Global trends of menthol cigarette use among people who smoke in 25 countries of the International Tobacco Control Project, 2005-2023.

Abstract

Introduction: We examine menthol market share among adults who smoke cigarettes in 25 countries, comparing trends in four countries that banned menthol cigarettes versus 21 non-ban countries.

Methods: Data from International Tobacco Control Surveys between 2005-23 in 25 countries (adults smoking menthol: N = 21 512; non-menthol: N = 125 214) were analyzed with logistic regression with generalized estimating equations (GEE) to estimate menthol market share (the percentage of smoking population using menthol cigarettes) and temporal trends. A GEE controlling for secular time trend estimated pre- and post-ban differences in menthol share in menthol-ban countries. Two-level models (country, individual) estimated the overall country-level average and linear time trends for non-ban countries. All models controlled for sex, age group, daily versus non-daily smoking, and time-in-sample.

Results: At most recent survey, menthol share was highest in Zambia (2014 = 41.3%) and lowest in Spain (2021 = 0.6%), and menthol share was lower in menthol-ban versus non-ban countries (2.8% vs. 11.0%, P = .02). In pre-post analyses, menthol share decreased in all four menthol-ban countries (Canada: 7.3% [2010-16] to 4.1% [2018-22], P < .001; United Kingdom/England: 11.8% [2010-20] to 8.0% [2022], P < .001; Netherlands: 7.4% [2015-20] to 4.5% [2020-22], P < .001; and Spain: 0.9% [2016-18] to 0.5% [2021], P = .03). Among the 21 non-ban countries, menthol share increased in Zambia: 25.8% [2012] to 42.0% [2014], P < .001; China: 0.9% [2006] to 18.7% (2013-15), P < .001; Republic of Korea: 17.5% [2016] to 28.1% [2023], P = .002; and Mexico: 3.7% [2006] to 14.5% [2014-15], P < .001), and no significant declining trends were observed in 17 countries.

Conclusions: Banning the sale of menthol cigarettes is associated with a reduced menthol market share.

Implications: Findings from this study-the most comprehensive multi-country analysis of menthol cigarette market share to date-suggest that menthol cigarette bans are associated with reductions in menthol cigarette share. While menthol share did not decline to zero, all four countries that implemented menthol bans had significantly lower menthol share after the ban. In contrast, among the 21 countries without menthol bans, menthol share increased significantly in four countries and showed no significant declines in the remaining 17 countries over the available survey periods. These findings are consistent with previous studies linking menthol cigarette bans to reduced smoking cessation and increased cessation among people who smoke menthol cigarettes. Together, these findings provide international evidence that may inform countries considering the implementation of menthol cigarette bans, particularly those with a high smoking prevalence.