Introduction:
Europe is a global leader in banning flavours, including menthol, in cigarettes. The 27 European Union member states, the United Kingdom, Moldova, and Turkey banned menthol as a characterising flavour in cigarettes in May 2020.

Objectives:
As other countries aim to ban flavours of tobacco products it is critical to understand the lessons learned from Europe to ensure regulations are maximised. This mixed methods study examined implementation and impact of European menthol cigarette bans.

Material and Methods:
Quantitative data came from the International Tobacco Control (ITC) Project Surveys among adults who smoke in the Netherlands (2020) and youth who smoke in England (2021). Qualitative data came from review of policy documents, as well conducting semi-structured interviews with key informant stakeholders in Moldova and Turkey. Outcomes examined included: factors influencing policy implementation, quitting behaviours, illicit purchasing, use of flavour accessories, and health equity.

Results:
Key factors that were perceived by stakeholders in Moldova and Turkey to influence implementation of the menthol ban included: social climate, institutional capacity and operational effectiveness, political commitment, and tobacco industry interference. Findings from the Netherlands indicate that the menthol ban resulted in 17.3% additional quit attempts and 12.0% additional quitting among adults who smoked menthol cigarettes compared to non-menthol, while not increasing illicit purchasing. However, one-quarter of youth who smoke in England reported using menthol accessories, with disproportionately higher use among youth identifying as Black (60%). Use of ‘non-menthol’ replacement cigarette brands were also popular in England and the Netherlands.

Conclusions:
The experiences of European countries in implementing menthol cigarette bans can support other countries in taking measures to ban products known to facilitate smoking initiation and regular use. Menthol regulations may be strengthened by banning all additives with sensory and flavour properties, as well as flavour accessories.