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Annually, tobacco use is estimated to cost the United States $193 billion in direct medical expenses and lost productivity

however, legal challenges have meant that this measure has still not yet been implemented.62 In the European Union (EU), a new draft Directive by the European Commission was published in December 201263 and was adopted in final form in 2014.64 This Directive included an obligation for the 28 EU countries to ban characterising flavours, including menthol, in cigarettes and roll-your-own tobacco, effective 20 May 2020

Maintenance requirements varied depending on the venue and volume of use

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