Study: Menthol cigarettes linked with decreased quitting in the U.S.

Could a mint-flavored additive to cigarettes have a negative impact on smoking cessation efforts? New research from investigators at The Cancer Institute of New Jersey (CINJ) and UMDNJ-School of Public Health shines a light on this topic. It finds that menthol cigarettes are associated with decreased quitting in the United States, and that this effect is more pronounced for blacks and Puerto Ricans. The findings, which appear in the American Journal of Preventive Medicine, are ideally timed as the FDA's Center for Tobacco Products is currently considering banning menthol cigarettes after its own Tobacco Product Scientific Advisory Committee (TPSAC) concluded that "removal of menthol cigarettes from the marketplace would benefit public health in the United States." CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

Previous studies regarding the impact of smoking menthol cigarettes and smoking cessation efforts have produced mixed results. For instance, some research did not take into account the overall population of smokers, while other studies lacked focus on periods of successful smoking cessation and instead targeted attempts to quit. This current study, Smoking Cessation Prevalence among Menthol and Non-Menthol Smokers in the United States, looks at whether those who smoke menthol cigarettes are less likely to quit than smokers of non-menthol cigarettes and whether these findings differ by race/ethnicity as well as among various subgroups of smokers, such as those trying to quit.

Utilizing data from the 2003 and 2006-2007 National Cancer Institute Tobacco Use Supplement to the Current Population Survey, investigators focused on white, black and Hispanic "ever-smokers," who were defined as current smokers and former smokers who quit in the past five years. Current smokers were further defined as having smoked 100 cigarettes in a lifetime and smoking every day or some days at the time of the survey. Former smokers were noted as those who smoked 100 cigarettes in a lifetime and were not smoking at all during the time of the survey. Blacks included multi-racial blacks, and the Hispanic data set was further broken down by Hispanic origin (ie: Mexico vs. Puerto Rico). Socioeconomic factors including education and household income were examined for all groups.

Overall, menthol smoking was more common among females and young adults, ages 18 to 24. Menthol smoking varied considerably by race/ethnicity; among blacks, 71.8 percent smoked menthols, which is significantly greater than whites (21 percent) and Hispanics (28.1 percent). However, among Hispanics there were wide variations. Menthol smoking was more common among those of Puerto Rican descent (62 percent) than among those of Mexican (19.9 percent) and other Hispanic origins (26.5 percent).

The study further found that menthol cigarette smoking was associated with lower levels of smoking cessation compared to non-menthol smokers, and this relationship was more pronounced among blacks and those of Puerto Rican descent. A key strength of the study was that the research team examined the relationship between menthol smoking and cessation for five different sample restrictions (e.g., all smokers vs. smokers with quit attempt history). The main finding held true even after analyzing the data using several different samples. "Because our evidence suggests that the presence of menthol may partially explain the observed differences in cessation outcomes, the recent calls to ban this flavoring would be prudent and evidence-based," the authors state.

CINJ Member Cristine Delnevo, PhD, MPH, director of the Center for Tobacco Surveillance and Evaluation Research Program and interim chair, Department of Health Education and Behavioral Science at UMDNJ-School of Public Health, is the lead author of the study. She notes one thing that sets this study apart from others on this subject is further recognizing the diversity of the Hispanic population.

"Historically, smoking cessation research has generally grouped Hispanics together and contrasted them with non-Hispanic whites, thus ignoring the broad heterogeneity of the Hispanic population. By further drilling down into these subgroups, the opportunity exists to develop targeted interventions for quit efforts among this population," she stated.

Dr. Delnevo and colleagues indicate there were some limitations to the study including the self-reported and retrospective nature of the data; however, they note previous research utilizing self-reported measures of tobacco use has been shown to produce valid results.