BMC Women's Health Volume 21, Article Number: 155 (2021) Cite this article

Flavored capsule cigarettes are one of the fastest growing parts of the tobacco market, and there is evidence that young Australians are increasingly using menthol-flavored capsule cigarettes. This qualitative study investigated how young women construct and experience menthol capsule cigarettes as part of their smoking habits, and explored the perceived difference between menthol capsule cigarettes and regular cigarettes. Semi-structured face-to-face in-depth interviews were conducted with 41 young Australian female smokers using constructivist grounded theory methods.

The survey results show that the freshness and improved taste of menthol and the ability to customize the smoking process have a positive contribution to the experience of young women smoking menthol capsule cigarettes. In particular, menthol capsule-flavored cigarettes are portrayed by young women as "fresh", "light" and "mint flavor". The "burst" menthol capsules allow young women to personalize their smoking experience.

These results indicate that specific public health campaigns and legislation should be formulated to counter the powerful attractive effects and innovative appeal of menthol capsule cigarettes.

Australia is a global leader in implementing tobacco control policies [1]; in 2012, it took the lead in enacting the world's first plain tobacco packaging legislation [2, 3]. This legislation has been recognized by the World Health Organization [4] and is a measure implemented by other countries around the world since then (for example, [5,6,7]). The core goal of plain packaging is to reduce the attractiveness of cigarettes, increase the significance of health warnings, and reduce perceptions of harm [1]. Recent studies have provided support for the effectiveness of plain packaging [2,3,4,5,6 , 7,8,9,10,11]. However, the tobacco industry’s history of continuous product innovation in the face of bans and legislation is well documented [2, 12, 13], and the industry’s response to plain packaging is no different [14, 15]. Since plain packaging, tobacco companies have continued to develop novel packaging sizes, ultra-long and slim cigarettes, premium brands [16], innovative filters, and flavored capsule cigarettes [17]. The latest innovations in filters are a key strategy used by the industry to maintain brand differentiation and promotion [18]. Flavored capsule cigarettes are one of the most important filter innovations in the tobacco industry [19]. In Australia, flavored capsule cigarettes were introduced before plain packaging legislation [20] and have not been banned since. In fact, flavor capsules are one of the fastest growing parts of the tobacco market in the world [21, 22] and Australia [23], and are not included in plain packaging. Within two years after the implementation of plain packaging, Australia’s preference for capsule cigarettes has increased significantly from 1% to about 3%, and capsules are particularly popular among young people [23]. One of the most popular flavor capsules is the menthol capsule [23], which is an ordinary cigarette that can impart a menthol flavor by crushing a ball in a cigarette filter containing menthol liquid [20].

There are a number of well-documented public health problems surrounding the use of menthol cigarettes (see [24,25,26,27,28]), however, the relative novelty of menthol-flavored capsule cigarettes means that there is a lack of research on their use. The use of flavor capsule cigarettes is a priority research area of ​​the World Health Organization [29], especially because menthol capsules are specifically targeted at young people and are used by young people [30, 31], and older people are more likely to position capsules as gimmicks [32]. Although age has always been considered a factor affecting capsule use, there are limited studies on other identity factors related to capsule use; specifically, gender. Because menthol-flavored capsules are very attractive to young women[19, 33], and the tobacco industry is feminizing menthol cigarettes[17, 34, 35] and certain cigarettes are regarded as essential to women’s gender expression[19, 33] 36, 37]. Previous studies have also emphasized the different smoking preferences of women and men, including women prefer the taste of menthol than men, and the taste characteristics of cigarettes are more important to women than men [34]. A few studies on the use of menthol capsule cigarettes by young women have revealed many problematic health and gender insights [31]. For example, in their focus group study, Moody et al. [32] It was found that young women believed that menthol cigarettes had better taste, less smell and less harm than ordinary cigarettes. Capsules are also regarded as "cool" and "fashionable" and are particularly attractive to young women because they are seen as being shared among friends. Young women are also particularly likely to report that the capsule may encourage non-smokers to experiment, encourage smokers to consume more, and prevent attempts to quit smoking [38].

Although some qualitative studies involve the use of menthol capsules [17, 32, 39], most of our understanding of menthol capsule cigarettes comes from the review of tobacco industry documents [40, 41], or from quantitative and experimental research design; Measure the trend or consumer perception of menthol capsules and the surrounding behavioral intentions [42,43,44,45]. The primacy of quantitative and experimental research in this field means that we lack the subjective experience of smoking menthol capsules, as well as in-depth insights into how young women's experience of using menthol capsule cigarettes is related to gender. In order to add more and more research on peppermint capsule cigarettes, in this qualitative interview study, we studied how young women who currently smoke use peppermint capsule cigarettes as part of their smoking habits, and explore the perception between menthol capsules Difference between cigarettes and ordinary cigarettes.

41 female college students volunteered to participate in this study. The age of the participants ranged from 18 to 37, with an average age of 22. The cultural identities of young women are diverse. Participants identified their cultural backgrounds as: Middle East (N = 14), Europe (N = 9), Australia (N = 6), Asia (N = 3), Oceania ( N = 2), Africa (N = 2), or mixed culture (N = 5). 33 participants self-identified as heterosexual, 4 bisexuals, 3 lesbians, and 1 participant chose not to reveal her sexual identity. The smoking rate in Australia is particularly high among people with lower socioeconomic status [46], and this study mainly included participants from these groups. Using the Regional Socio-Economic Index (SEIFA) [47] of the Australian Bureau of Statistics, all young women live in geographic locations with lower socio-economic levels. Most are first-generation families who went to college, and most reported that their parents also smoked and were in low-skilled occupations [48].

Participants started smoking in the age range of 11 to 20 years (average 17 years). Usually the number of cigarettes smoked per day ranged from 0 to 25. Most (N = 29) women smoked 5 or less per day, 8 participants smoked 6-10 cigarettes per day, and 3 participants smoked 11-25 cigarettes per day. , 2 participants described their daily smoking status as “variable”. Young women self-identified as regular smokers or social smokers, of which 16 participants reported smoking for 0-10 days of the past 30 days, 9 participants smoked for 11-20 days of the past 30 days, and 15 participated The person smoked 21-30 days in the past 30 days, and one participant was “unsure” how many cigarettes she had smoked in the past 30 days. In addition, 18 people reported “smoking with others by themselves”, while 23 people reported “mainly smoking with others”. Most (N=23) reported smoking menthol-flavored capsule cigarettes, and only one participant reported that she smoked menthol cigarettes without capsules. It should be noted that in Australia, menthol or menthol is the only flavoring agent allowed to be added to cigarettes, and all participants who smoked capsule cigarettes have smoked menthol capsule cigarettes. Of the remaining 18 participants, 14 young women reported smoking regular cigarettes (tasteless and no capsules), 3 smoked thin sticks or rolled their own cigarettes, and 1 participant was unsure of the type of cigarettes she smoked. Among the 23 mint-flavored capsule smokers, Winfield Optimum Crush Blue is the most common smoking brand. Among the 18 young women who do not smoke flavored capsule cigarettes, Winfield is also the most frequently smoked brand.

The ethical approval of this study has been approved by the Human Research Ethics Committee (H13025) of Western Sydney University. All research design schemes involving humans are in compliance with the guidelines of the National Human Research Ethical Behavior Statement. Participants are recruited through an online Australian university research recruitment platform, which allocates course credits to university students in exchange for research participation. Participants were selected based on their identification as women between the ages of 18 and 40, and that they were "current" smokers. Current smoking status is defined as smoking daily, weekly or less than weekly [46]. Sampling has been carried out until the theoretical saturation is reached, and no new or relevant data appears [49]. Before participating, participants were asked to read an information sheet detailing the nature of the research, sign an informed consent form to confirm their voluntary participation, and complete a short background questionnaire, including demographic questions and questions about smoking behavior and types of cigarettes Smoke, brand smoke and typical smoking environment (additional file 1).

Subsequent semi-structured face-to-face in-depth interviews with female smokers were conducted to explore current insights and experiences about smoking, feelings about smoking, ideas about plain packaging, types and brands of cigarettes smoked; while exploring women’s perception of peppermint capsules The experience of cigarettes was not initially the focus of this research, but as the interview progressed, it became clear that the preference for capsules or ordinary cigarettes is an important issue to be explored. See the attachment for the interview schedule. As soon as the author conducts all interviews, they are one-off, usually lasting forty-five minutes to an hour, from May to December 2019. All interviews were recorded and transcribed verbatim. The excerpts appearing in this article have only been edited, only some irrelevant sentences and words have been replaced with ellipsis, and overused colloquialisms such as "like" and "um" have been deleted. Square brackets indicate certain undercurrents in the interview, such as [pause] or [laughter]. When the sentence ends without further elaboration,... is used as an indicator. In order to remain anonymous, all young women have used pseudonyms.

The constructivist grounded theory approach is used to generate theories around the background of the co-smoking phenomenon, and involves the systematic integration of data collection and data analysis stages [50, 51]. With the progress of the interview process and the improvement of research, "theoretical sampling" is adopted, that is, sampling based on the representativeness of concepts that have theoretical relevance to the evolving theory [51]. This means that the research is inductive, where concepts and categories are derived from data, rather than deduced or informed based on existing smoking stereotypes. For example, the initial iteration of the interview schedule focused on women’s feelings about smoking and their views on plain packaging. However, with the progress of the interview, data collection and simultaneous analysis, the interview schedule (Additional File 2) has been continuously reformulated and refined to reflect the narrative of the participants-"flavor capsule cigarettes" is a key issue discussed by all young women .

For analysis, each interview record was manually coded, and in order to obtain a high degree of abstraction, a three-stage grounded theory coding was used. The data is first "open coded", including careful reading of each transcript to identify "first-order concepts". In vivo tags/concepts are attached to data fragments, which starts the initial process of data reasoning. A series of coding concepts were created around young women's understanding of smoking, cigarette types and brands. Some of these include "tobacco smell", "tobacco smell", "inhalation smoke", "burn", "filter", "fresh", "mint", "mint", "crushed/explosive capsule". After creating first-order concepts, use "axial coding" to develop "categories" that contain many first-order concepts. In the axial stage of coding, the relationship between categories is explored, and new connections and recoding are carried out. To give some examples, "tobacco smell", "tobacco smell", "inhalation of smoke" and "burning" are combined to create categories;'physical sensations related to smoking'. Combining categories such as "filter", "refreshing", "mint", "mint", and "crushed/explosive capsules" creates this category; the'mint capsule-flavored cigarettes are'fresh','light' and 'Mint flavor'. As the analysis progresses, in the final stage of the "selective" coding, the title is: "Menthol Capsule Flavored Cigarettes". The axial codes are "fresh", "light" and "menthol"; the "pop-up" mint is developed. "Brain capsules and personalized smoking experience" and "Ordinary cigarettes have more flavor and substance" link all related concepts and categories. The core category of the results is "freshness", which allows theorization of the data set.

This qualitative study aims to broadly explore the importance young women place on smoking and plain packaging. However, in the research process, women's construction and experience of menthol capsule-flavored cigarettes were found to be the dominant and primary theme. In this overall theme, menthol capsule-flavored cigarettes are constructed as "fresh", "light" and "mint flavor" and are considered to improve the smoking experience.

Most young women believed that menthol capsules improved the taste of cigarettes. Participants described the taste of menthol as "fresh", "refreshing", "like a menthol" (Grace) and "not so bitter" (Ai Ai). Mika) ordinary cigarettes. As Meredith said,'It's almost like breathing fresh air. They just look cleaner and fresher.' For Emika, the menthol capsule "feels healthier in a way because it is more refreshing" and "it is more like an air conditioner in your mouth". For many people, menthol capsules also make cigarettes feel "lighter", "milder", "uncomfortable in the throat" (Sarah), "not as thick as regular cigarettes", and allow them to avoid "in my Mouth' (Tenika). As Cassandra described;

I don't like irritating cigarettes. They (Winfield Optimum Crush) feel very, very light. This is why I like them. Especially if you pop them out at the beginning, they will be very light. Pleasant and light, yes.

Some young women explained that compared to menthol-flavored capsule cigarettes, ordinary cigarettes are "just dirty", "dirty taste", "horrible" and "looks disgusting." In fact, some participants, such as Meredith, offered the saying "If I can't buy menthol cigarettes, I won't smoke". Unlike ordinary cigarettes that many young women describe as “tastes like chemicals” (Claudia), menthol-flavored capsule cigarettes are like smoking sweetness or mint—“they don’t even taste like cigarettes”. They taste like you are smoking mints" (Adeline). As Irene said;

Just like this little ball, you pop it. Some people actually take it out and taste it. It's like it pops in your mouth, like mint.

The minty flavor of menthol capsules masked the taste of tobacco. Participants like Nora said: "You don't really taste the taste of tobacco", which makes cigarettes look fresher and "cleaner." For Meredith, the sense of cleanliness also extends from the taste of menthol capsule cigarettes to the smell;

There is a strange thing in my mind, maybe-more subconsciously-I will not smell the smell of cigarettes, because if I can't taste the dirty smell, I can't smell the dirty smell. They look cleaner and fresher.

Most young women report that they have been crushing the capsules to release the menthol taste. The capsule was crushed at the beginning of smoking—"before the first puff" (Rashida) or "before I lit it" (Claudia), "after a few puffs" (Emika), "close to the end" ( Heidi). According to reports, the "burst" capsule allows young women to interact with cigarettes and personalize their smoking experience, as Chloe said, "It's like you eat halfway through, and then it tastes weird, and then you remember to pop it." . Lena said'I will be normal, and then finally I will pop it up'. When asked why she would crush after smoking, Lena replied "in order to get a fresh sensation of mint". Similarly, Giorga explained how to crush menthol capsules in the middle of smoking so that she has the "best of both worlds";

I smoke half of it, and then I crush it. I know people will smash it directly, but I like the best of both worlds (...) I even need to have it. So, I need to pump it directly, normal, and then when I reach a certain point, I need to pop it.

When asked what the smell of cigarettes would be if the menthol capsules were not crushed, many people said "it tastes like real cigarettes" (Sarah) or "tastes like shit" (George). In contrast, it is reported that crushing menthol capsules can cause "I have a minty taste in my mouth (Grace), which tastes better" (Selena), because "I don't have that disgusting taste in my mouth." Taste, and it’s not as harsh as if you smoke yourself' (Tenika). When discussing what they like to crush capsules, many participants said it was because, as Aylin explained, “It bursts and tastes good "And "Whenever it starts to go bad, I burst."

Almost all 18 young women who did not smoke flavored capsule cigarettes reported that they "cannot stand menthol" (Stephanie) or "menthol" (Inesa). For Amisha, menthol capsules make cigarettes taste "plastic" and "artificial", and Stephanie described menthol capsules as "like someone eats a lot of mint and then spit it in his mouth." On the contrary, many people think that ordinary cigarettes taste "much better" (Kyah) and "smooth" (Sabeen) than menthol capsule cigarettes, and many people prefer "rich taste and texture" (Daniela) and "pure". . The tobacco flavor of ordinary cigarettes (Amisha). For example, when talking about Marlboro Red, Daniela said;

I like the burning of cigarettes, all right. I like to inhale my lungs and exhale it like a deep breath, but like it has more substance.

Chiara also talked about "the heat generated when inhaling ordinary cigarettes", "the rush" makes "everything becomes clearer than before" and "makes me feel immersive." It makes me feel right now'. Similarly, Stephanie, who smokes Rothman Black cigarettes, said; because it’s a bit like a burn when I feel stressed, but it keeps me focused (...)

Most young women smoked menthol capsule cigarettes and discussed the increasing popularity of menthol capsules among young women, which adds to the growing evidence that capsule cigarettes are “attractive” and “popular” among young people. [52]. Compared with the elderly, the proportion of young people using capsules is higher, which is the model of various countries including Australia [21, 23, 32]. Smokers of menthol capsules stated that the taste of menthol capsules improves the taste of ordinary cigarettes, confirming other recent studies that capsules are considered "taste better" than ordinary cigarettes [53]. In particular, previous studies have shown that female menthol smokers are more likely than men to emphasize the importance of taste, smell and sensation, which is related to their attitudes and beliefs about smoking [54]. Ordinary cigarettes are positioned as dirty, irritating and disgusting by capsule smokers. They believe that capsule cigarettes are fresher, lighter, milder, cleaner, and less irritating than ordinary cigarettes, which also supports other research in this field [32, 39 , 55]. Some young women in the study smoked regular cigarettes and reported that they liked the aroma and tobacco taste of regular cigarettes more than menthol capsule cigarettes. For these young women, menthol capsule cigarettes are positioned as "plastic" artificial, or too menthol flavored, and are considered to be detrimental to the substance and "rich" texture of ordinary cigarettes. In a larger and more representative research sample, it is found that non-daily smokers prefer flavored peppermint capsules than everyday smokers [56]. However, we found that the number of social smokers and ordinary smokers who prefer menthol capsules is higher than that of regular smokers. There is no major difference between cigarettes being better than regular cigarettes-probably because of our smaller sample size. In fact, most of the female smokers in our study do not represent the “average” smokers in Australia. They usually smoke more than 5 cigarettes a day; this suggests that perhaps flavored capsule smokers do not smoke like regular cigarette smokers. In fact, other studies have shown that capsules are "entry products"[57], and larger and more representative studies are needed to study this issue in more detail; compare the smoking of ordinary cigarettes and capsules by daily smokers and social smokers Mode and consumption.

We also found that many young women compare the taste of menthol capsule cigarettes to sweet or menthol; menthol capsules mask the taste and taste of tobacco, so that these cigarettes are regarded as "real cigarettes" to some extent. , And is more regarded as candy. Although some existing studies have carried out detailed cooperation arrangements between tobacco manufacturers and candy cigarette manufacturers[58], we found that the positioning of menthol capsules is similar to that of candy, and it is worthy of further investigation because it is a kind of use. The underlying strategy for recruiting children and young people becomes smoking. This is also particularly important because the tobacco industry has a history of strategic marketing of menthol cigarettes, which is considered to have a taste advantage [25]. The tobacco industry has recently used menthol and other capsule flavorings to mask the pungency of tobacco and improve the palatability of tobacco. Products [59]. At the same time, decades of evidence indicate that the tobacco industry recruits young women to use certain types of cigarettes, especially menthol cigarettes. For example, internal documents of the tobacco industry pointed out: "The smoking behavior of female smokers is different from that of male smokers"; "women are more willing to smoke than men and find it more difficult to quit" [60], tobacco marketing activities "utilize" and "use society To develop cigarette categories for women, they either insist on or resist the dominant social construction of femininity [61]. In fact, the'success' of Virginia Slims is largely due to the fact: "This is a male cigarette company, in fact,'woman, we put you on a pedestal. We think you are great, You are great, you are great. We love you, and we hope you have this cigarette we made for you"[62]. Historically, menthol cigarettes have been viewed by competitors as a progressive way to lure women out of Virginia Slims, targeting young and culturally diverse female cultural identities, and being promoted as "refreshing"[63]; The construction of the discourse of alcohol cigarettes has made a significant contribution. As our research results show, this discourse continues to dominate among young female smokers, and menthol capsules are not only regarded as refreshing, but also related to other traditional female cigarette characteristics, such as "lightness", "Mild" and "clean" [64].

In this study, we also found that almost all young female smokers report that they have been crushing capsules. The crushing occurs at all stages of the smoking process, including the beginning, after a few puffs, halfway through, or at the end of smoking. Confirmed by other studies [23]. For these young women, capsules enable them to interact with cigarettes and personalize their smoking experience. These findings are also consistent with other studies that show that capsule cigarettes are technically attractive [29], and capsules provide "customization" and "Consumer interaction" cigarettes, while young people like "click capsules", changing from ordinary flavor to menthol flavor [38]. Although our research results and other recent studies remind us of the innovative appeal of capsule cigarettes, further research is needed to test the potential personal and collective social appeal of large-scale personalization of capsule cigarettes.

Several limitations of this study need to be addressed; to a large extent it is related to sampling. We only evaluated the structure and experience of women in smoking habits and capsule use. There is evidence that people of different genders can use capsules, and young men are also attracted by the charm of menthol capsules. A systematic comparison of the use of capsules by men and women is needed to clearly identify the gender aspects of capsule use and smoking more commonly. In addition, since this is a qualitative study, our sample is relatively small, the participants were recruited from a university, and the women were mainly light smokers. If we are to fully solve the problem of insufficient research on capsules and pay attention to the major deficiencies that may exist in global public health, future research is needed to solve the problem of capsule smoking in a larger and more representative sample. Even in our small sample, these findings have had a significant impact on policy and practice, including providing information for legislation and public health campaigns surrounding smoking, and a more comprehensive understanding of the attractiveness of young women to menthol capsule cigarettes.

In summary, the results of this study support research that urges the ban on menthol capsule cigarettes to improve public health [65, 66], and provide evidence for increasing legislation for common tobacco products to include innovative filters. Australia and internationally. In view of emerging international studies that support menthol smokers from all disadvantaged groups to ban menthol[67, 68], and there is evidence that menthol bans will prompt menthol smokers to quit, this is a particularly important recommendation; reduce Tobacco-related diseases and deaths [69]. At the same time, it is important to evaluate the bans on flavored cigarettes, such as those implemented throughout the EU and the UK since May 2020. In addition, we suggest that specific public health campaigns should be developed to counter the powerful and attractive influence of menthol capsule cigarette types and brands, especially among young women.

The data set used and/or analyzed in the current research can be obtained from the corresponding author upon reasonable request.

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This work was supported by the Western Sydney University Researcher Development Grant: Career Interruption.

School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia

E. Gilbert and A. Ewald

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EG designed the study, collected all the main data, analyzed and interpreted the data, and wrote the main manuscript. AE participated in the analysis and interpretation of data, participated in the retrieval and writing of literature reviews, and revised the main documents. Both authors read and approved the final manuscript.

This study was approved by the Human Research Ethics Committee (H13025) of Western Sydney University. All research designs involving humans comply with the guidelines of the National Human Research Ethical Behavior Statement of the Declaration of Helsinki. Participants are required to read the detailed instructions before participating. Research information form, and sign an informed consent form to confirm their voluntary participation.

The authors declare that they have no competing interests.

Springer Nature remains neutral on the jurisdiction claims in the published maps and agency affiliates.

A census of young female smokers.

Interview schedule for young female smokers.

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Gilbert, E., Ewald, A. Fresher with flavor: The structure and experience of menthol capsule cigarettes and regular cigarettes by young female smokers. BMC Women's Health 21, 155 (2021). https://doi.org/10.1186/s12905-021-01297-2

DOI: https://doi.org/10.1186/s12905-021-01297-2

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