The EU TPD ban on the sale of menthol cigarettes was implemented in May 2020. Between July 2020 and June 2021 a substantial minority of smokers continued to report currently smoking menthol flavoured cigarettes, with an observed reduction between April-June 2021. Further monitoring of the decline will inform whether it reflects a secular trend or natural variation.
One possible reason for this pattern in England is that smokers were buying menthol cigarettes from illicit sources. However, reported purchase from any illicit source was less common in the first 6 months of 2021 than in 2020. Moreover, the observed prevalence is not consistent with stockpiling behaviour, which would be expected to drop as personal stocks dwindle. A more likely explanation is that the survey measure assessing flavoured cigarette smoking covers tobacco accessories, including menthol flavoured capsules, filter tips, cards or flavoured rolling papers that are sold separately from cigarette packs. These accessories are exempt from the ban and were introduced and promoted to retailers in the months before implementation (12). It is likely that many smokers shifted to using these compliant products (1), which is supported by leaked industry figures that in the 12 months following the ban, Japan Tobacco International sold over 2 billion ban-compliant ‘menthol replacement’ cigarettes in the UK (6), and by the fact that legal sources of purchase were reported at similar levels across the study period. However, without data on the prevalence of only menthol flavour accessory use before the ban, we cannot infer whether a transition occurred or if this was a continuation of increases in the UK market share of capsule cigarettes leading up to the ban (1). Further monitoring should examine changes in the proportion of cigarettes bought by type (factory-made vs roll-your-own tobacco) and whether substitution occurred with other products such as heated-tobacco and ‘cigarette-like’ menthol cigarillos (13).
Regarding the sociodemographic profile of menthol smokers, our findings support evidence on the popularity of menthol cigarettes among younger age groups (14) and women (15). This pattern among women likely reflects established preferences for menthol during smoking initiation (16) and the misconception that menthol cigarettes are safer than non-menthol tobacco cigarettes (17). There is also some evidence for a genetic component influencing taste preference of menthol cigarettes among women (18).
Contrary to US evidence indicating higher dependence potential of menthol cigarettes(3)(19), our results suggest that menthol smokers were less dependent than tobacco smokers. However, given that cigarette dependence develops for several years, the lower dependence in our sample may reflect the younger age profile of menthol compared with just tobacco smoking (20). The divergence may also reflect different regulatory and tobacco industry contexts; e.g., targeting of more disadvantaged and dependent smokers by menthol advertising campaigns in the US (20).
Inferences from our data are limited by an absence of measures on menthol smoking before the ban was implemented. Moreover, apparent changes in the proportion of menthol cigarette smokers may reflect natural variation/seasonality. Further limitations relate to the self-reported menthol smoking and past six-month source of purchase, which may lack accuracy due to recall bias.
The EU TPD ban on menthol cigarettes has not led to a precipitous short-term decline in menthol smoking in England. In Canada, where a more comprehensive ban was implemented covering menthol as an ingredient in cigarettes rather than just as a characterising flavour, research has found increased probability of quitting among daily menthol vs non-menthol smokers two years following the ban (21). Further research in England is needed to examine the longer-term trends in use and the potential impact the ban has had on smoking cessation among menthol cigarette smokers.
Role of funding sources
Data collection for the Smoking and Alcohol Toolkit Studies is supported by Cancer Research UK (C1417/A22962). Authors are supported by the UK Prevention Research Partnership (MR/S037519/1), an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England), and the UK devolved administrations and leading health research charities. No funders had any involvement in the design of the study, the analysis or interpretation of the data, the writing of the report or the decision to submit the paper for publication.
LK, JB and LS conceived of the study. All authors contributed to the study analysis plan. LK conducted the analysis and write up. All authors contributed to the final manuscript. LK is the guarantor of this work and, as such, had full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis.