Epidemiology of menthol cigarette use in the United States

Abstract

BackgroundApproximately one-fourth of all cigarettes sold in the United States have the descriptor “menthol” on the cigarette pack. It is important to determine what socio-demographic factors are associated with smoking menthol cigarettes if indeed these types of cigarettes are related to smoking initiation, higher exposure to smoke constituents, nicotine dependence, or reduced smoking cessation.MethodsThe National Cancer Institute (NCI) conducted a review of the scientific literature on this topic which we completed by adding more recently published articles via PubMed. We also conducted further data analyses using the National Survey on Drug Use and Health, the National Youth Tobacco Survey, the Monitoring the Future Survey, and the National Health and Nutrition Examination Survey to provide up-to-date information on this topic.ResultsMenthol cigarettes are disproportionately smoked by adolescents, blacks/African Americans, adult females, those living in the Northeast of the United States and those with family incomes lower than $50,000. Based on self-reports of menthol cigarette use, menthol cigarette use among smokers have increased from 2004 to 2008. However, no increase was observed during these years for predominantly menthol brands like Newport™, Kool,™ and Salem™, however, this lack of significant trend may be due, at least in part, due to smaller numbers of smokers of specific brands or sub-brands, which provide estimates which are less precise.ConclusionMenthol cigarettes are disproportionately smoked by groups of U.S. cigarette smokers. It is likely that other disparities in menthol cigarette use exist that we have not covered or have not been studied yet.

The lingering question of menthol in cigarettes

“…Menthol cigarettes account for a substantial portion of market share in the USA and many parts of the world; current market shares for mentholated brands include 26 % in the USA, 60 % in the Philippines, 35-40 % in Cameroon, 26 % in Hong Kong, 22 % in Singapore, and 5-10 % in other countries surveyed [13,14]. Menthol cigarettes are disproportionally used by certain segments of the population [15]. In the USA, youths, women, and communities of color, particularly, African-Americans, Hispanics, and other racial and ethnic minorities of low income, are preferential users of menthol cigarettes [15][16][17].…”

“…Menthol cigarettes are disproportionally used by certain segments of the population [15]. In the USA, youths, women, and communities of color, particularly, African-Americans, Hispanics, and other racial and ethnic minorities of low income, are preferential users of menthol cigarettes [15][16][17]. The disparate use of menthol cigarettes by smokers of different gender, race, or ethnicity is thought to contribute, at least, partly to the uneven distribution of tobacco-attributable diseases across populations [18][19][20][21][22].…”

Measures of initiation and progression to increased smoking among current menthol compared to non-menthol cigarette smokers based on data from four U.S. government surveys

“…These analyses were limited to respondents 15-19 years of age who started smoking up to two years prior to the survey, based on the calculated difference between age at survey and reported age at first regular smoking. Following the methods suggested by Caraballo and Asman (2011), stages of progression from experimentation to established smoking were defined by number of days smoked during the past month (1-30 days) and usual number of cigarettes smoked per day (1, 2-5, 6-10, 11-19 and P20 cigarettes/day). To include as many experimenting smokers as possible, no minimum number of days smoked during the past month or cigarettes smoked per day was required.…”

“…Findings of an earlier age of smoking initiation among menthol compared to non-menthol smokers and/or a higher prevalence of menthol cigarette use among younger compared to older smokers could be interpreted as evidence that menthol cigarettes are disproportionately used to initiate smoking and/or that the availability of menthol cigarettes has increased the likelihood of initiating smoking. Such inferences would be inappropriate, as smokers first initiate cigarette smoking at different ages and then progress to increased smoking by different trajectories (e.g., Caraballo and Asman, 2011). Stronger inferences on the potential effect of menthol cigarette use on smoking initiation would be supported by, for example, cross-sectional analyses examining the prevalence of menthol cigarette use among smokers who had recently initiated smoking, compared to those who had progressed to increased (i.e., regular or daily) smoking.…”

“…The 2004, 2006 and 2009 National Youth Tobacco Survey (NYTS) includes information on duration of smoking and prevalence of menthol versus non-menthol cigarette use among less experienced and more experienced smokers, based on number of days smoked during the past month and cigarettes smoked per day; Caraballo and Asman (2011) examined these data among youth who had begun cigarette use within two years prior to the survey. Findings from this study showed that menthol cigarette use was less prevalent among youth who had smoked <1 cigarette per day on 1-5 days during the past month compared to those who had smoked 1-5 cigarettes per day on either 1-5 days or 20-29 days during the past month; and, menthol cigarette use was similar among youth in other stages or trajectories of smoking progression.…”