Who smokes flavoured cigarettes in Singapore?

The use of flavoured cigarettes in Singapore is common, particularly among younger and women smokers, according to a recent study. Flavours also seem to be more appealing to those who have lower nicotine dependence.

“This study is, to our knowledge, the first to identify correlates of flavoured cigarette use in a multi-ethnic Asian population,” the researchers said, noting that the frequency of use in Singapore is high, even exceeding estimates in Western countries.

A cross-sectional, self-completed online or postal survey of 1,123 adult current smokers revealed that most smoked daily with either a moderate (48.0 percent) or low (28.0 percent) level of dependence on nicotine. Around a fifth of the respondents was trying to quit at the time of the survey and a similar proportion was planning to do so in the future. [Tob Induc Dis 2021;19:42]

The vast majority (85.2 percent) of participants had ever used a flavoured cigarette, while 55.7 percent had ever used a capsule cigarette.

Regression analysis identified seven potential predictors of current flavoured cigarette use. Compared with participants aged 30–39 years, those aged 40–49 years (adjusted odds ratio [aOR], 0.63, 95 percent confidence interval [CI], 0.41–0.98; p=0.04) and ≥50 years (aOR, 0.60, 95 percent CI, 0.37–0.97; p=0.04) were significantly less likely to use flavoured cigarettes.

Similarly, such use was lower among respondents of Indian ethnicity (vs Chinese: aOR, 0.39, 95 percent CI, 0.24–0.52; p<0.01).

Daily smokers who had moderate (aOR, 0.57, 95 percent CI, 0.36–0.88; p=0.01) and high (aOR, 0.34, 95 percent CI, 0.13–0.86; p=0.02) nicotine dependence were also less likely to use flavoured cigarettes than comparators with lower levels of dependence.

On the other hand, women (aOR, 2.53, 95 percent CI, 1.77–3.63; p<0.01) showed significantly stronger preference to flavoured cigarettes than men, as did those who started smoking at the ages of 16–20 (aOR, 1.72, 95 percent CI, 1.23–2.41; p<0.01) and ≥21 (aOR, 2.19, 95 percent CI, 1.33–3.66; p<0.01) years, as opposed to those who were ≤15 years at initiation.

When users were asked what they would do if flavoured cigarettes were to be banned in Singapore, most of them (67.7 percent) said they would simply switch to another cigarette, 32.0 percent would try to quit, while 18.3 percent said they would find other means to obtain flavoured cigarettes.

“Flavoured cigarettes contain additional characterizing flavours such as menthol, mint, fruit, or sweets. These flavours may be added to the tobacco leaf or incorporated into cigarettes in diverse forms,” the researchers explained, adding that when in the stick’s filter, they “provide an on-demand flavour which enables the user to selectively add one or more flavours to the cigarette.”

Important limitations of the present study include a sample unrepresentative of the Singapore population, the use of self-reported data, and its cross-sectional design, which precluded causal conclusions.

“To address these limitations, future research would utilize a longitudinal cohort design with a rigorous representative sampling procedure,” said the researchers.