Abstract
INTRODUCTIONSingapore, a city-state with a multi-ethnic Asian population, has one of the world’s largest market shares for cigarettes with added flavors, such as menthol and fruit, which increase the appeal of smoking. Little is known on the sociodemographic or smoking-related traits associated with flavored cigarette use in the Asian context.METHODSA cross-sectional survey was conducted in January–March 2020 of 1123 Singaporean adult (aged 21–69 years) current smokers using a self-completed online or postal questionnaire. We used descriptive statistics and bivariate analyses to compare the answers of flavored and non-flavored cigarette users and fitted a multivariate logistic regression model to identify correlates of flavored cigarette use.RESULTSOf the respondents, 85.2% reported ever use and 52.7% of respondents with a regular brand reported current use of flavored cigarettes. Older age 40–49 years (AOR= 0.63) age ≥50 years (AOR=0.60), Indian ethnicity (AOR=0.39), and a moderate (AOR=0.57) or high (AOR=0.34) dependence level were correlated with non-flavored cigarette use, while female gender (AOR=2.53) and a later initiation age (16–20 years: AOR=1.72; age ≥21 years: AOR=2.19) were correlated with flavored cigarette use.CONCLUSIONSConsistent with findings from other countries, flavored cigarette use in Singapore is associated with being younger in age, female, of a certain ethnicity (Malay or Chinese), and having a lower nicotine dependence level.
Highlights
Singapore, a city-state with a multi-ethnic Asian population, has one of the world’s largest market shares for cigarettes with added flavors, such as menthol and fruit, which increase the appeal of smoking
Those who selected ‘yes’ were asked the open-ended question ‘what is the full name of your preferred brand and variant of cigarette?’ and a multiple choice question ‘how would you describe the flavor of that brand?’ with the choice to select any of the options: 1) regular or full flavor; 2) light or mild; 3) menthol or mint flavored; 4) clove flavored; 5) fruit or candy flavored; and 6) flavor capsule
Sociodemographics and smoking-related behaviors Compared to the 2010 Singapore National Health Survey[33], a nationally representative survey of smokers in Singapore, our sample was similar in terms of age distribution but had a larger proportion of females (25.6%) and Indians (13.1%)
Summary
A city-state with a multi-ethnic Asian population, has one of the world’s largest market shares for cigarettes with added flavors, such as menthol and fruit, which increase the appeal of smoking. Flavored cigarettes contain additional characterizing flavors such as menthol, mint, fruit or sweets. These flavors may be added to the tobacco leaf or incorporated into cigarettes in diverse forms such as scent infusions, surface coatings, threads, granules, microcapsules, or crushable capsules embedded in the filter. Tobacco flavor bans came in response to evidence which consistently shows that tobacco flavors, especially menthol, encourage smoking initiation[5,6,7,8,9,10], increase the addictiveness of cigarettes[11,12], and mislead people into thinking cigarettes are less harmful[13,14,15,16]. Evidence from numerous countries has illustrated the popularity of capsule cigarettes among young people owing to their novelty appeal, youthful designs, and wide variety of flavors[17,18,19,20,21,22,23]
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