Dependence, plans to quit, quitting self-efficacy and past cessation behaviours among menthol and other flavoured cigarette users in Europe: The EUREST-PLUS ITC Europe Surveys

Aleksandra Herbec, Mateusz Zatonski, Witold A. Zatonski, Kinga Janik-Koncewicz, Ute Mons, Geoffrey T. Fong, Anne C.K. Quah, Pete Driezen, Tibor Demjén, Yannis Tountas, Antigona C. Trofor, Esteve Fernández, Ann McNeill, Marc Willemsen, Constantine I. Vardavas, Krzysztof Przewozniak

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Abstract

INTRODUCTION This study characterises smoking and cessationrelated behaviours among menthol and other flavoured cigarette users in Europe prior to the implementation of the European Tobacco Products Directive (TPD) ban on the sale of flavoured cigarettes. METHODS An analysis of cross-sectional data from the 2016 EUREST-PLUS ITC Europe Surveys was conducted among a sample of 10760 adult smokers from eight European Union Member States. Respondents were classified as menthol, other flavoured, unflavoured, or no usual flavour cigarette users and compared on smoking and cessation behaviours and characteristics. Data were analysed in SPSS Complex Samples Package using bivariate and multivariate regression analyses adjusted for sociodemographic characteristics, dependence, and country. RESULTS In bivariate analyses, cigarette flavour was significantly associated with all outcomes (p<0.001). After adjusting for sociodemographic characteristics, these associations attenuated but remained significant and in the same direction for dependence, self-efficacy, plans to quit, past quit attempts, and ever e-cigarette use. In fully adjusted models, compared to smokers of non-flavoured cigarettes, menthol smokers were less likely to smoke daily (AOR=0.47, 95% CI: 0.32-0.71), smoke within 30 min of waking (0.52,0.43-0.64), consider themselves addicted (0.74,0.59-0.94), and more likely to have ever used e-cigarettes (1.26,1.00-1.57); other flavoured cigarette smokers were less likely to smoke daily (0.33,0.15-0.77), and have higher self-efficacy (1.82,1.20-2.77); no usual flavour smokers were less likely to smoke daily (0.34,0.22-0.51), smoke within 30 min of waking (0.66,0.55-0.80), consider themselves addicted (0.65,0.52-0.78), have ever made a quit attempt (0.69,0.58- 0.84), have ever used e-cigarettes (0.66,0.54-0.82), and had higher self-efficacy (1.46,1.19-1.80). CONCLUSIONS Smokers of different cigarette flavours in Europe differ on smoking and cessation characteristics. The lower dependence of menthol cigarette smokers could lead to greater success rates if quit attempts are made, however cross-country differences in smoking behaviours and quitting intentions could lead to the TPD ban on cigarette flavours having differential impact if not accompanied by additional measures, such as smoking cessation support.

Original languageEnglish
Article numberA19
JournalTobacco Induced Diseases
Volume16
Issue number2
DOIs
Publication statusPublished - 31 Dec 2018
Externally publishedYes

Bibliographical note

Funding Information:
The EUREST-PLUS Project takes place with the financial support of the European Commission, Horizon 2020 HCO-6-2015 programme (EUREST-PLUS: 681109; CV) and the University of Waterloo (GTF). Additional support was provided to the University of Waterloo by the Canadian Institutes of Health Research (FDN-148477). GTF was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research. EF was supported by the Instituto de Salud Carlos III, Government of Spain (INT16/00211 and INT17/00103), co-funded by the European Regional Development Fund (FEDER), and by Ministry of Universities and Research, Government of Catalonia (2017SGR319). The Wave 1 of the ITC 4 Country E-cigarette Project in England was supported by grant P01 CA200512-01 from the National Cancer Institute of the USA, and a Foundation Grant (118096) from the Canadian Institute of Health Research. The Wave 10 of the Netherlands Project was supported by the Dutch Cancer Foundation (KWF) (UM 2014-7210). Partnering organizations include the European Network on Smoking Prevention (Belgium), Kings College London (United Kingdom), German Cancer Research Centre (Germany), Maastricht University (The Netherlands), National and Kapodistrian University of Athens (Greece), Aer Pur Romania (Romania), European Respiratory Society (Switzerland), the University of Waterloo (Canada), The Institute Català d’Oncologia (Spain), Smoking or Health Hungarian Foundation (Hungary), Health Promotion Foundation (Poland), University of Crete (Greece), and Kantar Public Brussels (Belgium).

Funding Information:
The authors declare that they have no competing interests, financial or otherwise, related to the current work. K. Przewoźniak reports grants and personal fees from the Polska Liga Walki z Rakiem (Polish League Against Cancer) and grants and personal fees from World Health Organization, outside the submitted work. C.I. Vardavas reports that he is the Strategic Development Editor of TID and that there are no conflicts of interest with this current work. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.

Funding Information:
The EUREST-PLUS project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 681109 (C.I.V.) and the University of Waterloo (G.T. Fong). Additional support was provided to the University of Waterloo by the Canadian Institutes of Health Research (FDN-148477). G.T. Fong was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research. E. Fernández is partly supported by Ministry of Universities and Research, Government of Catalonia (2017SGR319) and by the Instituto Carlos III and co-funded by the European Regional Development Fund (FEDER) (INT16/00211 and INT17/00103), Government of Spain.

Keywords

  • Attitudes
  • Cross-sectional
  • Europe
  • Menthol cigarettes
  • Smoking cessation

ASJC Scopus subject areas

  • Health(social science)
  • Medicine (miscellaneous)
  • Public Health, Environmental and Occupational Health

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