The widespread use of menthol cigarettes in underage smokers has been overlooked according to new research from the University of Stirling and Cardiff University.
The study – the first to reveal the full extent of flavoured cigarette use in this age group – found that menthol cigarettes were used by three-fifths of 11- to 16-year-old smokers in Wales in 2019, prior to a ban on flavours in cigarettes coming into force in 2020.
Although flavoured cigarettes are now banned, an expert from the Institute for Social Marketing and Health (ISMH) at Stirling believes the findings raise questions as to why those working in public health – in the UK and worldwide – failed to recognise this problem.
Dr Crawford Moodie, Senior Research Fellow at the ISMH, led the paper and hopes the work will be informative for countries where these products remain on sale. He said: “Our research used data from Wales’s School Health Research Network (SHRN) Student Health and Wellbeing Survey, completed by almost 120,000 school pupils aged between 11 and 16 years. It is the largest youth survey in the world, with the sample accounting for two-thirds of all children within that age group in Wales. Therefore, the findings provide an extremely important insight into this group.”
Institute for Social Marketing and Health
We must understand why an evaluation of the flavour ban – potentially one of the most significant public health policies in the UK in decades – has largely been overlooked. A comprehensive evaluation is essential to understanding whether the policy has been effective.
The popularity of menthol cigarettes across the UK was driven by the introduction in 2011 of cigarettes that contained one or more capsules in the filter, that could be squeezed to change the flavour. At the time of the study, the UK was the largest market in Europe for capsule cigarettes and one of the biggest in the world.
Dr Moodie said the lack of research on flavoured cigarette use, and capsule cigarette use in particular, was “perplexing”, adding: “Questions must be asked as to why capsule cigarettes, and the risks they pose to children and young people in particular, have received so little attention.
“One reason for this oversight is the excessive focus on electronic cigarettes. While e-cigarettes merit investigation, to do so to the almost total neglect of a product that makes smoking appear cool and fun to children is a major failing.
“In addition, we must understand why an evaluation of the flavour ban – potentially one of the most significant public health policies in the UK in decades – has largely been overlooked. A comprehensive evaluation is essential to understanding whether the policy has been effective.”
The new research reveals that 60.5% of young smokers reported using menthol cigarettes in the 30 days prior to the survey – with 42.3% using menthol capsule cigarettes and 18.2% using traditional, non-capsule menthol cigarettes.
“Given the large sample size, this is a significant finding as it shows how popular flavoured cigarettes – particularly capsule cigarettes – are among young people,” Dr Moodie said.
“While the UK and European Union have recently banned flavoured cigarettes, our findings are relevant as they help to justify the ban, and they are extremely important for countries where these products remain available.”
Dr Moodie collaborated on the research with Dr Nicholas Page and Professor Graham Moore, of The Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer) at Cardiff University.
Dr Page said: “That three in five underage smokers in Wales had used menthol cigarettes in the 30 days prior to the survey clearly shows just how popular these products were among young smokers prior to the ban.
“Findings such as this also act to demonstrate the value of continuing to monitor issues affecting children’s health and wellbeing through population surveys, such as those undertaken within the School Health Research Network in Wales.”
The paper, Prevalence of menthol cigarette use among 11-16 year olds in Wales prior to a ban on characterising flavours in cigarettes: Findings from the 2019 Student Health and Wellbeing survey, is published in Nicotine and Tobacco Research.
SHRN is a partnership between DECIPHer at Cardiff University, Wales Institute of Social & Economic Research, Data & Methods (WISERD), Welsh Government, Public Health Wales and Cancer Research UK. It is funded by Health and Care Research Wales, the Health & Social Services and Education & Public Services departments, Welsh Government and by Public Health Wales.