RESEARCH PAPER
Characterising smokers of menthol and flavoured cigarettes, their attitudes towards tobacco regulation, and the anticipated impact of the Tobacco Products Directive on their smoking and quitting behaviours: The EUREST-PLUS ITC Europe Surveys
Mateusz Zatoński 1, 2, 3  
,  
Aleksandra Herbeć 4, 5, 6
,  
Witold Zatoński 1, 3
,  
Ute Mons 7
,  
Geoffrey T. Fong 8, 9
,  
Tibor Demjén 10
,  
Yannis Tountas 11
,  
Antigona C. Trofor 12, 13
,  
Esteve Fernández 14, 15
,  
Ann McNeill 4, 16
,  
Marc Willemsen 17
,  
Karin Hummel 17
,  
Anne C. K. Quah 18
,  
Christina N. Kyriakos 19, 20
,  
 
 
More details
Hide details
1
Health Promotion Foundation (HPF), Warsaw, Poland
2
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
3
European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
4
UK Centre for Tobacco and Alcohol Studies, London, United Kingdom
5
Department of Behavioural Science and Health, University College London, London, United Kingdom
6
Maria Skłodowska-Curie Institute - Oncology Center, Warsaw, Poland
7
Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
8
Department of Psychology & School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
9
Ontario Institute for Cancer Research, Toronto, Canada
10
Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
11
University of Athens (UoA), Athens, Greece
12
University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
13
Aer Pur Romania, Bucharest, Romania
14
Tobacco Control Unit, Catalan Institute of Oncology (ICO), and Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Catalonia, Spain
15
School of Medicine and Health Sciences, University of Barcelona, Catalonia, Spain
16
National Addiction Centre, King’s College London, London, United Kingdom
17
Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
18
Department of Psychology, University of Waterloo (UW), Waterloo, Canada
19
European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
20
University of Crete (UoC), Heraklion, Greece
CORRESPONDING AUTHOR
Mateusz Zatoński   

Health Promotion Foundation (HPF), Warsaw, Poland
Publish date: 2018-12-14
 
Tob. Induc. Dis. 2018;16(Suppl 2):A4
KEYWORDS
TOPICS
Smoking
 
*EUREST-PLUS consortium members: European Network on Smoking and Tobacco Prevention (ENSP), Belgium: Constantine I. Vardavas, Andrea Glahn, Christina N. Kyriakos, Dominick Nguyen, Cornel Radu-Loghin, Polina Starchenko University of Crete (UoC), Greece: Aristidis Tsatsakis, Charis Girvalaki, Chryssi Igoumenaki, Katerina Nikitara, Sophia Papadakis, Aikaterini Papathanasaki, Manolis Tzatzarakis, Alexander I. Vardavas Kantar Public (TNS), Belgium: Nicolas Bécuwe, Lavinia Deaconu, Sophie Goudet, Christopher Hanley, Oscar Rivière Smoking or Health Hungarian Foundation (SHHF), Hungary: Tibor Demjén,Judit Kiss, Piroska A. Kovacs Catalan Institut of Oncology (ICO); Bellvitge Biomedical Research Institute (IDIBELL), Spain: Esteve Fernández, Yolanda Castellano, Marcela Fu, Sarah O. Nogueira, Olena Tigova Kings College London (KCL), United Kingdom: Ann McNeill, Katherine East, Sara C. Hitchman Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Germany: Ute Mons, Sarah Kahnert University of Athens (UoA), Greece: Yannis Tountas, Panagiotis Behrakis, Filippos T. Filippidis, Christina Gratziou, Paraskevi Katsaounou, Theodosia Peleki, Ioanna Petroulia, Chara Tzavara Aer Pur Romania, Romania: Antigona C. Trofor, Marius Eremia, Lucia Lotrean, Florin Mihaltan European Respiratory Society (ERS), Switzerland; Goethe University Frankfurt, Germany: Gernot Rohde, Tamaki Asano, Claudia Cichon, Amy Far, Céline Genton, Melanie Jessner, Linnea Hedman, Christer Janson, Ann Lindberg, Beth Maguire, Sofia Ravara, Valérie Vaccaro, Brian Ward Maastricht University, the Netherlands: Marc Willemsen, Hein de Vries, Karin Hummel, Gera E. Nagelhout Health Promotion Foundation (HPF), Poland: Witold A. Zatoński, Aleksandra Herbeć, Kinga Janik-Koncewicz, Krzysztof Przewoźniak, Mateusz Zatoński University of Waterloo (UW); Ontario Institute for Cancer Research, Canada: Geoffrey T. Fong, Thomas K. Agar, Pete Driezen, Shannon Gravely, Anne C. K. Quah, Mary E. Thompson
ABSTRACT
Introduction:
Little research exists on the sociodemographic characteristics of menthol and flavoured cigarette (MFC) smokers in Europe. This study assessed the proportion of MFC smokers in Europe, their sociodemographic characteristics, and their attitudes towards tobacco control measures.

Methods:
Cross-sectional data were collected in 2016 among 10760 adult current smokers from 8 European countries (ITC Europe Project and EUREST-PLUS). Smokers of menthol, other flavoured, unflavoured tobacco, or no usual brand were compared on sociodemographic characteristics, attitudes towards a range of tobacco control measures (e.g. ban on flavouring), and on intentions regarding their smoking behaviour following the ban on flavoured tobacco. Data were analysed in SPSS Complex Samples Package using univariate analyses.

Results:
Among the respondents, 7.4% smoked menthol cigarettes and 2.9% other flavoured tobacco, but large differences existed between countries (e.g. 0.4% smokers smoked menthol cigarettes in Spain vs 12.4% in England). Compared to other groups, menthol cigarette smokers were younger, more likely to be female, better educated, had higher household income, and smoked fewer cigarettes (all p<0.001). A quarter of menthol smokers supported a ban on additives, compared with almost half of all other smokers (p<0.001). In case of a ban on flavourings, around a fifth of all MFC smokers intended to switch to another brand, and a third to reduce the amount they smoked or to quit smoking, but there was no consistent pattern across MFC smokers among the countries.

Conclusions:
The ban on flavourings introduced by the EU Tobacco Products Directive (extended to 2020 for menthols) will affect one in ten smokers in the countries surveyed, which provides an opportunity for targeting these groups with cessation programmes. However, smokers of menthol and flavoured cigarettes in the different European countries are a heterogeneous group and may need different approaches.

 
REFERENCES (33)
1. Lewis MJ, Wackowski O. Dealing With an Innovative Industry: A Look at Flavored Cigarettes Promoted by Mainstream Brands. American Journal of Public Health. 2006;96(2):244-251. doi:10.2105/ajph.2004.061200
2. Sutton CD, RG Robinson. The marketing of menthol cigarettes in the United States: Populations, messages, and channels. Nicotine & Tobacco Research. 2004;6(Suppl_1):S83-S91. doi:10.1080/14622203310001649504
3. Manning KC, Kelly KJ, Comello ML. Flavoured cigarettes, sensation seeking and adolescents’ perceptions of cigarette brands. Tob Control. 2009;18(6):459-465. doi:10.1136/tc.2009.029454
4. Kuiper NM, Gammon D, Loomis B, et al. Trends in Sales of Flavored and Menthol Tobacco Products in the United States During 2011-2015. Nicotine & Tobacco Research. 2018;20(6):698-706. doi:10.1093/ntr/ntx123
5. Kreslake JM, Wayne GF, Connolly GN. The Menthol Smoker: Tobacco Industry Research on Consumer Sensory Perception of Menthol Cigarettes and its Role in Smoking Behavior. Nicotine & Tobacco Research. 2008;10(4):705-715. doi:10.1080/14622200801979134
6. Kaleta D, Polanska K, Bak-Romaniszyn L, Wojtysiak P. Perceived Relative Harm of Selected Cigarettes and Non-Cigarette Tobacco Products—A Study of Young People from a Socio-Economically Disadvantaged Rural Area in Poland. International Journal of Environmental Research and Public Health. 2016;13(9):885. doi:10.3390/ijerph13090885
7. Hersey JC, Ng SW, Nonnemaker J, et al. Are Menthol Cigarettes a Starter Product for Youth? Nicotine & Tobacco Research. 2006;8(3):403-413. doi:10.1080/14622200600670389
8. Villanti AC, Richardson A, Vallone DM, Rath JM. Flavored Tobacco Product Use Among U.S. Young Adults. American Journal of Preventive Medicine. 2013;44(4):388-391. doi:10.1016/j.amepre.2012.11.031
9. World Health Organization. Fact sheet on ingredients in tobacco products. In: World Health Organization, ed. Geneva: WHO Press; 2015.
10. Feirman SP, Lock D, Cohen JE, Holtgrave DR, Li T. Flavored Tobacco Products in the United States: A Systematic Review Assessing Use and Attitudes. Nicotine Tob Res. 2016;18(5):739-749. doi:10.1093/ntr/ntv176
11. Curtin GM, Sulsky SI, Van Landingham C, et al. Patterns of menthol cigarette use among current smokers, overall and within demographic strata, based on data from four U.S. government surveys. Regulatory Toxicology and Pharmacology. 2014;70(1):189-196. doi:10.1016/j.yrtph.2014.06.018
12. Okuyemi KS, Ebersole-Robinson M, Nazir N, Ahluwalia JS. African-American menthol and nonmenthol smokers: differences in smoking and cessation experiences. Journal of the National Medical Association. 2004;96(9):1208-1211.
13. Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004–2014. Tobacco Control. 2016;25. doi:10.1136/tobaccocontrol-2016-053329
14. Rose SW, Emery SL, Ennett S, McNaughton Reyes HL, Scott JC, Ribisl KM. Public Support for Family Smoking Prevention and Tobacco Control Act Point-of- Sale Provisions: Results of a National Study. American Journal of Public Health. 2015;105(10):e60-e67. doi:10.2105/ajph.2015.302751
15. Wackowski OA, Manderski MTB, Delnevo CD. Young Adults’ Behavioral Intentions Surrounding a Potential Menthol Cigarette Ban. Nicotine & Tobacco Research. 2014;16(6):876-880. doi:10.1093/ntr/ntu003
16. O’Connor RJ, Bansal-Travers M, Carter LP, Cummings KM. What would menthol smokers do if menthol in cigarettes were banned? Behavioral intentions and simulated demand. Addiction. 2012;107(7):1330-1338. doi:10.1111/j.1360-0443.2012.03822.x
17. Oxford Economics. The influence of the availability of menthol cigarettes on youth smoking prevalence. Commissioned by Philip Morris International. 2012.
18. Giovino GA, Sidney S, Gfroerer J, et al. Epidemiology of menthol cigarette use. Nicotine Tob Res. 2004;6 Suppl 1:S67-81. doi:10.1080/14622203710001649696
19. WHO Study Group on Tobacco Product Regulation (TobReg). Advisory note: banning menthol in tobacco products. Geneva: World Health Organization; 2016.
20. Borland R, Yong HH, Siahpush M. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control. 2006;15(suppl 3):iii34-iii41. doi:10.1136/tc.2004.008748
21. Joosens L, Ross H, Stokłosa M. EU Policy and Cigarette Smuggling: Assessing the Impacts. In: Workshop on Cigarette Smuggling. Brussels: European Parliament, Directorate-General for Internal Policies; 2014.
22. Vardavas CI, Bécuwe N, Demjén T, et al. Study Protocol of European Regulatory Science on Tobacco (EURESTPLUS): Policy implementation to reduce lung disease. Tobacco Induced Diseases. 2018;16 (Suppl 2:A2). doi:10.18332/tid/93305
23. ITC Project. ITC Four Country Smoking and Vaping Survey Wave 1 (2017). Technical Report. In: University of Waterloo, Medical University of South Carolina, Cancer Council Victoria, King’s College London, eds. http://www. itcproject.org/files/4CV1_Tech.... pdf. Published, 2017. Accessed June 5, 2018.
24. Fong GT, Thompson ME, Boudreau C, et al. The Conceptual Model and Methods of Wave 1 (2016) of the EUREST-PLUS ITC 6 European Countries Survey. Tobacco Induced Diseases. 2018;16(Suppl 2:Α3). doi:10.18332/tid/99881
25. Fong GT, Cummings KM, Borland R, et al. The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project. Tobacco Control. 2006;15(suppl 3):iii3-iii11. doi:10.1136/tc.2005.015438
26. International Tobacco Control (ITC) Evaluation Project. Surveys. http://www.itcproject.org/surv.... Published, 2018. Accessed June 5, 2018.
27. Nagelhout GE, Willemsen MC, Thompson ME, Fong GT, van den Putte B, de Vries Hein. Is web interviewing a good alternative to telephone interviewing? Findings from the International Tobacco Control (ITC) Netherlands survey. BMC Public Health. 2010;10:351. doi:10.1186/1471-2458-10-351
28. Zethof D, Nagelhout GE, de Rooij M, et al. Attrition analysed in five waves of a longitudinal yearly survey of smokers: findings from the ITC Netherlands survey. Eur J Public Health. 2016;26(4). doi:10.1093/eurpub/ckw037
29. ITC Project. ITC Netherlands Survey Wave 1 to 8 (2008-2014). Technical Report. University of Waterloo, Maastricht University. http://www.itcproject.org/file... ITC_NLWaves1-8TechReport-v2.pdf. Published, 2015. Accessed June 5, 2018.
30. Trofor L, Gherghesanu R, Chirita R, Trofor A. Outcomes of smoking cessation in moderate nicotine dependent smokers. European Psychiatry. 2014;29(1). doi:10.1016/s0924-9338(14)78375-0
31. Kaleta D, Usidame B, Szosland-Fałtyn A, Makowiec- Dąbrowska T. Use of flavoured cigarettes in Poland: data from the global adult tobacco survey (2009- 2010). BMC Public Health. 2014;14(1):127. doi:10.1186/1471-2458-14-127
32. Pisinger C, Jorgensen T, Toft U. A multifactorial approach to explaining the stagnation in national smoking rates. Dan Med J. 2018;65(2).
33. SKIM. The impact of a ban on menthol cigarettes on illicit trade in Poland. Philip Morris International. 2013
eISSN:1617-9625