Characterizing smoking, cessation behaviours and attitudes toward tobacco control policies among smokers of menthol and flavored cigarettes: the EUREST-PLUS ITC Europe Surveys

Introduction:
Since May 2020, the ban on production and sale of menthol and other flavored cigarettes will come into force in the European Union countries. Then millions of cigarette smokers can quit smoking or switch to other tobacco products, both conventional and novel.

Study aim:
To assess the prevalence, socio-demographic characteristics, cessation behaviors and attitudes of menthol and other flavored cigarette smokers towards tobacco control policies and programs.

Material and Methods:
Cross-sectional data were collected in 2016 among 10,760 adult current smokers from 8 European countries (EUREST-PLUS ITC Europe Project). Smokers of menthol, other flavoured, unflavored tobacco, or no usual brand were compared on smoking prevalence, socio-demographic characteristics, tobacco dependence, motivation to quit, self-efficacy, prior cessation behaviours, and attitudes towards tobacco control measures. The univariate data analysis adjusted to few confounding factors was made with the use of SPSS Complex Samples Package.

Results:
Study results shows that around 7% of adults in all 8 analyzed European countries smoke menthol cigarettes and around 3% other flavored cigarettes. However, prevalence of menthol smoking substantially varies between countries (0.4% in Spain to 12.4% in England). Compared to other groups, menthol cigarette smokers are younger, more likely to be female, better educated, had higher household income, and smoked fewer cigarettes. In comparison to smokers of unflavored cigarettes, smokers of menthol and other flavoured cigarettes are less likely to smoke daily, tend to be less dependent and have higher quitting self-efficacy. In comparison to all other smokers, menthol smokers are less likely to support a ban on sale of flavored tobacco products, including menthol cigarettes. After enforcement of the ban, around a fifth of all menthol and flavored cigarette smokers intends to switch to another brand, and a third to reduce the amount they smoked or to quit smoking.

Conclusions:
The EU TPD ban on sale of flavored cigarettes will affect one in ten smokers in the countries surveyed and provides an opportunity for targeting these groups with tobacco control policies and cessation programs. Lower tobacco dependence rates found in smokers of menthol and other flavored cigarettes may lead to greater success rates if quit attempts are strengthened by smoking cessation programs. However, smokers of different cigarette flavours in Europe differ on a range of smoking and cessation characteristics and may need different, target-tailored approaches.