Measures to ban or restrict menthol and other flavours in tobacco products are under consideration or newly implemented in an increasing number of jurisdictions across the world. As one of the world leaders, Canada’s experience in successfully developing and implementing such measures can be instructive for other jurisdictions. This paper explores the history of how Canada was able to implement tobacco flavour bans including menthol, examines some of the challenges and presents lessons learnt for other jurisdictions. The crucial motivation for these bans emerged from surveillance data showing high rates of flavoured tobacco use by youth, including menthol cigarette smoking, that was publicised by non-governmental organisations. Further data showed that early legislation in 2009 contained loopholes (cigar size exemptions and menthol exemptions) that limited the benefits of the legislation. Leadership by the provinces created an environment in which the federal ban on menthol ingredients in 2017 was a clear and obvious step to ensure implementation across the country. The Canadian measures have been successful at reducing the use of flavoured tobacco including menthol cigarettes and facilitating smoking cessation. Lessons learnt include the downsides of exemptions, the lack of a contraband issue (despite an existing supply in Canada), the benefits of availability of youth flavour prevalence data and the success of subnational regulations to advance national regulation.

Background: In 2008, the World Health Organization (WHO) introduced MPOWER-a package of evidence-based, high-impact policy measures to help countries reduce tobacco use. These measures align with selected articles within the World Health Organization’s Framework Convention on Tobacco Control (FCTC), a global public health treaty to prevent and reduce tobacco use. Methods: Observational longitudinal study involving 195 countries that submitted biannual national reports between 2008 and 2018. To report changes in MPOWER scores, countries were assessed using a validated checklist of the seven MPOWER indicators and a maximum possible unweighted composite score of 34 points. Covariate analysis was conducted among selected health, sociopolitical, and economic indicators. Results: 176 out of 195 countries improved their MPOWER scores between 2008 and 2018, with two achieving full implementation (Brazil and Turkey). Twenty-three (23) countries representing 11.2% of the global population recorded an MPOWER scoring increase of at least 10 points between 2008 and 2018. The overall mean 10-year scoring increase was 5.1 points or a relative improvement of 27.1%. In 2018, 20 countries representing 10.4% of the global population excelled in MPOWER implementation by receiving a total composite score of at least 30 of 34 possible points. The MPOWER elements with the highest degree of implementation in 2018 include Warn (package), Protect (smoking ban) and Enforce (ad ban). Several covariates were positively associated with higher levels of MPOWER implementation, including cigarette affordability, the existence of national tobacco control objectives, the human development index score, the national corruption index score, national literacy rates and the political regime index score. Conclusions: MPOWER implementation increased markedly between 2008 and 2018 in all seven WHO regions and countries representing all four World Bank income classifications. However, only two countries achieved full implementation by 2018. More work is needed to improve MPOWER implementation. Countries with low-income levels, compromised human development, reduced literacy rates, higher rates of corruption, and autocratic political regimes appear to struggle more with MPOWER implementation.

Aims: In 2014, in response to evidence that Canada’s tobacco use would lead, inexorably, to substantial morbidity and mortality for the foreseeable future, a group of experts convened to consider the development of a “Tobacco Endgame” for Canada. The “Tobacco Endgame” defines a time frame in which to eliminate structural, political, and social dynamics that sustain tobacco use, leading to improved population health. Strategies: A series of Background Papers describing possible measures that could contribute to the creation of a comprehensive endgame strategy for Canada was prepared in advance of the National Tobacco Endgame Summit hosted at Queen’s University in 2016. At the summit, agreement was reached to work together to achieve <5% tobacco use by 2035 (<5 by ’35). A report of the proceedings was shared widely. Achievements: Progress since 2016 has been mixed. The Summit report was followed by a national forum convened by Health Canada in March 2017, and in 2018, the Canadian Government adopted “<5 × ’35” tobacco use target in a renewed Canadian tobacco reduction strategy. Tobacco use has declined in the last 5 years, but at a rate slower than that which will be needed to achieve the 5 million smokers in Canada, signaling that smoking-related diseases will continue to be an enormous health burden. Furthermore, the landscape of new products (e-cigarettes and cannabis) has created additional risks and opportunities. Future directions: A bold, reinvigorated tobacco control strategy is needed that significantly advances ongoing policy developments, including full implementation of the key demand-reduction policies of the WHO Framework Convention on Tobacco Control. Formidable, new disruptive policies and regulations will be needed to achieve Canada’s Endgame goal.

This commentary discusses whether the proposed national target of reducing tobacco use to less than 5% prevalence by 2035 is still achievable.

Tobacco consumption has long been implicated in several lethal diseases. However, the tobacco industry has continued to develop new products and marketing schemes to attract new generations of customers and sustain its market share and sales. This year’s World No-Tobacco Day theme zeroes in on the driving force behind the global tobacco epidemic – the tobacco industry and its relentless pursuit of new victims.

Introduction: Tobacco vendor training is recognized as an essential element to reduce youth access to tobacco. The TRAC training program was developed utilizing bestpractices in tobacco retailer training, adult instruction, and e-learning. The objective of this mixed-methods study is to...