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Prevalence (%) of use of menthol cigarettes among past 30-day smokers, by age and gender, race/ethnicity, household income and the number of days smoked/month in the USA, 2008-2010
Source publication
Mentholated cigarettes are at least as dangerous to an individual's health as non-mentholated varieties. The addition of menthol to cigarettes reduces perceived harshness of smoke, which can facilitate initiation. Here, we examine correlates of menthol use, national trends in smoking menthol and non-menthol cigarettes, and brand preferences over ti...
Contexts in source publication
Context 1
... differences in menthol cigarette use among current cigarette smokers Table 1 presents overall and age-specific data on the use of men- tholated cigarettes among current smokers during 2008-2010 by gender, race/ethnicity, household income and the number of days smoked during the previous 30 days. Menthol use was most preva- lent among adolescent smokers overall (56.7%, representing 1.2 million smokers) and consistently high across all subgroups exam- ined. ...
Context 2
... differences were seen across cat- egories of household income and days smoked/month. Recent trends in the prevalence of smoking menthol and non-menthol cigarettes in the USA Figure 1 and table 3 and online supplementary table S3 show the results of analyses that examined overall trends from 2004- 2010 in the prevalence of smoking menthol and non-menthol cigarettes among adolescents, young adults and adults. Note that the denominator here is all individuals in the relevant age groups, not just cigarette smokers. ...
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Citations
... Following decades of advocacy and research, in 2022 the U.S. Food and Drug Administration (FDA) issued a proposed product standard that would ban menthol as a characterizing flavor in cigarettes, as well as a separate proposed product standard banning all characterizing flavors in cigars. 1 This proposed "menthol ban" carries enormous political, public health, and economic consequences as menthol cigarettes represent ~37% of the $83 billion/year cigarette market in the United States 2,3 and are used by 11 + million Americans. 4 A dimension of this regulatory activity that should not be undervalued; however, is its potential to advance racial health equity. African American/black (AA/B) individuals experience the highest levels of tobacco-induced morbidity and mortality. ...
... Cigarette nicotine dependence was indexed via the PROMIS Short Form 4a which covers items such as tolerance, withdrawal severity, temptations to smoke, and smoking as a behavioral priority (when responses are zero-indexed, scores range from 0 to 16 and the average score among daily and nondaily users of cigarettes is 8). 31 Next, we asked participants to rate the following barriers to smoking cessation (Not a challenge [1], Minor challenge [2], Moderate challenge [3], Major challenge [4]): Cost of quitting-smoking medications/ nicotine replacement therapy, cost of quit-smoking classes or programs, concern of gaining weight, loss of a way to handle stress, interfere with relationships, cravings or withdrawal. 31 We then asked participants to rate how motivating (Not a motivation [1], Minor motivation [2], Moderate motivation [3], Major motivation [4]) the following reasons for quitting smoking were to them: Information about health hazards, cost of cigarettes, decline in health (your own or that of a friend or relative), physical fitness, encouragement from a friend or relative, smoking restrictions in the workplace or school, and smoking restrictions in the home. ...
... 31 Next, we asked participants to rate the following barriers to smoking cessation (Not a challenge [1], Minor challenge [2], Moderate challenge [3], Major challenge [4]): Cost of quitting-smoking medications/ nicotine replacement therapy, cost of quit-smoking classes or programs, concern of gaining weight, loss of a way to handle stress, interfere with relationships, cravings or withdrawal. 31 We then asked participants to rate how motivating (Not a motivation [1], Minor motivation [2], Moderate motivation [3], Major motivation [4]) the following reasons for quitting smoking were to them: Information about health hazards, cost of cigarettes, decline in health (your own or that of a friend or relative), physical fitness, encouragement from a friend or relative, smoking restrictions in the workplace or school, and smoking restrictions in the home. 32 Because several of the motives and barriers had few (<10%) rate them as "Not a motivation" or "Not a challenge," we combined these responses with the "Minor motivation" and "Minor challenge" responses respectively ( Table 1). ...
Introduction
The Food and Drug Administration (FDA) has proposed banning cigarettes and cigars with characterizing flavors—products used disproportionately by African American/black (AA/B) individuals. Little is known about how AA/B individuals who smoke menthol cigarettes will respond to flavor bans or how to amplify the intended benefits. This study explored predictors of quit intentions following a hypothetical flavor ban and further probed anticipated ban-related responses.
Aims and Methods
We recruited 213 AA/B individuals who use menthol cigarettes from Richmond, VA (September 2021–August 2022) for a mixed-methods study. Participants rated seven motivations for quitting and six barriers to quitting (Not a motivation or challenge[1]—Major motivation or challenge[4]), then reported how likely they were to quit smoking if characterizing flavors were banned in cigarettes and cigars. A subsample of 31 participants completed semi-structured interviews to further explore reactions to flavor restriction policies.
Results
Multivariable linear regressions suggested that participants who were more motivated to quit smoking because of “information about health hazards” and the “cost of cigarettes” reported higher quit intentions following a hypothetical menthol ban (p < .05). Additionally, those with cessation-related weight concerns reported lower post-ban quit intentions (p < .05). Interview themes highlighted smoking for stress reduction, harm/addiction perceptions of flavored tobacco products, trusted sources of tobacco-related information (including testimonials from people who formerly smoked), potential ban responses, and varying experiences with cessation strategies.
Conclusions
Culturally specific cessation strategies that emphasize the health-related benefits of quitting, particularly those featuring the experiences of people who formerly smoked, may help AA/B individuals who smoke menthol cigarettes quit following a menthol ban.
Implications
For the FDA’s proposed bans on characterizing flavors in cigarettes and cigars to advance racial health equity, they must maximize cessation among African American/black (AA/B) individuals who use menthol cigarettes. This work suggests information on the health hazards and costs of smoking, as well as concerns over gaining weight, were predictors of quit intentions in a hypothetical flavor ban. Qualitative data suggest messaging highlighting the experiences of individuals who successfully quit may constitute an effective communication strategy. These insights can be used in the development of culturally specific cessation strategies for AA/B individuals who smoke menthol cigarettes.
... Cornelius and colleagues (11) examined the prevalence of menthol-flavored tobacco use among US middle and high school students. Among all students who reported current use of any tobacco product in 2022, approximately 24% reported using a menthol-flavored tobacco product (11). Their findings show that prevalence was highest among high school students (24.3%) and males (25.6%) (11). ...
... Among all students who reported current use of any tobacco product in 2022, approximately 24% reported using a menthol-flavored tobacco product (11). Their findings show that prevalence was highest among high school students (24.3%) and males (25.6%) (11). Among racial and ethnic groups, the prevalence was highest among non-Hispanic White students (30.1%) and lowest among non-Hispanic Black students (7.8%) (11). ...
... Their findings show that prevalence was highest among high school students (24.3%) and males (25.6%) (11). Among racial and ethnic groups, the prevalence was highest among non-Hispanic White students (30.1%) and lowest among non-Hispanic Black students (7.8%) (11). This result contrasts with earlier find-The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. ...
... Additionally, smoking-related disparities may partly be driven by barriers to tobacco-cessation programs, poverty, and social conditions, as well as targeted marketing and advertising by the tobacco industry towards specific ethnic groups [9]. For example, the use of mentholated cigarettes has been reported in approximately 25% White, 30% Asian, 38% Hispanic, and 88% Black populations [12]. Such differences in smoking behavior impact inhalation patterns, nicotine dependence, and smoking cessation, consequently contributing to disparities in NSCLC incidence and mortality rates [13]. ...
Inequitable access to care continues to hinder improvements in diagnosis and treatment of lung cancer. This review describes healthcare disparities in the changing landscape of non–small cell lung cancer (NSCLC) in the United States, focusing on racial, ethnic, sex-based, and socioeconomic trends. Furthermore, strategies to address disparities, overcome challenges, and improve patient outcomes are proposed. Barriers exist across lung cancer screening, diagnosis, and treatment regimens, varying by sex, age, race and ethnicity, geography, and socioeconomic status. Incidence and mortality rates of lung cancer are higher among Black men than White men, and incidences in young women are substantially greater than in young men. Disparities may be attributed to geographic differences in screening access, with correlating higher incidence and mortality rates in rural versus urban areas. Lower socioeconomic status is also linked to lower survival rates. Several strategies could help reduce disparities and improve outcomes. Current guidelines could improve screening eligibility by incorporating sex, race, and socioeconomic status variables. Patient and clinician education on screening guidelines and patient-level barriers to care are key, and biomarker testing is critical since ~ 70% of patients with NSCLC have an actionable biomarker. Timely diagnosis, staging, and comprehensive biomarker testing, including cell-free DNA liquid biopsy, may provide valuable treatment guidance for patients with NSCLC. Efforts to improve lung cancer screening and biomarker testing access, decrease bias, and improve education about screening and testing are needed to reduce healthcare disparities in NSCLC.
... The shifts in prevalence and the trends in the number of cigarettes smoked over time within these subgroups have not been thoroughly investigated. Previous studies have examined sociodemographic trends, but their focus has been limited to specific time periods time (Agaku et al., 2014;Doogan et al., 2017;Giovino et al., 2015), or they have not considered a broad range of sociodemographic factors or the number of cigarettes smoked (Meza et al., 2020;Weinberger et al., 2019). This lack of comprehensive data hinders our ability to develop targeted interventions and policies to reduce tobacco use and its associated health risks. ...
... Studies have also highlighted variations in smoking trends based on age, metropolitan status, and racial/ethnic differences among adults. One analysis showed that young adults aged 18-25 exhibited a steeper decline in cigarette use compared to adults aged 26 and older between 2004 and 2010 (Giovino et al., 2015). Similarly, a study observed decreased cigarette use among urban and rural populations between 2007 and 2014 . ...
Cigarette smoking remains a significant public health problem that causes many deaths worldwide. We used the Tobacco Use Supplement to the Current Population Study data to analyze how smoking behavior changed among different U.S. subpopulations from 1992 to 2019. We employed joinpoint regression analysis, the Cochran-Armitage test, and the Jonckheere-Terpstra test to detect changes in smoking trends and daily cigarette consumption. We found that the overall smoking prevalence declined from 24.46 to 11.46%, with the largest decline in the 18–24 age group. However, we also found persistent disparities in smoking rates by gender, urbanization, and ethnicity. Separated individuals and those with lower education had higher smoking rates than others throughout the study period. Unemployed people also had very high smoking prevalences consistently. Daily cigarette consumption decreased over the study period as well. Our study shows that while there has been progress in reducing cigarette use, there are still significant gaps among some sociodemographic groups that need more attention and intervention.
... 15 Fourth, menthol may change puff topography, causing people who smoke to take more puffs. 12 Marketing of menthol cigarettes 16 17 has also dramatically shaped use patterns in the USA [18][19][20] and the persistence of menthol use in young adults who smoke cigarettes. 21 22 Of particular importance ...
Introduction
This study assessed the substitutability of plausible combustible menthol cigarette alternatives (MCAs) for usual brand menthol cigarettes (UBMCs) in adults who smoke menthol cigarettes.
Methods
Following three in-lab sampling sessions, 80 adults aged 21–50 who smoke menthol cigarettes chose their preferred MCA: (1) a menthol roll-your-own cigarette (mRYO), (2) a menthol filtered little cigar (mFLC) or (3) a non-menthol cigarette (NMC). Participants were instructed to completely substitute their preferred MCA for their UBMC for 1 week and complete daily diaries documenting adherence and subjective effects. At the final lab visit, participants completed concurrent choice and cross-price elasticity tasks with their substitute product and UBMC as the comparator.
Results
Most (65%) participants chose mRYO as their preferred product, followed by NMC and mFLC. Adherence to MCA was high for all products across the week (range: 63%–88%). Positive subjective effects for mRYO decreased over time but remained numerically higher than the other MCA products; craving reduction also decreased for NMC across phases. In the progressive ratio task, participants chose their UBMC in 61.7% of choices; this did not differ by preferred MCA, although the median breakpoint was highest for mRYO and similar for mFLC and NMC. Cross-price elasticity comparing UBMC and the preferred product indicated high substitutability of each MCA at phase 3 ( I values −0.70 to −0.82).
Conclusions and relevance
mRYOs were the most preferred MCA among the study products, but all MCAs were acceptable substitutes for UBMC using behavioural and economic measures in a short-term trial period.
Trial registration number NCT04844762 .
... The response options were regular, light, or menthol, and those who responded "menthol" were considered menthol tobacco product users. "Regular" cigarettes and tobacco products were found to be frequently used in the previous research to distinguish from flavored tobacco products [21,29]. "Light" cigarettes were redesigned forms of cigarettes with certain features that were marketed with such labeling [42]. ...
... The question was asked only to those who reported being current smokers. Menthol tobacco has been linked to increased nicotine dependence and decreased cessation [29,58], making it an important outcome to investigate. ...
Background
Socioeconomic status (SES) indicators such as educational attainment are fundamental factors affecting health. One mechanism through which education affects health is by reducing the likelihood of engaging in high-risk behaviors such as smoking. However, according to the marginalization-related diminished returns (MDRs) theory, the association between education and health may be weaker for marginalized populations such as Black than White, primarily due to racism and discrimination. However, little is known about the racial variations in the differential associations between educational attainment and tobacco use in a local setting.
Aim
This study aimed to investigate the differential association between educational attainment and tobacco use among racial groups in a community sample in Baltimore City.
Methods
This cross-sectional study used data from a community survey conducted in 2012–2013 in Baltimore City among adults aged 18 years or older. The participants were 3501 adults. Univariate, bivariate, and logistic regression analyses were performed using Stata to investigate the racial difference in the association between education and two outcomes: current smoking status and menthol tobacco product use.
Results
The study found that adults with a graduate degree were less likely to be current smokers (adjusted odds ratio [AOR]: 0.10, 95% confidence interval [CI]: 0.08–0.13) and menthol tobacco users (AOR: 0.10, 95% CI: 0.07–0.14) compared to those with less than high school diploma. The inverse associations between educational attainment and current smoking (AOR: 1.83, 95% CI: 1.05–3.21) and menthol tobacco product use (AOR: 4.73, 95% CI: 2.07–10.80) were weaker for Back individuals than those who were White.
Conclusion
Due to MDRs of educational attainment, while highly educated White adults show a low risk of tobacco use, educated Black adults remain at a disproportionately increased risk. The study emphasizes the need for better policies and programs that address minorities’ diminished return of education for tobacco use.
... (Tobacco Products Scientific Advisory Committee, 2011;Villanti et al., 2017;Mills et al., 2021;Delnevo et al., 2011;Trinidad et al., 2009;Smith et al., 2020;Leas et al., 2023) Non-Hispanic Black/African American adults who smoke menthol cigarettes are less likely to achieve successful smoking cessation compared to other racial and ethnic groups despite non-Hispanic Black/African American adults who smoke cigarettes reporting more smoking quit attempts. (Tobacco Products Scientific Advisory Committee, 2011;Villanti et al., 2017;Mills et al., 2021;Delnevo et al., 2011;Trinidad et al., 2009;Smith et al., 2020;Leas et al., 2023;National Center for Chronic Disease Prevention and Health Promotion, 1998;Babb et al., 2017) Other studies on menthol cigarette use focus on sex and age-related differences in prevalence among female and younger adults who smoke; (Seaman et al., 2022;Villanti et al., 2016;Smith et al., 2017;Giovino et al., 2015) however, it is unclear whether prevalence trends for menthol smoking cessation among female and young adults who smoke mirror overall increases in combusted cigarette cessation. (Babb et al., 2017). ...
People who smoke menthol cigarettes, particularly those who are non-Hispanic Black/African American, are less likely to achieve successful smoking cessation compared with people who smoke non-menthol cigarettes. This study examined the 2003–2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) harmonized data to estimate cross-sectional trends in cigarette smoking cessation among U.S. adults, stratified by menthol cigarette use, race/ethnicity, sex, and age. The analytic sample included respondents who smoked for ≥ 2 years (current users and former users who reported quitting during the past year). We tested cessation trends using orthogonal polynomial contrasts for overall, menthol, and non-menthol smoking cessation prevalence and stratified by race/ethnicity, sex, and age in logistic regression models. We also analyzed the 2018–2019 non-harmonized TUS-CPS data among recent quitters to examine differences in characteristics (e.g., demographic characteristics, smoking frequency, use of smoking cessation aids, switching to other tobacco products) by menthol cigarette use. We observed significant linear changes in prevalence trends for overall cigarette smoking cessation, menthol smoking cessation, and non-menthol smoking cessation (p < 0.0001 for all linear trends), and changes in menthol cessation among non-Hispanic White and non-Hispanic Other race/ethnicity categories during 2003–2019. In the 2018–2019 wave, we observed differences in menthol status for sex, race/ethnicity, age, and educational attainment. We did not observe differences for other characteristics. We observed changes in overall cigarette smoking cessation, menthol, and non-menthol smoking cessation prevalence during the study period; however, gains in cigarette smoking cessation were not experienced among non-Hispanic Black/African American adults who smoke.
... Historically, males have higher prevalence of smoking than females at any time points, more cigarettes per day 8,12 , and higher rates of the use of tobacco related products 12 . Men were more likely to smoke more harmful non-menthol cigarettes 13,14 . The decreased smoking prevalence in the past decades attributes to reduced incidences of lung cancer and other cigarette related cancers. ...
Lung cancer ranks as one of the top malignancies and the leading cause of cancer death in both males and females in the US. Using a cancer database covering the entire population, this study was to determine the gender disparities in lung cancer incidence during 2001–2019. Cancer patients were obtained from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) database. The SEER*Stat software was applied to calculate the age-adjusted incidence rates (AAIR). Temporal changes in lung cancer incidence were analyzed by the Joinpoint software. A total of 4,086,432 patients (53.3% of males) were diagnosed with lung cancer. Among them, 52.1% were 70 years or older, 82.7% non-Hispanic white, 39.7% from the South, and 72.6% non-small cell lung cancer (NSCLC). The AAIR of lung cancer continuously reduced from 91.0 per 100000 to 59.2 in males during the study period, while it increased from 55.0 in 2001 to 56.8 in 2006 in females, then decreased to 48.1 in 2019. The female to male incidence rate ratio of lung cancer continuously increased from 2001 to 2019. Gender disparities were observed among age groups, races, and histological types. In those aged 0–54 years, females had higher overall incidence rates of lung cancer than males in recent years, which was observed in all races (except non-Hispanic black), all regions, and adenocarcinoma and small cell (but not squamous cell). Non-Hispanic black females aged 0–54 years had a faster decline rate than males since 2013. API females demonstrated an increased trend during the study period. Lung cancer incidence continues to decrease with gender disparities among age groups, races, regions, and histological types. Continuous anti-smoking programs plus reduction of related risk factors are necessary to lower lung cancer incidence further.
... 35 Numerous studies have shown higher prevalence of menthol cigarette smoking among black smokers. 24,[36][37][38] It is thus important to assess menthol-related health disparities with respect to smoking initiation, dependence, and cessation. Focusing on initiation, a longitudinal study had shown that retrospectively, a higher percentage of African American smokers initiated smoking with menthol cigarettes, compared with smokers from all other races. ...
Introduction:
Certain subpopulations in the United States are highly vulnerable to tobacco initiation and addiction, and elimination of disparities among those groups is crucial to reducing the burden of tobacco use.
Methods:
This study evaluated the racial/ethnic differences in smoking initiation of menthol/mint flavored cigarettes and cigars among never-users, and in subsequent tobacco use among new users of menthol-flavored products, using longitudinal data from Waves 1¬4 of the Population Assessment of Tobacco and Health Study. The outcomes of interest were new use of menthol-flavored products, and subsequent past 30-day and past 12-month cigarette and cigar smoking, irrespective of flavors, after initiation.
Results:
The percentages of new users of menthol-flavored cigarettes and cigars at Waves 2¬4 were disproportionately higher in non-Hispanic Black and Hispanic than in non-Hispanic White people. Adjusting for age and sex, Black people who first used any menthol cigars had higher risk of past 30-day use of the same cigar category at the subsequent wave (adjusted risk ratio, aRR 1.48; 95% confidence interval, CI 1.11¬1.96) and past 12-month (aRR 1.74; 95% CI 1.55¬2.63) compared to non-Hispanic White smokers. Black people who first used menthol-flavored cigarettes had marginally higher risk of subsequent past 30-day cigarette use (aRR 1.44; 95% CI 0.99¬2.10) compared with their non-Hispanic White counterparts.
Conclusions:
This study shows that racial/ethnic differences exist in both initiation of menthol-flavored tobacco products and product-specific subsequent use after first using menthol-flavored products; Black and Hispanic people have higher rates of initiation; Black people also have higher rates of subsequent use.
Implications:
Use of menthol flavors in tobacco products is confirmed to be a contributor to large disparities in tobacco use; Black and Hispanic people are more likely to maintain smoking through use of mentholated products than non-Hispanic White people. The findings suggest educational and regulatory actions on menthol-flavored tobacco products including restricting the selective marketing to vulnerable communities and banning characterizing flavors in cigarettes and cigars may reduce tobacco-related disparities and inform the FDA's evidence-based rulemaking process.
... 12,13 Furthermore, the likelihood of becoming an established smoker is greater for those who initiate experimenting with menthol cigarettes. 14,15 Flavor capsule cigarettes, which contain a capsule that the consumer can crush to flavor the smoke, have rapidly gained market share worldwide. 16 In 2018, Guatemala had the second highest market share for these cigarettes (30%) worldwide. ...
Objective:
To assess how first experimenting with ciga-rettes or e-cigarettes is associated with current use in Gua-temala, a middle-income country with weak tobacco control and no e-cigarette regulations.
Materials and methods:
We surveyed students from private schools in Guatemala City, limiting analyses to ever users (n=1 026). Multinomial logistic models regressed current product use on first product used, adjusting for sociodemographics and friends and family use.
Results:
The most common first product used was e-cigarettes (56%), followed by flavored cigarettes (24%) and regular cigarettes (20%). At the time of the survey, 4% were exclusive smokers, 37% were exclusive e-cigarette users, 18% dual users, and 40% had ever tried either but were not current users. Compared to those who first tried cigarettes, students who first tried e-cigarettes were less likely to be current smokers (RR=0.19 [CI: 0.11,0.31]) or dual users (RR=0.26 [CI: 0.14,0.49]) and students who first tried flavored cigarettes were more likely to be current smokers (RR=1.66 [CI=1.13,2.42]).
Conclusions:
In our sample, Guatemalan adolescents from private schools more frequently experiment and continue to use e-cigarettes than cigarettes. There is urgent need to implement e-cigarette restrictions in addition to tobacco control policy implementation.
