Smoking prevalence and purchasing of menthol cigarettes since the menthol flavour ban in Great Britain: a population-based survey between 2020 and 2023

Abstract

AbstractBackgroundMenthol cigarettes have been banned in Great Britain (GB) since May 2020. Still, menthol accessories and unlabelled cigarettes perceived as mentholated are available, and people can buy menthol cigarettes overseas or illicitly. This study assessed: trends in smoking menthol cigarettes among all adults and 18-to-24-year-olds in GB between October 2020 and March 2023; trends in and differences between England, Scotland, and Wales during the same period; and purchase sources among people smoking menthol versus non-flavoured cigarettes.MethodsPopulation-weighted data were from a monthly cross-sectional survey of adults in GB. Among people smoking cigarettes, we calculated the proportion smoking menthol cigarettes across all adults and 18-to-24-year-olds, and prevalence ratios (PR) between first and last quarter. We also calculated proportions of people smoking menthol/non-flavoured cigarettes by purchase source (including illicit sources).ResultsIn the first quarter, 16.2% of adults smoking cigarettes reported menthol cigarette smoking with little to no decline throughout the study (PR=0.85, 0.71-1.01), while it declined slightly among 18-to-24-year-olds (PR=0.75, 0.63-0.89). The prevalence of menthol cigarette smoking fell by two-thirds in Wales (PR=0.36, 0.19-0.62) but remained relatively stable in England (PR=0.88, 0.72-1.06) and Scotland (PR=0.94, 0.59-1.53). The main purchasing sources were licit (93.9%), 14.8% reported illicit sources and 11.5% cross-border purchases, without notable differences from people smoking non-flavoured cigarettes.ConclusionsRoughly one million adults in GB still smoke menthol cigarettes and, with the exception of Wales, there were no noteworthy changes in the post-ban period. There was no indication that this was driven by illicit purchases.What is already known on this topicTobacco companies have used various loopholes in the legislation to circumvent the menthol cigarette ban in Great Britain and, in general, some people tend to migrate towards illicit purchases when their product is banned.What this study addsDespite the ban, menthol cigarettes have remained popular among adults who smoke in Great Britain, with roughly one in seven reporting smoking menthol cigarettes. Between October 2020 and March 2023, there was no noteworthy change in menthol cigarette smoking prevalence in the overall British adult population, but there was a sharp decline among the Welsh population.How this study might affect research, practice or policySince the majority of people who reported menthol cigarette smoking purchased cigarettes through licit sources, it might indicate that most of them either use accessories to add menthol flavour to their cigarettes or they purchase cigarette brands that are perceived to contain menthol flavouring without being labelled as such. If the aim is to reduce menthol cigarette smoking prevalence to nearly zero, policymakers in Great Britain should consider closing loopholes in the current legislation, such as prohibiting all menthol and its analogues and derivatives in all tobacco-related products, including accessories.