Trends in youth use of non-cigarette tobacco products in England, Canada, and the US and the impact of Englands menthol cigarette ban on use

IntroductionIn England, non-cigarette tobacco products (e.g., cigarillos, cigars, waterpipes, bidis, smokeless tobacco, heated tobacco) are subject to fewer regulatory restrictions than cigarettes/rolling tobacco. This study assessed trends in youth use of these products in England, Canada, and the US, focussing on evaluating the impact of Englands May 2020 ban on menthol in cigarettes but not non-cigarette tobacco. MethodsData were from the ITC Youth Tobacco and Vaping Survey (16-19-year-olds; N=129,575) across ten waves (2017-2024). Segmented regressions assessed changes in trends of non-cigarette tobacco products before vs. after May 2020, adjusting for race/ethnicity/sex/age. ResultsIn England, non-cigarette tobacco use increased similarly before (aOR=1.16,1.02-1.31) and after (1.13,1.07-1.20) the ban (change in trend: 0.98,0.91-1.06), from 7.4% in 2017 and reaching in 11.6% in 2024. In contrast, non-cigarette tobacco use decreased similarly before and after the ban in both the US (pre-ban: 0.82, 0.73-0.93; post-ban: 0.84,0.80-0.89; change in trend: 1.02,0.94-1.11; from 10.2% reaching 7.1%), and Canada (pre-ban: 0.84,0.76-0.93; post-ban: 0.90,0.86-0.94; from 9.2% reaching 7.9%), although the decline in Canada after the ban was slightly slower (1.07,1.001-1.15). Cigarillo, cigar, and smokeless tobacco use specifically increased to a greater extent in England than Canada and the US. ConclusionsBetween 2017 and 2024, youth non-cigarette tobacco product use increased in England and surpassed declining use in Canada and the US. There was little evidence that Englands menthol cigarette ban accelerated increases, although increases highlight the need for comprehensive regulations encompassing all tobacco products in England. IMPLICATIONSYouth use of non-cigarette tobacco products has been increasing in England but declining in Canada and the US. Englands menthol cigarette ban did not appear to alter trends in use of non-cigarette tobacco, but findings highlight a need for more comprehensive regulation encompassing all tobacco products to mitigate youth uptake.