Menthol Cigarettes May Make it Tougher to Quit Smoking for Certain Populations
New Brunswick, N.J. – 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.
Along with Delnevo, the author team consists of Daniel A. Gundersen, MA, UMDNJ-School of Public Health; Mary Hrywna, MPH, UMDNJ-School of Public Health; Sandra E. Echeverria, PhD, MPH, UMDNJ-School of Public Health; and Michael B. Steinberg, MD, MPH, FACP, CINJ and UMDNJ-Robert Wood Johnson Medical School.
The research was supported by a contract from the FDA Center for Tobacco Products; however, the work and conclusions of this study are solely those of the authors and not the FDA.
About The Cancer Institute of New Jersey
The Cancer Institute of New Jersey (www.cinj.org) is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center dedicated to improving the detection, treatment and care of patients with cancer, and serving as an education resource for cancer prevention. CINJ's physician-scientists engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. To make a tax-deductible gift to support CINJ, call 732-235-8614 or visit www.cinjfoundation.org. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School. Follow us on Facebook at www.facebook.com/TheCINJ.
The CINJ Network is comprised of hospitals throughout the state and provides the highest quality cancer care and rapid dissemination of important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. System Partner: Meridian Health (Jersey Shore University Medical Center, Ocean Medical Center, Riverview Medical Center, Southern Ocean Medical Center, and Bayshore Community Hospital). Major Clinical Research Affiliate Hospitals: Carol G. Simon Cancer Center at Morristown Medical Center, Carol G. Simon Cancer Center at Overlook Medical Center, and Cooper University Hospital. Affiliate Hospitals: CentraState Healthcare System, JFK Medical Center, Mountainside Hospital, Robert Wood Johnson University Hospital Hamilton (CINJ Hamilton), Somerset Medical Center, The University Hospital/UMDNJ-New Jersey Medical School*, and University Medical Center at Princeton. *Academic Affiliate
About the UMDNJ-School of Public Health
The UMDNJ-School of Public Health (SPH) is sponsored by the University of Medicine and Dentistry of New Jersey in cooperation with Rutgers, The State University of New Jersey and New Jersey Institute of Technology. As the eighth school of UMDNJ, the SPH serves a vital function in New Jersey. The SPH offers the MPH degree, Certificate programs, the MS in Biostatistics degree and PhD and DrPH degrees as well as a number of dual degree opportunities. With educational opportunities offered in Piscataway/New Brunswick, Newark and Stratford/Camden, the SPH is conveniently accessible from across the state. Numerous continuing education opportunities are also available at the school. SPH students have opportunities to participate in leading public health research and access to resources of UMDNJ, RU and NJIT. Plus, students can put their public health education into practice through participating in our international health or community service projects.