Menthol cigarettes will be removed from shelves in the UK

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Menthol cigarettes will be removed from shelves in the UK this Wednesday (20 May 2020), yet new research has found that tobacco companies failed to use the four-year phasing-in period (from 2016) to prepare for this week’s ban.

Instead they continued to sell and promote menthol products and to develop new products which circumvent the ban.

The University of Bath researchers behind the study – which is out today (Monday 18 May 0001 GMT) in the BMJ’s Tobacco Control – argue this highlights how tobacco companies have exploited a delay in the ban to develop new products, keeping menthol products on the market for as long as possible, rather than phasing them out.

A menthol ban was first agreed in 2014 and originally due to be implemented in 2016, alongside accompanying measures such as standardised packaging.

However, after intense lobbying, its implementation was put back four years, until this week when it will be implemented in the midst of Covid-19.

For the new study, the researchers from the Tobacco Control Research Group analysed industry analyst data to track menthol market cigarette share from legislation agreement through to 2018.

They also analysed documentary evidence – industry documents, websites and retail publications – to understand tobacco industry activities.

Their results show that during the grace period the tobacco industry was given to prepare, the UK market share of menthol cigarettes grew rapidly from 14% of cigarette sales in 2014 to over a fifth (21%) in 2018.

With one in six menthol smokers stating they would quit after the menthol ban, an impact which potentially could reduce UK cigarette sales overall by 3%, the researchers say the menthol ban will be an important driver in the fight against deaths and illness from cigarette smoking.

Dr. Rosemary Hiscock, lead author, explains: “Our findings suggest the tobacco industry was driving sales of menthol cigarettes right up to the ban – a product whose serious health implications had led to the ban in the first place.”

In the paper, the authors argue that the tobacco industry used the delay to develop and introduce new menthol products that will circumvent the ban once it is implemented: menthol filters and flavour cards which smokers can add to cigarette packs or roll-your-own tobacco pouches to make them minty.

Due to a loophole in the tobacco display ban legislation, these accessories, unlike cigarettes, can be promoted to customers near the cash till in England and Wales (but not Scotland).

They also find that two tobacco companies have introduced cigarette-like ‘cigarillos’ (small cigars) with a flavour capsule. Although cigarillos have a small market share of UK tobacco sales at the moment, Euromonitor forecasts that this market will grow, not least because they are subject to lower taxes than cigarettes and are mostly exempt from plain packaging legislation.

Dr. Hiscock added: “We recommend loopholes in legislation be closed as soon as possible to prevent tobacco companies undermining the intended public health impacts of the legislation.

This includes preventing the display of tobacco accessories and extending the menthol ban to all tobacco products, including cigarillos and heated tobacco products.

“In Canada, the menthol ban stops menthol being used at all, whereas UK legislation only stops menthol’s use as a characterising flavour. Banning menthol’s use would stop menthol masking the harsh effects of smoking when it is present at undetectable levels.”

Finally, the researchers highlight how big tobacco companies have created new websites and sponsored retail industry pieces which effectively undermine the intended public health benefit of the ban.

These websites push consumers to switch to other products rather than quitting: a key concern is that they promote new heated tobacco products, such as IQOS, which are still allowed to have a menthol flavour.

Professor Anna Gilmore, Director of the Tobacco Control Research Group, explains: “The way tobacco companies are using the ban on menthol cigarettes to promote new menthol tobacco products which are heated rather than burned undermines the very purpose of this ban.

It also flies in the face of tobacco company claims that they wish to reduce the harm from smoking. They realise the menthol ban will trigger smokers to quit.

Instead they seek to move the smokers onto new tobacco products which independent evidence indicates are as dangerous as smoking and from which they make even more profit.”

The team conclude that the tobacco industry’s exploitation of the phase-in of the menthol ban repeats what happened during the 12-month phase-in period of standardised packaging, revealed by previous TCRG work.

In both cases, tobacco companies misused the phase-in period to find ways to circumvent legislation and to shore up profits at the expense of public health, say the researchers.

The addition of menthol to cigarettes takes away some of the harsh sensations of smoking. Public health experts suggest this can make them more appealing to younger people and could lead them to become more quickly dependent on nicotine in comparison with non-menthol products.

A menthol flavour can be added to cigarettes during the manufacturing process or smokers can add it themselves by crushing a menthol capsule.

Significantly however, menthol can mask early respiratory disease symptoms, so menthol smokers may carry on smoking after they start to become ill, at a time when smokers of other products might be prompted to quit.


Cigarette sensory characteristics (eg, taste, smell, visual stimuli) can reinforce smoking behavior and enhance nicotine self-administration.1–4

Menthol as a cigarette additive is more than just a flavor; menthol is involved with neurobiological processes that trigger reward pathways in the brain through quick dopamine release.5,6

Menthol also exerts a range of sensory effects on the airways such as anesthesia and cooling, helping mask and smooth the harshness of tobacco smoke while increasing appeal, and ease of smoking among naïve smokers.3,7–10

Menthol cigarettes increase the likelihood of smoking initiation and nicotine addiction and are also harder to quit.10–15

Moreover, the proportion of menthol use among youth smokers is higher than adult smokers, which is concerning, as it may facilitate progression to more established smoking.16

The menthol cigarette market share in the United States increased from 32% in 2011 to 36% in 2017,17 while the overall US cigarette smoking prevalence decreased over the past decade.18,19

In the past two decades, youth menthol smoking prevalence has been higher than non-menthol smoking, suggesting that menthol cigarette use may be slowing overall youth smoking reductions.12,20

Findings from the National Survey on Drug Use and Health (NSDUH) indicated that youth menthol smoking prevalence decreased from 4.6% in 2004 to 2.5% in 2014, while non-menthol smoking decreased from 6.3% to 2.2% during this period.20

Youth cigarette smoking prevalence from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study showed that 4.6% of youth were past 30-day cigarette smokers,21 of whom 59.5% smoked menthol cigarettes22,23; of the 13.4% of youth who reported ever smoking a cigarette, 43% reported their first cigarette was a menthol cigarette,23 and 50.1% reported that their first tobacco product used was flavored.22

Menthol cigarette smoking may also play a role in smoking and tobacco use transitions in youth. Studies have reported an association between first use of menthol cigarettes and established cigarette smoking the following year,15,24 and that menthol smoking increases the likelihood of other tobacco use, including non-cigarette flavored tobacco use and use of multiple products.25–30

Youth cigarette smokers who initiate with menthol cigarettes are more likely to progress to smoking ≥20 out of the past 30 days and to report smoking ≥100 cigarettes in their lifetime, compared to smokers who initiate with non-menthol.15

Furthermore, youth who initiate cigarette smoking with menthol display more nicotine dependence symptoms than youth who initiate with non-menthol,15 including a shorter time to smoking their first cigarette of the day and more withdrawal and craving symptoms.13,31–33

Demographic characteristics, cigarette brand familiarity, and popularity and availability of menthol cigarettes in the social environment are important factors associated with youth menthol smoking.

Youth aged 12–17 years have three to four times higher odds of smoking menthol cigarettes than adults aged 35 years or older,12,20 and female smokers have nearly two times higher odds of menthol smoking compared to males.12,20

Regarding differences by race/ethnicity, non-Hispanic black smokers traditionally have had higher odds of smoking menthol cigarettes compared to non-Hispanic white smokers,20 and racial differences have been noted in cigarette brand identification.34

In a study examining three major cigarette brands (two menthol, one non-menthol), recognition of menthol brands predicted cigarette smoking at 12-month follow-up for high school nonsmokers at baseline; non-Hispanic black students were more likely to identify menthol brands compared to white students.34

For cigarettes specifically, non-Hispanic black youth smokers tend to increase the number of cigarettes smoked and accelerate their cigarette consumption when the brand of choice is menthol.35

From the social environment perspective, menthol cigarettes are advertised extensively in neighborhoods that are low-income or have a high proportion of minority residents.36 A 2012 study reported that schools in California with a higher proportion of black students and in areas with more school-age youth had more retail tobacco advertising, including menthol cigarette advertising.37

While previous studies have examined trends and factors associated with menthol cigarette smoking in adults,11,20,23,25,38 the most recent US study focusing on youth trends in menthol use utilized data through 2014.20

This study provides updated estimates and trends in youth menthol and non-menthol smoking from 2011 to 2018. Using nationally representative data from the National Youth Tobacco Survey (NYTS), this study assessed: (1) trends in the prevalence of past 30-day cigarette smoking by menthol status among US middle and high school students from 2011 to 2018; (2) trends in the proportion of past 30-day menthol smoking among youth smokers, overall and stratified by race/ethnicity, sex, and school level; and (3) factors associated with menthol cigarette use among youth smokers during 2016–2018.

Trends in Overall Cigarette Smoking and Menthol Cigarette Smoking: 2011–2018

Table 1 provides estimates of the trends of youth current cigarette smoking from 2011 to 2018, including by menthol use status. From 2011 to 2014, the prevalence of all current cigarette smoking among youth significantly decreased (10.8% to 6.3%, APC1: −17.0% [95% CI: −23.5, −10.0]), while not significantly changing from 2014 to 2018 (6.3% to 5.4%, APC2: −5.7% [95% CI: −11.5, 0.6]). Similarly, the prevalence of youth current menthol smoking significantly decreased from 2011 to 2016 (6.2% to 2.6%, APC1: −16.0% [95% CI: −21.3, −10.4]), but did not significantly change from 2016 to 2018 (2.6% to 2.5%, APC2: −1.8% [95% CI: −23.3, 25.8]). Pairwise parallel tests show differences between prevalence trends in menthol and non-menthol (p ≤ .001).

Table 1. -Percentage and Trend of Current Menthol Cigarette Smokingab During the Preceding 30 Days, by School Level, Sex, and Race/Ethnicity—National Youth Tobacco Survey, United States, 2011–2018

20112012201320142015201620172018Joinpoint regression trendsc
% (95% CI)d% (95% CI)d% (95% CI)d% (95% CI)d% (95% CI)d% (95% CI)d% (95% CI)d% (95% CI)dYearAPC1 (95% CI)d,eYearAPC2 (95% CI)d,e
Estimated number of smokersf (N             
 Total smokers  2 880 000 2 510 000 2 260 000 1 680 000 1 660 000 1 450 000 1 390 000 1 410 000 — — — — 
 Menthol smokers  1 650 000 1 370 000 1 200 000 900 000 850 000 690 000 680 000 640 000 — — — — 
 Non-menthol smokers  1 090 000 1 030 000 940 000 700 000 710 000 660 000 630 000 660 000 — — — — 
 Unknown menthol status  130 000 110 000 110 000 80 000 80 000 90 000 80 000 90 000 — — — — 
Prevalence of smoking by menthol status among all youth              
 Overall smoking  10.8 (9.3, 12.6) 9.4 (8.4, 10.6) 8.5 (7.5, 9.5) 6.3 (5.7, 7.0) 6.2 (5.2, 7.4) 5.5 (4.7, 6.4) 5.3 (4.6, 6.0) 5.4 (4.7, 6.1) 2011–2014 −17.0 (−23.5, −10.0) 2014–2018 −5.7 (−11.5, 0.6) 
 Menthol smoking  6.2 (5.2, 7.4) 5.2 (4.5, 5.9) 4.5 (3.9, 5.3) 3.4 (2.9, 4.0) 3.2 (2.7, 3.9) 2.6 (2.2, 3.1) 2.6 (2.2, 3.1) 2.5 (2.1, 2.8) 2011–2016 16.0 (21.3, −10.4) 2016–2018 −1.8 (−23.3, 25.8) 
 Non-menthol smoking  4.1 (3.5, 4.8) 3.9 (3.2, 4.7) 3.5 (3.0, 4.2) 2.6 (2.3, 3.0) 2.7 (2.1, 3.5) 2.5 (1.9, 3.2) 2.4 (2.0, 2.8) 2.5 (2.2,3.0) 2011–2018 7.6 (10.9, −4.1) — — 
 Unknown menthol status  0.5 (0.4, 0.6) 0.4 (0.3, 0.5) 0.4 (0.3, 0.6) 0.3 (0.2, 0.4) 0.3 (0.2, 0.5) 0.4 (0.3, 0.5) 0.3 (0.2, 0.4) 0.4 (0.3, 0.5) 2011–2014 −13.5 (−37.4, 19.5) 2014–2018 7.4 (−9.2, 27.1) 
Proportion by menthol status among all youth smokers              
 Menthol smoking  57.3 (53.7, 60.9) 54.6 (49.5, 59.5) 53.2 (47.9, 58.4) 53.6 (47.9, 59.1) 51.7 (45.8, 57.4) 47.8 (41.1, 54.6) 48.6 (43.6, 53.8) 45.7 (42.1, 49.4) 2011–2018 3.0 (3.6, −2.4) — — 
 Non-menthol smoking  38.2 (34.5, 41.9) 41.0 (36.1, 46.2) 41.8 (36.7, 47.2) 41.7 (36.4, 47.2) 43.1 (37.3, 49.0) 45.6 (39.0, 52.3) 45.4 (40.4, 50.4) 47.3 (43.5, 51.1) 2011–2018 +2.9 (2.3, 3.4) — — 
 Unknown menthol status  4.5 (3.5, 5.8) 4.4 (3.5, 5.5) 5.0 (3.6, 6.9) 4.8 (3.5, 6.5) 5.3 (4.1, 6.8) 6.7 (5.0, 8.8) 6.0 (4.5, 8.0) 7.0 (5.6, 8.7) 2011–2018 +7.1 (4.5, 9.8) — — 
Proportion of menthol use among current smokers by demographic characteristicsg              
 School level Middle School 53.2 (47.3, 59.0) 41.6 (33.6, 50.0) 49.1 (42.4, 55.9) 48.4 (38.1, 58.8) 48.8 (39.4, 58.3) 45.7 (35.8, 55.9) 43.3 (33.0, 54.2) 42.0 (33.4, 51.1) 2011–2018 −2.6 (−5.2, 0.1) — — 
 High School 58.2 (54.0, 62.3) 56.9 (51.7, 62.0) 54.1 (48.0, 60.1) 54.5 (48.4, 60.4) 52.2 (45.7, 58.7) 48.0 (40.7, 55.4) 49.0 (43.6, 54.4) 46.1 (41.9, 50.3) 2011–2018 3.2 (3.8, −2.6) — — 
 Sex Female 62.2 (56.4, 67.6) 56.9 (50.6, 63.0) 56.1 (50.8, 61.3) 55.8 (48.7, 62.7) 56.2 (48.8, 63.3) 50.4 (40.3, 60.5) 48.2 (41.6, 54.9) 45.9 (39.7, 52.2) 2011–2018 3.8 (5.0, −2.5) — — 
 Male 54.0 (49.4, 58.5) 52.9 (48.0, 57.8) 51.0 (44.7, 57.2) 51.8 (45.4, 58.1) 48.7 (42.7, 54.7) 46.0 (39.6, 52.5) 48.3 (41.9, 54.8) 45.4 (40.7, 50.2) 2011–2018 2.4 (3.1, −1.7) — — 
 Race/ ethnicityh NH white 55.4 (51.0, 59.6) 50.0 (43.9, 56.1) 46.0 (39.6, 52.5) 51.4 (43.8, 59.0) 44.4 (36.4, 52.8) 42.2 (34.2, 50.7) 43.7 (36.9, 50.7) 42.8 (37.9, 47.8) 2011–2018 3.6 (5.2, −1.9) — — 
 NH black 80.5 (73.6, 86.0) 76.9 (65.0, 85.6) 70.2 (59.7, 78.9) 70.5 (60.1, 79.1) 81.8 (74.9, 87.2) 64.7 (53.6, 74.5) 71.9 (55.5, 84.0) 51.4 (32.8, 69.7) 2011–2018 −1.7 (−5.5, 2.3) — — 
 Hispanic 52.4 (47.0, 57.8) 54.3 (47.7, 60.8) 59.3 (52.0, 66.2) 52.3 (44.3, 60.1) 54.9 (48.6, 61.1) 56.0 (43.9, 67.4) 54.6 (48.1, 60.9) 50.6 (44.1, 57.0) 2011–2018 −0.3 (−2.1, 1.6) — — 
 NH Other Race 60.1 (51.4, 68.1) 57.5 (47.7, 66.7) 63.3 (54.1, 71.5) 58.1 (48.9, 66.8) 56.7 (45.2, 67.4) 51.9 (39.7, 63.9) 51.0 (39.4, 62.5) 44.8 (35.0, 54.9) 2011–2013 +2.8 (−7.3, 13.9) 2013–2018 5.7 (8.4, −3.0) 
aCurrent cigarette smoking was determined by asking, “During the past 30 days, on how many days did you smoke cigarettes?.”
bMenthol cigarette status was determined by asking, “Menthol cigarettes are cigarettes that taste like mint. During the past 30 days, were the cigarettes that you usually smoked menthol?” and “During the past 30 days, what brand of cigarettes did you usually smoke?” Among past 30-day cigarette smokers, those responding “Yes” to the menthol question, or who reported “Newport” or “Kool” as the usual cigarette brand, were classified as menthol smokers; those who reported “No” to the menthol question, or who did not report “Newport” or “Kool” brands, were classified as non-menthol smokers; all other past 30-day cigarette smokers were classified as missing menthol smoking status.
cJoinpoint regression is used to identify statistically significant trend change points and the APC in each trend segment using a Monte Carlo permutation method allowing for a maximum of 1 joinpoint. For example, this is reflected in the proportion of male menthol smokers among all youth smokers where an inflection point was found in 2015. No inflection points were found for any other covariates.
d95% CI = 95% confidence interval.
eAPC = Annual Percent Change. Bold indicates significance at the p < .05 level.
fThe estimated number of cigarette smokers were rounded down to the nearest 10 000.
gProportions reflect the percentage of youth menthol smokers among youth current smokers among each covariate.
h“NH” refers to “non-Hispanic”.

The proportion of menthol smoking among youth current cigarette smokers significantly decreased (57.3% to 45.7%, APC: −3.0% [95% CI: −3.6, −2.4]) from 2011 to 2018, while the proportion of non-menthol smoking (38.2% to 47.3%, APC: 2.9% [95% CI: 2.3, 3.4]) and those with unknown menthol smoking status (4.5% to 7.0%, APC: 7.1% [95% CI: 4.5, 9.8]) significantly increased.

Pairwise parallel tests for the proportion of youth smokers by menthol status showed differences in trends between menthol and non-menthol (p = .004), menthol and unknown menthol status (p = .007), and non-menthol and unknown menthol status (p = .007).

While current menthol smoking generally decreased among all youth from 2011 to 2018, some differences were observed by demographic subgroup. The proportion of menthol use among high school cigarette smokers significantly declined (58.2% to 46.1%, APC: −3.2% [95% CI: −3.8, −2.6]) whereas the proportion of menthol use among middle school cigarette smokers did not significantly change (53.2% to 42.0%, APC: −2.6% [95% CI: −5.2, 0.1]).

For both female and male cigarette smokers, the proportion of menthol use significantly declined (females: 62.2% to 45.9%, APC: −3.8% [95% CI: −5.0, −2.5]; males: 54.0% to 45.4%, APC: −2.4% [95% CI: −3.1, −1.7]). Pairwise parallel tests for the proportion of menthol use by sex show similar trends between male and female youth menthol smokers (p = .243).

By race and ethnicity, the proportion of menthol use among non-Hispanic white youth cigarette smokers significantly decreased (55.4% to 42.8%, APC: −3.6% [95% CI: −5.2, −1.9]); however, menthol use did not significantly change among non-Hispanic blacks (80.5% to 51.4%, APC: −1.7% [95% CI: −5.5, 2.3]) and Hispanics (52.4% to 50.6%, APC: −0.3% [95% CI: −2.1, −1.6]).

Among non-Hispanic Other Race smokers, the proportion of menthol use did not significantly change from 2011 to 2013 (60.1% to 63.3%, APC1: 2.8% [95% CI: −7.3, 13.9]), but then significantly declined from 2013 to 2018 (63.3% to 44.8%, APC2: −5.7% [95% CI: −8.4, −3.0]).

Characteristics of Current Cigarette Smoking by Menthol Status: 2016–2018

Table 2 presents the proportion of menthol and non-menthol use among youth smokers for each demographic characteristic. In 2016–2018, 50.7% of youth smokers reported using menthol cigarettes. Proportions of menthol and non-menthol use were nearly equal among males (53.6% vs. 55.3%, respectively; p = .499) and by school level (84.2% of menthol and non-menthol smokers were in high school; p = .999); however, a significantly higher proportion of menthol smokers were either non-Hispanic black, Hispanic, or non-Hispanic Other Race (43.3% of menthol smokers and 30.4% of non-menthol smokers were a race other than non-Hispanic white; p < .001).

Table 2. – Characteristics of Past 30-Day Cigarette Smokers by Menthol Smoking Statusa—National Youth Tobacco Survey, United States, 2016–2018

Menthola Non-mentholape
nb% (95% CI)cWeighted Ndnb% (95% CI)cWeighted Nd
Overall  1529 50.7 (47.5, 53.9) 670 000 1304 49.3 (46.1, 52.5) 650 000  
Sex Male 829 53.6 (50.1, 57.1) 350 000 730 55.3 (51.5, 59.1) 350 000  
 Female 677 46.4 (42.9, 49.9) 300 000 564 44.7 (41.0, 48.5) 290 000 .499 
School levels Middle school 256 15.8 (13.1, 18.9) 100 000  224 15.8 (13.0, 19.0) 100 000   
 High school 1239 84.2 (81.2, 86.9) 550 000  1072 84.2 (81.0, 87.0) 540 000  .999 
Race/ethnicity Non-Hispanic white 713 56.7 (52.4, 60.8) 360 000 773 69.6 (65.4, 73.6) 440 000  
 Non-Hispanic black 151 8.3 (6.4, 10.6) 50 000 54 3.4 (2.4, 4.8) 20 000  
 Hispanic 448 26.1 (22.9, 29.6) 160 000 288 18.3 (15.3, 21.8) 110 000  
 Non-Hispanic Other Race 145 9.0 (7.2, 11.1) 50 000 145 8.7 (7.0, 10.7) 50 000 <.001 
Number of days smoked in the past 30 days 1–5 days (infrequent) 729 48.2 (44.7, 51.7) 320 000 769 57.6 (54.1, 61.2) 370 000  
 6–19 days (moderate) 328 21.9 (19.3, 24.7) 147 000 267 20.0 (17.4, 22.9) 130 000  
 ≥20 days (frequent) 427 30.0 (27.0, 33.0) 202 000 268 22.3 (18.6, 26.5) 140 000 <.001 
Number of cigarettes smoked per dayf <1 cigarette/day 304 19.7 (17.2, 22.5) 130 000 371 27.8 (24.7, 31.2) 180 000  
 1 cigarettes/day 294 20.6 (17.8, 23.7) 130 000 284 22.2 (19.3, 25.3) 140 000  
 2–5 cigarettes/day 562 38.9 (35.3, 42.7) 250 000 427 32.5 (29.2, 36.0) 210 000  
 More than 5 cigarettes/day 345 20.7 (17.9, 23.8) 130 000 204 17.5 (14.3, 21.2) 110 000 <.001 
Lifetime number of cigarettes 5 or less 265 16.1 (13.9, 18.7) 100 000 332 24.1 (21.0, 27.4) 150 000  
 6–25 328 21.4 (19.0, 24.1) 140 000 314 23.1 (20.3, 26.2) 150 000  
 26–99 245 17.4 (14.7, 20.6) 110 000 195 15.9 (13.5, 18.6) 100 000  
 ≥100 683 45.0 (41.6, 48.4) 300 000 452 36.9 (33.0, 41.1) 230 000 <.001 
E-cigarette use Current userg 857 61.4 (56.9, 65.7) 395 000 717 58.0 (53.7, 62.2) 367 000  
 Ever, but not current userh 400 26.4 (22.7, 30.4) 170 000 333 28.6 (24.9, 32.6) 181 000  
 Never user 199 12.3 (10.1, 14.8) 79 000 206 13.5 (11.1, 16.2) 85 000 .465 
Cigar use Current userg 819 55.2 (51.0, 59.4) 351 000 547 45.4 (41.9, 48.9) 279 000  
 Ever, but not current userh 394 28.3 (25.3, 31.6) 180 000 370 31.1 (27.9, 34.4) 191 000  
 Never user 217 16.4 (13.9, 19.3) 104 000 312 23.5 (21.0, 26.3) 145 000 <.001 
Hookah use Current userg 431 30.6 (27.0, 34.5) 194 000 246 19.1 (16.1, 22.5) 118 000  
 Ever, but not current userh 336 24.0 (21.3, 27.0) 152 000 269 24.8 (21.8, 28.1) 153 000  
 Never user 656 45.4 (41.5, 49.3) 287 000 704 56.1 (52.0, 60.1) 346 000 <.001 
Smokeless tobacco usei Current userg 627 44.1 (40.6, 47.7) 288 000 531 41.6 (38.4, 44.8) 267 000  
 Ever, but not current userh 256 18.1 (15.5, 21.2) 119 000 243 20.4 (17.8, 23.2) 131 000  
 Never user 589 37.8 (34.2, 41.4) 247 000 506 38.1 (35.1, 41.2) 245 000 .417 
Other tobacco usej Current userg 430 34.3 (30.9, 37.9) 204 000 343 32.2 (26.8, 38.1) 189 000  
 Ever, but not current userh 292 20.7 (18.1, 23.6) 123 000 260 22.0 (19.1, 25.1) 129 000  
 Never user 620 45.0 (41.1, 48.9) 267 000 563 45.8 (41.0, 50.8) 269 000 .709 
Current, non-cigarette tobacco use, by flavor use statusk Does not use a non- cigarette tobacco product 222 13.4 (11.4, 15.7) 90 000 221 16.7 (14.3, 19.5) 109 000  
 Flavored, non-cigarette tobacco use 938 64.0 (60.6, 67.2) 429 000 707 55.8 (52.0, 59.6) 364 000  
 Non-flavored, non-cigarette tobacco use 166 9.7 (8.0, 11.7) 65 000 219 15.0 (12.7, 17.6) 97 000  
 Non-cigarette tobacco use, flavor unknown 191 12.9 (10.8, 15.4) 87 000 149 12.5 (10.0, 15.5) 87 000 .008 
Household tobacco use Yes 977 75.4 (71.2, 79.2) 290 000 809 67.6 (63.6, 71.4) 270 000  
 No 365 24.6 (20.8, 28.8) 90 000 386 32.4 (28.6, 36.4) 130 000 .008 
Speak English at home Yes 949 71.1 (67.1, 74.8) 430 000 905 77.1 (73.8, 80.0) 460 000  
 No 431 28.9 (25.2, 32.9) 170 000 309 22.9 (20.0, 26.2) 130 000 .004 
Ease of buying tobacco Easy/Somewhat easy 1117 78.6 (75.6, 81.3) 490 000 985 78.1 (74.8, 81.0) 480 000  
 Not easy 309 21.4 (18.7, 24.4) 130 000 245 20.5 (21.9, 25.2) 130 000 .830 
Believe cigarettes are harmful Some/A lot 894 65.9 (62.1, 74.4) 400 000 841 71.3 (68.0, 74.4) 430 000  
 No/Little 487 34.1 (30.5, 37.9) 200 000 370 28.7 (25.6, 32.0) 170 000 .024 
Believe tobacco products are harmful Strongly disagree/Disagree 454 30.6 (27.3, 34.0) 190 000 340 25.6 (22.9, 28.5) 150 000  
 Strongly agree/Agree 950 69.4 (66.0, 72.7) 430 000 888 74.4 (71.5, 77.1) 450 000 .026 
Craving tobacco Yes 812 56.4 (53.1, 59.6) 360 000 623 51.5 (47.8, 55.3) 320 000  
 No 651 43.6 (40.4, 46.9) 280 000 639 48.5 (44.7, 52.2) 300 000 .037 
Want tobacco within 30 min of waking Yes 442 30.7 (27.8, 33.8) 190 000 337 28.0 (24.2, 32.1) 170 000  
 No 1006 69.3 (66.2, 72.2) 430 000 923 72.0 (67.9, 75.8) 450 000 .241 
aAmong current cigarette smokers, menthol cigarette smoking was measured using two questions. The first question was: “Menthol cigarettes are cigarettes that taste like mint. During the past 30 days, were the cigarettes that you usually smoked menthol?.” Responses include: “I did not smoke cigarettes in the past 30 days,” “Yes,” “No,” or “Not Sure.” The second question was: “During the past 30 days, what brand of cigarettes did you usually smoke? (Choose only one answer).” Responses include: “I did not smoke cigarettes during the past 30 days,” “I did not smoke a usual brand,” “American Spirit,” “Camel,” “GPC, Basic, or Doral,” “Kool,” “Lucky Strike,” “Marlboro,” “Newport,” “Parliament,” “Virginia Slims,” “Some other brand not listed here,” or “Not sure.” Respondents who reported current cigarette smoking and answered (1) “Yes” past 30-day menthol cigarette smoking or (2) reported that they smoke “Kool” or “Newport” brands were classified as current menthol cigarette smokers. Those missing responses for both questions (n = 216) were excluded from this analysis.
bUnweighted n for 2016–2018 combined.
c95% CI = 95% confidence interval.
dBecause 2016–2018 were combined for this analysis, the weights were averaged, producing averaged point estimates (including the proportions and estimated number of smokers). The estimated number of cigarette smokers were rounded down to the nearest 10 000 persons.
ep-value is chi-square testing differences between menthol status groups (menthol vs. non-menthol). Bold indicates significance at p < .05 level.
fCutoffs determined based on the distribution.
gUsed in the past 30 days.
hUsed in their lifetime, excluding those who used in the past 30 days.
iSmokeless tobacco use includes chewing tobacco, dip, snuff, snus, and dissolvable tobacco.
jOther tobacco includes bidis, pipe tobacco, and roll-your-own cigarettes.
kCurrent, non-cigarette flavored tobacco use status was assessed among youth who used any non-cigarette tobacco product at least one day in the past 30 days, utilizing the question: “Which of the following tobacco products that you used in the past 30 days were flavored to taste like menthol (mint), alcohol (wine, cognac), candy, fruit, chocolate or any other flavors (Select one or more)?” Among current users, those who selected the corresponding product for the flavor question (eg, they smoked cigars more than one day in the past 30 days and selected “cigars, cigarillos, or little cigars” for the flavor product question) were defined as a “flavored, non-cigarette tobacco user” for that product. If a current user selected “I did not use any of the flavored tobacco products listed above in the past 30 days,” they were defined as a “non-flavored, non-cigarette tobacco user.” Lastly, if a current user did not provide a response to the flavor question (ie, missing), they were defined as a “non-cigarette tobacco user, flavor status unknown.” If a respondent did not use a non-cigarette tobacco product in the past 30 days, they were defined as a “does not use a non-cigarette tobacco product.”

For smoking pattern characteristics, higher proportions of menthol smokers reported smoking ≥20 in the past 30 days (menthol: 30.0%; non-menthol: 22.3%; p < .001), ≥2 cigarettes per day (menthol: 59.6%; non-menthol: 50.0%; p < .001), and ≥100 cigarettes in their lifetime (menthol: 45.0%; non-menthol: 36.9%; p < .001). A higher proportion of menthol smokers reported use of flavored, non-cigarette tobacco products (menthol: 64.0%; non-menthol: 55.8%, p < .001), whereas more non-menthol smokers reported current non-flavored, non-cigarette tobacco use (menthol: 9.7%; non-menthol: 15.0%, p < .001) or not using a non-cigarette tobacco product (menthol: 13.4%; non-menthol: 16.7%; p < .001).

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More information: Rosemary Hiscock et al, Tobacco industry tactics to circumvent and undermine the menthol cigarette ban in the UK, Tobacco Control (2020). DOI: 10.1136/tobaccocontrol-2020-055769

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