco companies for decades. Menthol cigarettes are believed to be easier to smoke due to their ‘fresher’ and ‘smoother’ taste. Menthol also has a numbing effect that reduces the irritation caused by nicotine in tobacco smoke. Tobacco industry studies have suggested that the appeal of menthol appears to be ‘less about the menthol taste, and more about the absence of cigarette taste’. Menthol can play a role in facilitating smoking initiation among young people by reducing the harshness of tobacco smoke. Menthol enables smokers to inhale more deeply, resulting in greater smoke intake per cigarette. Menthol may also act as a sensory cue which enhances the addictive properties of nicotine.
Flavourings such as menthol can also be used to disguise the smell of second-hand smoke. Tobacco companies hope to reduce concerns and complaints from non-smokers and thereby relieve smokers of some of the social pressure to quit.
In 2016, the WHO Study Group on Tobacco Product Regulation (‘TobReg’) recommended that countries ban the use of menthol in tobacco products. The US Food and Drug Administration (‘FDA’) advised that smokers of menthol cigarettes show greater signs of nicotine dependence and are less likely to successfully quit smoking. In addition, the FDA noted that menthol in cigarettes is likely to be associated with increased initiation and progression to regular smoking. The FDA is now considering banning menthol cigarettes in the US.
Tobacco industry documents suggest that tobacco companies are well aware of the important role menthol plays in increasing the addictiveness of nicotine. As a result, research indicates most cigarettes now contain at least small amounts of menthol. Given its widespread use and the important role menthol plays in developing and maintaining nicotine addiction, a menthol ban would be likely to decrease smoking rates among smokers of both menthol and so-called ‘non-mentholated’ cigarettes.
Article 9 of the WHO FCTC
The Partial Guidelines for Implementation of Articles 9 and 10 of the FCTC (‘the Partial Guidelines’) note that the harsh and irritating character of tobacco smoke provides a significant barrier to experimentation and initial use, and that from the perspective of public health, there is ‘no justification for permitting the use of flavouring agents, which help make tobacco products more attractive.’
Despite adopting the Partial Guidelines in 2010, very little has been done to implement the Guidelines and reduce the palatability of tobacco products in Australia.
In view of the significant role flavourings, including menthol, and masking agents play in increasing the addictiveness and attractiveness of tobacco products, a number of countries have taken steps to regulate their use in tobacco products. Key international developments are summarised below.
In March 2012, the Brazilian government introduced a resolution restricting the use of additives in tobacco products (see Resolution RDC ANVISA No 14, RDC14/2012). Specifically, the resolution prohibits the use of:
- Natural and synthetic substances with flavouring properties that may confer, enhance or modify the flavour or aroma of the product, including additives identified as flavouring agents or flavours (including menthol);
- Additives with stimulating or invigorating properties (such as taurine, guarana and caffeine);
- Pigments and colouring agents;
- Fruits and vegetables, or any product originating from the processing of fruits and vegetables (except charcoal and amides);
- Sweeteners, honey, molasses or any other substance that can impart a sweet flavour (apart from sugars added exclusively for the purpose of restoring natural sugars lost during the curing process);
- Seasoning, herbs and spices (or any substance that can impart a flavour of seasoning, herbs and spices);
- Ameliorants (i.e. substances added to balance or improve flavour).
One of the key objectives of the resolution was to minimise the attractiveness of tobacco products. The constitutionality of this resolution was challenged by the National Confederation of Industry Brazil. However, the Federal Superior Tribunal of Brazil upheld the ban on 1 February 2018.
In 2009, the Canadian Government introduced national legislation banning the use of ‘additives that have flavouring properties or enhance flavour’ in the manufacture of cigarettes, little cigars and ‘blunt wraps’ (see schedule 17 of Bill C-32). The use of sugars, sweeteners, fruits and vegetables, spices, seasonings and herbs was also prohibited by the legislation. In 2015, this ban was extended to most cigars.
On 2 October 2017 the legislative ban was extended to prohibit the use of menthol in cigarettes, blunt wraps and cigars.
The European Union
In May 2014, the EU adopted a Tobacco Product Directive requiring member states to regulate the use of flavourings in tobacco products (see Directive 2014/40/EU of the European Parliament and of the Council). The Directive requires member States to prohibit cigarettes and roll-your-own tobacco:
(a) with characterising flavours, including menthol (except for those which are essential for the manufacture of tobacco products, provided they do not result in a product with a characterising flavour and do not increase ‘to a significant or measurable degree’ the addictiveness, or toxicity of the product);
(b) containing additives that facilitate inhalation or nicotine uptake;
(c) containing flavourings in any of their components, such as filters, papers, packages, capsules or any technical features allowing modification of the smell or taste of the tobacco product concerned;
(d) containing additives that increase the toxic or addictive effect of the product ‘to a significant and measurable degree’.
The Directive also requires the tobacco industry to submit reports to the Member States regarding the specific ingredients used in tobacco products.
As of 20 May 2016, all Member States must comply with the Directive. There is, however, an additional transitional period for menthol flavoured cigarettes until 20 May 2020.
Key messages and recommendations
Flavourings, including menthol, masking agents and filter design features play a significant role in making tobacco products more palatable, more appealing, and therefore, more harmful. Through implementation of evidence-based tobacco control policies, Australia has made much progress to reduce the prevalence of tobacco use. Yet while international jurisdictions have taken significant steps towards regulating the composition of tobacco products, very little has been done to reduce the palatability of tobacco products in Australia. This lack of regulation has been noted in the “Mid-point review of the National Tobacco Strategy”.
The current lack of regulation in this area is of particular concern given that improvements in the palatability of tobacco products play a role in facilitating smoking initiation among young people. Tobacco companies appear to be exploiting this lack of regulation, by manipulating products through the use of flavourings and filter design features in order to maximise their appeal to new smokers and make it more difficult for regular smokers to quit.
Research indicates that reducing the palatability of tobacco products would be likely to result in a reduction in smoking prevalence in Australia. Cancer Council Australia therefore makes the following recommendations.
Recommendations for the regulation of filter design features
Cancer Council Australia recommends that the Commonwealth Government introduce legislation banning the sale and importation of tobacco products with filter ventilation or flavour capsules in Australia. Any prohibition should be broad enough to capture all filter design features which are likely to have the effect of improving the palatability or appeal of tobacco products. This would ensure that alternative filter innovations developed in future with the aim of improving palatability would be captured by the ban.
Recommendations for further regulation of tobacco products containing flavourings, including menthol, and masking agents
Cancer Council Australia recommends that the Commonwealth Government introduce comprehensive legislation banning the sale and importation of all tobacco products containing flavourings, including menthol, and masking agents. The ban should also cover all other products intended to be used for smoking (such as cigarette or cigar papers) which possess a flavourings, including menthol, and masking agents.
- Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Canberra: Australian Institute of Health and Welfare; 2016 Available from: https://www.aihw.gov.au/getmedia/d4df9251-c4b6-452f-a877-8370b6124219/19663.pdf.aspx?inline=true.
- World Health Organization. Fact sheet on ingredients in tobacco products. [homepage on the internet] World Health Organization; 2014 Available from: http://www.who.int/tobacco/industry/product_regulation/factsheetingredients/en/.
- Intergovernmental Committee on Drugs (IGCD) Standing Committee on Tobacco. National Tobacco Strategy 2012-2018. Canberra: Commonwealth of Australia; 2012.
- World Health Organization. WHO Framework Convention on Tobacco Control. Geneva, Switzerland: WHO; 2003.
- Health Policy Analysis. Mid-point review of the National Tobacco Strategy 2012-2018: Final report. Canberra: Commonwealth Department of Health; 2016 Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/D4E3727950BDBAE4CA257AE70003730C/$File/Mid-term%20review%20NTS.pdf.
- Farber HJ, Walley SC, Groner JA, Nelson KE, Section on Tobacco Control. Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke. Pediatrics 2015 Nov;136(5):1008-17 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26504137.
- Kozlowski LT, O'Connor RJ. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002 Mar;11 Suppl 1:I40-50 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11893814.
- Miller C, Scollo M. 12.4 General engineering features of Australian cigarettes and their relation to compensatory smoking. [homepage on the internet] Melbourne: Cancer Council Victoria; 2017 Available from: http://www.tobaccoinaustralia.org.au/chapter-12-tobacco-products/12-4-general-engineering-features-of-australian-ci#x1.
- Kozlowski LT, Frecker RC, Khouw V, Pope MA. The misuse of 'less-hazardous' cigarettes and its detection: hole-blocking of ventilated filters. Am J Public Health 1980 Nov;70(11):1202-3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7425194.
- Kozlowski LT, Pope MA, Lux JE. Prevalence of the misuse of ultra-low-tar cigarettes by blocking filter vents. Am J Public Health 1988 Jun;78(6):694-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3369602.
- Shiffman S, Pillitteri JL, Burton SL, Rohay JM, Gitchell JG. Effect of health messages about "Light" and "Ultra Light" cigarettes on beliefs and quitting intent. Tob Control 2001;10 Suppl 1:i24-32 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11740041.
- Song MA, Benowitz NL, Berman M, Brasky TM, Cummings KM, Hatsukami DK, et al. Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma. J Natl Cancer Inst 2017 Dec 1;109(12) Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28525914.
- Thrasher JF, Abad-Vivero EN, Moodie C, O'Connor RJ, Hammond D, Cummings KM, et al. Cigarette brands with flavour capsules in the filter: trends in use and brand perceptions among smokers in the USA, Mexico and Australia, 2012-2014. Tob Control 2016 May;25(3):275-83 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25918129.
- Scollo M, Occleston J, Bayly M, Lindorff K, Wakefield M. Tobacco product developments coinciding with the implementation of plain packaging in Australia. Tob Control 2015 Mar;24(e1):e116-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24789601.
- German Cancer Research Center. Menthol Capsules in Cigarette Filters – Increasing the Attractiveness of a Harmful Product. Heidelberg, Germany: German Cancer Research Center; 2012 Available from: https://www.dkfz.de/de/tabakkontrolle/download/Publikationen/RoteReihe/Band_17_Menthol_Capsules_in_Cigarette_Filters_en.pdf.
- White V, Williams T. Australian secondary school students' use of tobacco in 2014. Melbourne: Centre for Behavioural Research in Cancer; 2015 Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/BCBF6B2C638E1202CA257ACD0020E35C/$File/Tobacco%20Report%202014.PDF.
- Department of Health. Australian Health Ministers' Conference Communique. Melbourne: Department of Health; 2008 Apr 18 Available from: http://health.gov.au/internet/main/publishing.nsf/Content/A6D9FB13D22B41E7CA257BF0001F3EA5/$File/Australian%20Health%20Ministers%20Conference%20Communique.pdf.
- David Davis. Victoria Government Gazette No S 350. Melbourne, Australia: Victoria Government Gazette; 2011 Available from: http://www.gazette.vic.gov.au/gazette/Gazettes2011/GG2011S350.pdf.
- Daniel Andrews. Victoria Government Gazette No G 25. Melbourne, Australia: Victoria Government Gazette; 2010 Available from: http://www.gazette.vic.gov.au/gazette/Gazettes2010/GG2010G025.pdf.
- Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report: 2013. Canberra: AIHW; 2014 Nov. Report No.: Drug statistics series no. 28. Cat. no. PHE 183. Available from: http://www.aihw.gov.au/publication-detail/?id=60129549469&tab=3.
- Heydon NJ, Kennington KS, Jalleh G, Lin C. Western Australian smokers strongly support regulations on the use of chemicals and additives in cigarettes. Tob Control 2012 May;21(3):381-2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22170334.
- Anderson SJ. Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents. Tob Control 2011 May;20 Suppl 2:ii20-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21504928.
- World Health Organization. Report on the scientific basis of tobacco product regulation: 4th report of a WHO study group. Geneva, Switzerland: World Health Organization; 2012 Available from: http://apps.who.int/iris/bitstream/10665/44800/1/9789241209670_eng.pdf.
- World Health Organization. Advisory note: Banning menthol in tobacco products. Geneva, Switzerland: World Health Organization; 2016 Available from: http://apps.who.int/iris/bitstream/10665/205928/1/9789241510332_eng.pdf.
- Yerger VB, McCandless PM. Menthol sensory qualities and smoking topography: a review of tobacco industry documents. Tob Control 2011 May;20 Suppl 2:ii37-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21504930.
- Food and Drug Administration. Preliminary scientific evaluation of the possible. Maryland, USA: Food and Drug Administration; 2013 Available from: https://www.fda.gov/downloads/scienceresearch/specialtopics/peerreviewofscientificinformationandassessments/ucm361598.pdf.
- Garten S, Falkner RV. Role of mentholated cigarettes in increased nicotine dependence and greater risk of tobacco-attributable disease. Prev Med 2004 Jun;38(6):793-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15193900.
- Wickham RJ. How Menthol Alters Tobacco-Smoking Behavior: A Biological Perspective. Yale J Biol Med 2015 Sep;88(3):279-87 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26339211.
- Connolly GN, Wayne GD, Lymperis D, Doherty MC. How cigarette additives are used to mask environmental tobacco smoke. Tob Control 2000 Sep;9(3):283-91 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10982572.
- Giovino GA, Sidney S, Gfroerer JC, O'Malley PM, Allen JA, Richter PA, et al. Epidemiology of menthol cigarette use. Nicotine Tob Res 2004 Feb;6 Suppl 1:S67-81 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14982710.
- WHO Framework Convention on Tobacco Control, Richter AP. Best practices in implementation of Article 9 of the WHO FCTC Case study: Brazil and Canada. Rio de Janeiro, Brazil: WHO Framework Convention on Tobacco Control; 2008 Available from: http://www.who.int/fctc/publications/Best_practices_in_implementation_of_Article_9.pdf.
- Ferreira CGM, Silveira D, Hatsukami DK, Paumgartten FJR, Fong GT, Glória MBA, Toledo MCF, Talhout R. Report of the Working Group on Tobacco Additives. Rio de Janeiro, Brazil: Anvisa; 2014 Available from: http://portal.anvisa.gov.br/documents/106510/106594/Report+Working+Group+Tobacco+Additives/b99ad2e7-23d9-4e88-81cd-d82c28512199.