Impact of the Massachusetts Menthol Ban on Perceptions and Cigarette Use Behavior at a Large Safety-net Hospital: A Longitudinal Survey and Qualitative Study

Abstract

Abstract Background. Menthol cigarettes have had a profound adverse effect on public health. On June 1 2020, Massachusetts became the first state to restrict the sale of all flavored tobacco products, including menthol cigarettes. In this longitudinal study, we sought to understand how individuals in our hospital system who smoke menthol cigarettes perceived the Massachusetts menthol ban and if their perceptions and smoking behavior changed over time. Methods. We undertook a longitudinal survey and qualitative study (n=27), starting 1-month pre-ban (4/15-5/31/2020) and continuing 6-months post-ban. Pre-ban questionnaires assessed participants’ perceptions of the ban and probed their anticipated smoking behaviors after the ban. The post-ban assessments (1- and 6- months) probed how perceptions and smoking behaviors changed post-ban. We also elicited suggestions to mitigate unintended consequences of the ban that might undermine intended policy effects. Results. Participants were 37% female, 56% Black, and 96% Medicaid-insured. Perceptions of how individuals viewed the ban were dynamic. Many discussed how they smoked less because of the ban, although their smoking behavior was largely influenced by their ability to still obtain menthol cigarettes. Individuals suggested promoting tobacco treatment interventions to help people affected by the ban and a national ban to circumvent out-of-state travel. Conclusions. Banning the sale of menthol cigarettes improves smoking-related health disparities. To be most effective, healthcare workers must capitalize on this moment to promote tobacco treatment and states must ensure that tobacco treatment programs are readily accessible to individuals affected by the ban.