BACKGROUND: Menthol cigarette (MC) smoking has been reported to be growing in LMICs as high-income countries begin to regulate flavoured cigarettes. However, only limited information that can support regulatory action in LMICs is available on MC smoking. This study therefore sought to describe factors associated with MC smoking among South African adults who smoke daily.
METHODS: Data was collected during 2021 via an online survey of adult South Africans aged ≥ 18 years (N=10.587), including daily cigarette smokers (n=3.434). In addition to participants’ sociodemographic characteristics, information obtained included participants’ use of other tobacco or nicotine products, alcohol use, use of MC, and perception of the harm of MC compared to 'regular' cigarettes. Also obtained, were the participants’ past year quit attempts and intention to quit smoking in the next 6 months. Data were weighted to match the South African population distribution. Data analysis included chi-square statistics and multi-variable adjusted logistic regression (p<0.05).
RESULTS: Of those who smoke daily, 26.4% (22.1-31.3%) regularly smoked menthol cigarettes. About 9.4% and 58.9% perceive it to be less and just as harmful respectively. MC smoking was more common among females than males (35% vs. 21.3%; p=0.05). In the final model, MC smoking was not associated with past quit attempts but with higher odds of intention to quit (aOR=1.62; 95%CI=1.00-2.63), current weekly e-cigarette use (aOR=2.10; 1.06-4.16), problem-drinking (aOR=1.91; 1.67-3.27) and being a female (aOR=2.14; 1.34-3.42). The odds of MC smoking were higher among those with > High school education (aOR=2.37; 1.18-4.477) as compared to those with < High school education and, was higher among those who believe they are less harmful (aOR=3.51; 1.67-7.40) as compared to believing that they are just as harmful or more harmful than ‘regular’ cigarettes.
CONCLUSIONS: Menthol cigarette smoking seems more common among those looking to reduce harm from 'regular' smoking. Regulation of menthol cigarettes may benefit public health.