One million adults smoke menthol-flavored cigarettes in Britain despite ban: Study

One in seven adults who smoke in Great Britain report using menthol-flavored cigarettes despite UK legislation that aimed to curb their use, according to a new study by UCL (University College London) researchers.

The study, published in the journal Tobacco Control, looked at survey responses from 66,868 adults in England, Wales and Scotland between October 2020, five months after the ban was introduced, and March 2023.

The researchers found that 16% of adult smokers reported using menthol-flavored cigarettes at the start of the study period, with the figure remaining fairly stable at 14% by the end of the study—equivalent to one in seven adult smokers or nearly one million people still using menthol-flavored cigarettes.

Only about 15% of survey respondents who smoked menthol-flavored cigarettes reported purchasing from any illicit sources in the previous six months, such as 'under the counter' or 'cheap from friends'—a similar proportion to those who smoked non-flavored cigarettes.

Researchers said this indicated that most people are likely using legal accessories including menthol-flavored drops, filter balls or cards, or purchasing cigarettes perceived to contain menthol flavoring without being labeled as such.

Lead author Dr. Vera Buss (UCL Institute of Epidemiology & Health Care) said, "Our results suggest the tobacco industry may have used various loopholes in the law to continue to enable people to smoke menthol-flavored cigarettes."

"To effectively reduce the prevalence of menthol cigarette smoking to near zero, policymakers in the UK should consider closing current loopholes in the legislation. This would mean strictly banning all menthol and similar ingredients in all tobacco-related products, including accessories."

The legislation introduced in May 2020 banned cigarettes with a "characterizing flavor" but did not ban menthol or its derivatives as ingredients in cigarettes and accessories.

Menthol cigarettes are popular among young people as they are perceived to have a taste that is less harsh and easier to inhale. They have also been viewed wrongly as less harmful than non-flavored cigarettes. The ban that came into force in 2020 aimed to reduce youth uptake of smoking.

The research team used data from the Smoking Toolkit Study, in which a different sample of 2,450 adults in Great Britain (who are representative of the general population) were interviewed each month.

The proportion of people who reported smoking menthol-flavored cigarettes remained relatively stable in Scotland and England (where prevalence was highest) but fell by two-thirds in Wales (from 23% to 8%). However, researchers cautioned that a smaller number of survey respondents in Wales meant estimates of prevalence were less certain.

Among young people, the prevalence of menthol cigarette smoking also fell by a quarter, from 26% to 19%. This suggests that about one in five 18- to 24-year-olds still smoked menthol-flavored cigarettes towards the end of the study period in early 2023.

Survey respondents were asked which sources they purchased their cigarettes from. These were categorized as licit (petrol station shops, supermarkets, newsagents), illicit (under the counter at newsagents or from a friend or someone else who sells cheap cigarettes in the pub or on the street), and cross-border (buying them from abroad or from friends or family who get them outside the UK).

The researchers found that the proportion of cigarettes bought illicitly or cross-border was similar for respondents who smoked menthol-flavored cigarettes as for those who used non-flavored cigarettes.

The researchers said this showed there had been no increase in purchasing from illicit sources following the menthol ban. This, they said, was "another example of how the [tobacco] industry's oft-predicted surge in illicit cigarette purchases as a result of tobacco control measures did not materialize".

Senior author Professor Jamie Brown (UCL Institute of Epidemiology & Health Care) said, "The UK's menthol ban does not appear to have been effective—we have found that there are still around one million people who report smoking menthol-flavored cigarettes in Britain, three years after the 'ban' came into force."

"Nor has there been much sign of progress during that period. For an effective ban, menthol and all its analogs and derivatives should be completely prohibited in all tobacco-related products and accessories."

Dr. Ian Walker, Cancer Research UK's executive director of policy, said, "Smoking is still the leading cause of cancer, causing around 150 cancer cases across the UK every single day, so the number of people continuing to smoke menthol-flavored cigarettes is deeply concerning. These findings show why it's vital that measures to tackle smoking don't contain legal loopholes that the tobacco industry can exploit.

"We support the government's plans to include all tobacco products in proposed legislation to raise the age of sale of tobacco, which will help prevent the next generation from ever taking up smoking in the first place."