mokers of menthol cigarettes had a significantly lower quit rate than those who smoked nonmenthol brands, according to data from a large population survey.
Overall, menthol cigarettes were associated with about a 10% lower cessation rate among smokers who tried to quit, as reported online in the American Journal of Preventive Medicine.
The relationship was stronger among blacks, although some Hispanic subgroups had quit rates that were more than 40% lower if they smoked menthol cigarettes.
"Despite the small associations, the present results are nontrivial," Cristine D. Delnevo, PhD, of the University of Medicine and Dentistry of New Jersey and the Cancer Institute of New Jersey in New Brunswick, and co-authors wrote in their discussion of the findings.
"On the contrary, small but robust findings for smoking cessation are clinically meaningful because of the public health gains that accrue from stopping smoking."
One recent study suggested that a ban on menthol cigarettes would prevent 300,000 to 600,000 tobacco-caused deaths over the next 40 years (Am J Pub Health 2011; 101: 1236-1240), they added.
Studies of smoking cessation have yielded conflicting results with respect to the impact of menthol cigarettes on quit rates. Clinical/community studies and national population surveys have produced a mix of significant associations between menthol cigarettes and lower quit rates and no evidence of a relationship.
Delnevo and colleagues undertook a study that differed from previous investigations in that former smokers who recently quit were not excluded.
Additionally, five population restrictions were incorporated into the analysis to assess the robustness of associations in specific racial/ethnic groups. Finally, separate models were developed for Hispanics by country of origin to account for variable smoking practices.
Data for the analysis came from the Tobacco Use Supplement to the Current Population Survey. The Census Bureau conducts the labor force survey monthly for the Bureau of Labor Statistics, and the Tobacco Use Supplement is compiled every three years. The analysis comprised pooled data from 2003 and 2006/2007.
The authors tested five population restrictions:
- Formers smokers who quit within the past five years and all current smokers
- The same two groups, limited to those who did not use other forms of tobacco
- The same two groups, limited to current smokers who had ever tried to quit
- The same two groups, limited to smokers who had ever tried to quit, both groups using no other type of tobacco
- Past-12-month smokers who had tried to quit or who had successfully quit
The sample comprised 71,193 survey respondents: 54,662 current smokers and 16,531 former smokers.
With regard to racial/ethnic mix, whites accounted for 60,525 respondents, blacks for 5,827, and Hispanics for 4,841. The Hispanic group was further subgrouped into Mexicans (2,769) and Puerto Ricans (735).
About a fourth of the respondents reported smoking menthol cigarettes, including 27.9% of current smokers and 24.5% of former smokers. A higher proportion of women smoked menthol cigarettes (32.0% versus 22.8%), which also were associated with lower education and income and younger respondents.
Blacks overwhelmingly preferred menthol cigarettes (71.8%) as compared with whites (21.0%) and Hispanics (28.1%).
Overall, menthol smokers had an adjusted odds ratio for quitting of 0.91 as compared with smokers of nonmenthol cigarettes.
Of the four other population restrictions, three had odds ratios of 0.90 to 0.92 and were statistically significant. Only the odds ratio for past-12-month smokers did not achieve statistical significance but was in the same direction as the other analyses.
The odds decreased to 0.81 among blacks and ranged as low as 0.68 across the population restrictions.
Whites had an odds ratio of 0.93, which was statistically significant, and Hispanics an odds ratio of 0.94, which did not achieve significance.
The association between menthol cigarettes and quit rate varied among Hispanics by country of origin.
Overall, Mexicans who smoked menthol cigarettes had increased odds for quitting, ranging as high as 1.35. In contrast, Puerto Ricans who smoked menthol cigarettes had substantially lower quit rates, associated with odds ratios of 0.42 to 0.63.
"The magnitude of the relationships between menthol smoking and poorer cessation differed considerably by race/ethnicity and would have been masked in models that adjust only for race/ethnicity," the authors wrote in the discussion of their findings.
"Historically, smoking-cessation research generally has grouped Hispanics together and contrasted them with non-Hispanic whites," they continued. "This prevailing approach ignores the vast heterogeneity of the Hispanic population."
The study was supported by the FDA Center for Tobacco Products.
Co-author Michael B. Steinberg disclosed a relationship with Pfizer.
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