Article Text

Prevalence, perceptions and factors associated with menthol cigarette smoking: findings from the ITC Kenya and Zambia Surveys
  1. Susan Cherop Kaai1,
  2. Geoffrey T Fong1,2,
  3. Jane Rahedi Ong’ang’o3,
  4. Fastone Goma4,
  5. Gang Meng1,
  6. Lorraine V Craig1,
  7. Lawrence Ikamari5,
  8. Anne C K Quah1,
  9. Tara Elton-Marshall6,7,8,9
  1. 1 Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  2. 2 Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  3. 3 Kenya Medical Research Institute, Nairobi, Kenya
  4. 4 University of Zambia School of Medicine, Lusaka, Zambia
  5. 5 University of Nairobi, Nairobi, Kenya
  6. 6 School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
  7. 7 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
  8. 8 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  9. 9 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
  1. Correspondence to Dr Susan Cherop Kaai, Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; skaai{at}uwaterloo.ca

Abstract

Background Menthol masks the harshness of cigarette smoke, promotes youth smoking and encourages health-concerned smokers who incorrectly believe that menthols are less harmful to smoke menthols. This study of smokers in Kenya and Zambia is the first study in Africa to examine menthol use, smokers’ beliefs about its harmfulness and the factors associated with menthols.

Methods Data were from the International Tobacco Control (ITC) Kenya Wave 2 (2018) and Zambia Wave 2 Survey (2014), involving nationally representative samples of smokers. This study focuses on 1246 adult smokers (644 in Kenya, 602 in Zambia) who reported smoking a usual brand of cigarettes (menthol or non-menthol).

Results Overall, menthol use was significantly higher among smokers in Zambia than in Kenya (48.0% vs 19.0%), females (45.6% vs 31.2% males), non-daily smokers (43.8% vs 30.0% daily) and those who exclusively smoked factory-made (FM) cigarettes (43.0% vs 15.2%). The erroneous belief that menthols are less harmful was more likely among smokers in Zambia than in Kenya (53.4% vs 29.3%) and among female smokers (38.5% vs 28.2%). In Kenya, menthol smoking was associated with being female (adjusted odds ratios (AOR)=3.07; p=0.03), worrying about future health (AOR=2.28; p=0.02) and disagreeing with the statement that smoking was calming (AOR=2.05; p=0.04). In Zambia, menthol use was associated with being female (AOR=3.91; p=0.002), completing primary school (AOR=2.14; p=0.03), being a non-daily smoker (AOR=2.29; p=0.03), exclusively using FM cigarettes (AOR=14.7; p<0.001), having a past quit attempt (AOR=1.54; p=0.02), believing that menthols are less harmful (AOR=3.80; p<0.001) and choosing menthols because they believed it was less harmful (AOR=3.52; p<0.001).

Conclusions Menthols are highly prevalent among females in both countries. There is a need in African countries to combat the myth that menthols are less harmful and to ban menthol and other flavourings.

  • Global health
  • Low/Middle income country
  • Public policy
  • Prevention

Data availability statement

Data are available on reasonable request. In each country participating in the International Tobacco Control Policy Evaluation (ITC) Project, the data are jointly owned by the lead researcher(s) in that country and the ITC Project at the University of Waterloo. Data from the ITC Project are available to approved researchers 2 years after the date of issuance of cleaned data sets by the ITC Data Management Centre. Researchers interested in using ITC data are required to apply for approval by submitting an International Tobacco Control Data Repository (ITCDR) request application and subsequently to sign an ITCDR Data Usage Agreement. The criteria for data usage approval and the contents of the Data Usage Agreement are described online (http://www.itcproject.org) (accessed 25 February 2022).

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data are available on reasonable request. In each country participating in the International Tobacco Control Policy Evaluation (ITC) Project, the data are jointly owned by the lead researcher(s) in that country and the ITC Project at the University of Waterloo. Data from the ITC Project are available to approved researchers 2 years after the date of issuance of cleaned data sets by the ITC Data Management Centre. Researchers interested in using ITC data are required to apply for approval by submitting an International Tobacco Control Data Repository (ITCDR) request application and subsequently to sign an ITCDR Data Usage Agreement. The criteria for data usage approval and the contents of the Data Usage Agreement are described online (http://www.itcproject.org) (accessed 25 February 2022).

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Footnotes

  • Twitter @gfong570

  • Contributors SCK conceptualised the project and completed a first draft of the introduction, results and discussion sections. GM conducted statistical analyses and drafted the methods section. All authors reviewed and edited drafts of the manuscript and approved the final version. SCK is the guarantor and accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The ITC Kenya Wave 1 Survey and the ITC Zambia Waves 1 and 2 Surveys were supported by a Canadian Institutes of Health Research Operating Grant (CIHR MOP-115016). The ITC Kenya Wave 2 Survey was supported by the Canadian Institutes of Health Research Foundation Grant (FDN 148477). Additional support to Geoffrey T Fong was provided by a Prevention Scientist Award from the Canadian Cancer Society (2011–16), a Senior Investigator Award from the Ontario Institute for Cancer Research, and the Canadian Cancer Society 2020 O. Harold Warwick Prize.

  • Competing interests GTF has served as an expert witness or a consultant for governments defending their country’s policies or regulations in litigation and served as a member of the Brazil Health Regulatory Agency (ANVISA) Working Group on Tobacco Additives. All other authors have no conflicts of interest to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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