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Keywords:

  • Mentholated cigarettes;
  • nicotine dependence;
  • young adult smokers;
  • tobacco control policies

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. Declarations of interest
  8. References

Aim  To examine relationships between the preference for menthol cigarettes and young adult smoking behaviors, including the extent to which state tobacco control policies moderate these relationships.

Design  Cross-sectional design using secondary data from the 2006–07 Tobacco Use Supplements to the Current Population Surveys (TUS CPS) surveys appended with 2006 state-policy data.

Setting  United States nationally representative survey.

Participants  A total of 2241 young adult daily smokers and 688 young adult non-daily smokers.

Measurements  The two dependent variables of smoking behaviors were smoking first cigarette within 30 minutes of waking (TTF) and number of cigarettes smoked per day (cpd). Primary independent variables included menthol brand preference and state tobacco control policies (youth access laws, clean indoor air laws and cigarette excise taxes), adjusting for controls.

Findings  Among daily smokers, there were no significant associations between menthol brand preference and TTF or cpd. However, lower educational attainment, not being in the labor force and the lack of home smoking rules were associated positively with shorter TTF, being white and the lack of home smoking rules were associated positively with cpd. Among daily smokers, state excise taxes were associated negatively with higher cpd. Among non-daily smokers, menthol brand preference was associated positively with shorter TTF, but associations did not vary with state tobacco control policies. Menthol brand preference was not associated significantly with cpd, but male gender, unmarried status and the lack of home smoking rules were associated positively with greater cpd among non-daily smokers.

Conclusions  Young adult non-daily smokers who preferred menthol cigarettes were significantly more dependent than those who preferred non-menthol cigarettes, as shown through the shorter TTF. Associations between menthol brand preference and smoking behaviors did not vary with state tobacco control policies.


INTRODUCTION

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. Declarations of interest
  8. References

Young adults are at high risk for smoking due to increasing autonomy from parents, reaching legal age to purchase tobacco products, increasing use of other addictive substances and direct targeting by the tobacco industry to sustain tobacco use and recapture those who quit smoking [1–3]. According to national estimates from 2005–07, nearly 24% of young adults aged 18–24 years reported currently smoking every day or on some days—the highest smoking prevalence among all age groups [4]. In addition, young adult smokers' preference for menthol cigarettes increased from 34.1% to 40.8% between the years 2004–08 [5], which is concerning, because research suggests that menthol cigarettes may be a starter tobacco product and increase nicotine dependence [6]. Evidence of the role of menthol brand preference in shaping the smoking behaviors of young adults is limited, but research has found that adolescent menthol smokers have 45% higher odds of being above the median on nicotine dependence and are significantly less likely to consider quitting smoking than teens who smoked non-menthol cigarettes [6]. Research has found that people who quit smoking before the age of 35 have a life expectancy similar to those who never smoked [7]. Therefore, identifying variables related to nicotine dependence among young adult smokers may inform cessation strategies as recommended in the Institute of Medicine (IOM) report on ending the tobacco problem [8].

However, our understanding of the factors that prevent smoking or reduce nicotine dependence among young adults is limited due to a scarcity of research among this population [9], particularly among higher-risk groups who already smoke on a daily or occasional (non-daily) basis, as well as between menthol and non-menthol users. Research among adolescents and young adults suggests that state tobacco control policies, particularly cigarette taxes, may be effective in reducing the prevalence of smoking and increasing tobacco cessation [10,11]. However, research also found that increased cigarette taxes were associated with a reduction in the number of cigarettes smoked among young adults [12,13], but the increased tax also was associated with young adults' switching to cigarette brands with higher amounts of tar and nicotine [12]. Strong clean indoor air laws and increasing cigarette prices were associated with decreased cigarette consumption in a study among current smokers aged 15–80 years [13], while another found that young adults were more likely to quit smoking when exposed to more restrictive smoking bans in the work-site and public places [11]. Youth access policies and enforcement aim to reduce sales of cigarettes to minors, but studies provide only limited support of their effectiveness [14]. However, adolescents obtain most of their cigarettes from non-retail sources, such as older peers and parents or through theft; thus the effectiveness of state policy controls may be attenuated [14].

Because young adulthood is a critical time for the establishment of nicotine dependence [15], efforts to reduce smoking among this vulnerable population are imperative. Further research on the role of state tobacco control policies and nicotine dependence among young adults is needed, particularly among specific population groups and types of users. Therefore, the purpose of this research was twofold: [1] to examine associations between menthol brand preference and the smoking behaviors of young adult daily and non-daily smokers and [2] to examine the extent to which the associations between menthol brand preference and smoking behaviors were moderated by state tobacco control policies.

METHODS

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. Declarations of interest
  8. References

Study design and data sources

A cross-sectional design was employed using secondary data from the Tobacco Use Supplements to the Current Population Surveys (TUS CPS)—May 2006, August 2006 and January 2007 surveys appended with 2006 state-policy data on youth access laws, clean indoor air laws and cigarette excise taxes. The TUS is sponsored by the National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC) and surveys US households on smoking and other tobacco use [16]. The TUS is a supplement to the core CPS that the US Census Bureau conducts monthly to examine employment status and socio-demographic factors of US households. For this study, data on state-level youth access and clean indoor air laws were derived from NCI's State Cancer Legislative Database Program (http://www.scld-nci.net) and the data on state-level cigarette excise taxes were obtained from the American Lung Association (ALA; State of Tobacco Control).

Sample

The 2006–07 TUS CPS surveys were administered to approximately 267 000 civilian, non-institutionalized people. The sampling frame for our study was young adults aged 18–24 years who reported smoking daily (n = 2339) or non-daily (n = 795), which was defined as smoking 1–29 of the last 30 days. This study utilized only data from self-respondents, because certain items of interest related to tobacco use were not asked of proxies. Observations with missing data were excluded from analysis for a final sample size of 2241 young adult daily smokers (missing n = 98) and 688 non-daily smokers (missing n = 107) who lived across the 50 states and Washington, DC. The sample for this study was stratified by daily smoking and non-daily smoking for theoretical and methodological reasons. First, because menthol is thought to be a starter product to greater nicotine dependence [6], we wanted to capture the unique associations along this continuum. Secondly, non-daily and daily smokers most probably smoke for different reasons, with variations in risk and protective characteristics. Thirdly, although the TUS asks daily and non-daily smokers identical smoking behavior questions, items for the latter group refer to the average only on the days that they smoke, which complicates measurement and estimation if analyzed simultaneously.

Measures

Dependent variables

Smoking behaviors were operationalized as smoking within 30 minutes upon waking and the average number of cigarettes smoked per day. Time to first cigarette was measured as a categorical variable, with individuals who smoked their first cigarette within 30 minutes of waking categorized as ‘yes’. The distribution for the average number of cigarettes smoked was non-normal even after taking the log; thus we analyzed this as a continuous count variable.

Independent variables

Menthol brand preference was measured as a categorical variable, with ‘yes’ indicating that young adults preferred to smoke only menthol brand cigarettes. Individual-level control variables included key socio-demographic characteristics and household smoking rules. Race and ethnicity were categorized as Hispanic, non-Hispanic white, non-Hispanic black and non-Hispanic ‘other’, with the final category including those participants who self-identified as non-Hispanic Asian, American Indian and multi-racial, due to small sample sizes. Foreign birth was categorized as born in United States versus born outside United States. Socio-economic position was measured via three indicators—employment status, household income and educational attainment. Employment status was categorized as employed, unemployed and not in the labor force during the week before the survey. Individuals were classified by the TUS CPS as not in the labor force if they were retired, disabled or other status, which included students or those participants who were running a household. Income in the TUS CPS is an ordinal measure of annual family income that was accrued during the 12 months preceding the survey, including income obtained from employment, business, farm or rent, dividends, social security, pensions and interest. We categorized the income measure into four brackets (as in Table 1). Lower educational attainment was measured as those participants who were aged 18 years with less than 11th grade education or aged 19–24 years without a high school diploma. Presence of smoking rules in the household were measured categorically as no smoking rules in the home, some smoking allowed and no smoking allowed at all. Additional controls included age, gender, marital status (categorical measure of married versus never married, divorced, widowed or separated), and for non-daily smokers a control variable for the number of days that they smoked per month.

Table 1.  Descriptive findings of socio-demographic characteristics and menthol brand preference of young adult daily and non-daily smokers, including state tobacco control policiesa.
 Daily smokersNon-daily smokers
n = 2241n = 688
%Mean (SD)%Mean (SD)
  • a

    Unweighted analyses. SD: standard deviation.

Dependent variables
First cigarette smoked within 30 minutes of waking50.3 9.7 
Average number of cigarettes smoked daily13.5 (7.4)4.4 (4.2)
Independent variables
Menthol brand preference29.9 25.7 
Race    
 Black6.4 8.1 
 Hispanic7.0 14.5 
 Other6.7 8.0 
 White79.9 69.4 
Foreign birth4.5 11.5 
Socio-economic position    
 Household income    
  Missing7.0 6.1 
  $0–24 99943.1 43.5 
  $25–49 99928.5 26.4 
  $50 000+21.4 24.0 
 Lower education24.1 16.7 
 Employment    
  Unemployed12.7 10.8 
  Not in labor force19.2 17.7 
  Employed68.1 71.5 
 Age21.5 (1.9)21.8 (1.8)
 Male48.9 48.8 
 Married14.9 11.9 
 Lives with parent28.9 24.7 
 Number of days smoked per month  13.1 (7.1)
 Home smoking rules    
  Smoking allowed30.5 11.8 
  Some smoking allowed21.3 20.6 
  No smoking allowed48.2 67.6 
State youth access laws 19.3 (6.4) 19.4 (6.3)
State clean air laws 23.3 (12.2) 24.3 (12.1)
State cigarette excise tax $ 0.96 (0.59) 0.99 (0.57)
State logged cigarette excise tax $ −0.27 (0.74) −0.21 (0.71)
State prevalence of current smoking 24.6 (5.7) 23.3 (5.5)

Four state-level variables were examined: 2006 youth access tobacco laws, 2006 clean indoor air laws, 2006 cigarette excise tax and 2006–07 smoking prevalence. Youth access laws were measured using a composite developed by Alciati and colleagues [17] to rate the extensiveness to which states legislate tobacco use among youth. The composite rates nine tobacco control measures, including minimum age for purchase, sealed packaging, clerk intervention for purchase, photo identification for purchase, ban on the sale of tobacco products through vending machines, ban of free tobacco samples or rebates, graduated penalties for retailers violating the youth access laws, random inspections of retailers and state-wide enforcement of the laws. Six of the items are rated from 0 (no effective provision) to 4 (meets target) and three have the possibility to score 5 for exceeding the target goal for a possible total of 39 on the composite. The state clean indoor air laws also were measured using a composite developed by Chriqui and colleagues [18] that rates the extensiveness to which states restrict indoor tobacco use. The composite rates nine tobacco control measures, including smoking restrictions in seven site-specific areas and two provisions on enforcement. Scoring of items range from 0 (no effective provision) to 4 (meets target) and if the state exceeds the target on six of the nine items, then they are eligible to receive an additional 6 points for a maximum score of 42. Data on state excise taxes represent the tax added to the purchase of a pack of cigarettes in US dollars. The variable was logged for the purposes of this analysis to achieve a normal distribution. Because state excise taxes increased among several states between data collection points in the 2006–07 TUS, we disaggregated this measure to the individual level to adjust for these changes. All state-level policy variables were continuous measures. A state-level measure of the prevalence of young adults (aged 18–29 years) who smoked daily or non-daily was included as a control [19].

Analysis

Descriptive and multi-level analyses were conducted using SAS version 9.1 statistical software (SAS Institute, Cary, NC, USA) and HLM 6.07 (SSI, Inc., Lincolnwood, IL, USA). Multicollinearity was examined and no influential correlation between variables was found. All analyses were unweighted as multi-level modeling software packages are unable to accommodate replicate weights [20]. Descriptive analyses were conducted to yield characteristics of participants. Multi-level analyses were conducted to examine associations between menthol brand preferences and the dependent variables measuring smoking behaviors, including cross-level interactions with state-level tobacco control policies. Multi-level random intercept models were analyzed using the Bernoulli distribution for the binary dependent variable (first cigarette smoked within 30 minutes of waking) and a Poisson distribution corrected for overdispersion with a negative binomial distribution for the count dependent variable (average number of cigarettes smoked). [We chose this analytical technique because it allows for random effect modeling inherent to the nested nature of our data. However, this model will produce a prediction for the zero count but a zero is not included in the distribution of the dependent variable, which ranges from 1 to 60. We analyzed the data using a zero-truncated negative binomial regression model with robust standard errors and the findings were consistent between the two techniques.]

RESULTS

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. Declarations of interest
  8. References

Table 1 presents descriptive characteristics of young adult daily and non-daily smokers. Among young adult daily smokers, half the sample smoked their first cigarette within 30 minutes of waking and the mean number of cigarettes smoked was 13.5 (range 1–60). Approximately 30% of the young adult daily smokers reported that they preferred to smoke menthol cigarettes. The majority was non-Hispanic white (80%) and only 4.5% was foreign-born. In relation to socio-economic position, 68% were employed, but 43% reported a low household income and 24% had lower educational attainment. The sample was nearly 50% male and only 15% was married. Nearly half lived in households where smoking was not allowed anywhere, 21% lived in households where smoking was allowed only in certain places and 30% lived in households where smoking was allowed in all places.

Among non-daily smokers, on the days that they smoked approximately 10% smoked their first cigarette within 30 minutes upon waking and the mean number of cigarettes smoked was 4.4 (range 1–30). Nearly 26% of non-daily smokers preferred menthol cigarettes. Approximately 70% of the sample was non-Hispanic white and 11% was foreign-born. Socio-economic composition, gender and marital status were similar to daily smokers. Nearly 68% of non-daily smokers lived in households where smoking was not allowed anywhere, 21% lived in households where smoking was allowed only in certain places and 12% lived in households where smoking was allowed in all places.

Table 2 presents the findings of the multivariate analyses for both of the smoking behaviors among the sample of young adult daily smokers. Specifically, in relation to time to first cigarette, we found no associations between menthol brand preference and smoking within 30 minutes upon waking. In addition, no significant associations between the state tobacco control policies and timing to first cigarette were found, nor were there any significant moderating effect of policies on the associations between menthol brand preference and cigarette timing. Among control variables, we found that Hispanic (−0.49, P < 0.01) or foreign-born young adults (−0.77; P < 0.01) were less likely to smoke their first cigarette within 30 minutes of waking compared to those who were white or US-born, respectively. In addition, young adult daily smokers with lower educational attainment were more likely than their more educated peers to smoke their first cigarette within 30 minutes of waking (0.557; P < 0.001), as were those who were not in the labor force compared to those who were employed (0.447; P < 0.01). In addition, males were more likely than females to smoke their first cigarette within 30 minutes (0.538; P < 0.001). Household smoking rules were related significantly to the timing of first cigarette smoked. Specifically, compared to young adult daily smokers who lived in households where no smoking was allowed, young adult daily smokers who lived in households with no smoking rules were more likely to smoke their first cigarette within 30 minutes of waking (0.752; P < 0.001), as were those who lived in households where smoking was allowed in some places (0.250; P < 0.05).

Table 2.  Random effects models of menthol brand preference and smoking behaviors of young adult daily smokers; 2006–07 Tobacco Use Supplement to the Current Population Survey (n = 2241)a,b.
 First cigarette within 30 minutes of wakingAverage number of cigarettes smoked daily
Binary logit modelPoisson model
Coefficient (SE)Coefficient (SE)
  • *

    P < 0.05;

  • **

    P < 0.01;

  • ***

    P < 0.001.

  • a

    a Unweighted analyses.

  • b

    b Final models. Cross-level interactions non-significant, thus not depicted in model. Available upon request. SE: standard error.

Level I fixed effects
Menthol brand preference0.151(0.088)0.022(0.031)
Race    
 Black−0.102(0.171)−0.292(0.059)***
 Hispanic−0.49(0.170)**−0.185(0.050)***
 Other−0.192(0.214)−0.220(0.057)***
 White (reference)ref  ref
Foreign birth−0.771(0.289)**−0.188(0.062)**
Socio-economic position    
 Household income    
  Missing0.182(0.225)0.056(0.041)
  $0–24 9990.076(0.145)−0.023(0.032)
  $25–49 9990.085(0.144)0.028(0.033)
  $50 000+ (reference)ref  ref
 Lower education0.557(0.105)***0.055(0.028)
 Employment    
  Unemployed0.202(0.167)0.042(0.042)
  Not in labor force0.447(0.134)**0.023(0.034)
  Employed (reference)ref  ref
 Age0.019(0.022)0.021(0.006)**
 Male0.538(0.092)***0.176(0.026)***
 Married0.096(0.135)−0.011(0.030)
 Lives with parent−0.044(0.122)0.042(0.034)
 Home smoking rules    
  Smoking allowed0.752(0.096)***0.199(0.029)***
  Some smoking allowed0.250(0.108)*0.074(0.028)**
  No smoking allowed (reference)ref  ref
Level II fixed effects
State youth access laws−0.007(0.006)−0.001(0.002)
State clean air laws−0.002(0.003)0.001(0.001)
State logged cigarette excise tax $0.020(0.051)−0.046(0.017)**
State prevalence of current smoking0.013(0.007)0.004(0.003)
Random effects
Intercept−0.815(0.134)***2.43(0.039)***

In relation to the average number of cigarettes smoked among daily smokers, no significant differences in the number of cigarettes smoked daily were found between menthol and non-menthol cigarette smokers. Youth access and clean air laws had no significant effect on the average daily number of cigarettes smoked. However, a small significant effect was found for the logged state excise taxes. Specifically, if state tobacco taxes were increased by 100%, the average number of cigarettes smoked among daily smokers would decrease by 4.6%. None of the tobacco control policies moderated associations between menthol brand preference and number of cigarettes smoked. Among control variables, young adult daily smokers who were Hispanic (−0.185; P < 0.001), black (−0.292, P < 0.001) or categorized as ‘other’ (−220; P < 0.001) smoked fewer cigarettes than those who were categorized as white. Similarly, young adults who were foreign-born smoked fewer cigarettes than those who were US-born (−0.188; P < 0.01). Males smoked more cigarettes per day than females (0.176; P < 0.001) and the number of cigarettes smoked increased as age increased, although the effect was small (0.02; P < 0.01). Lastly, household smoking rules were related significantly to the number of cigarettes smoked. Specifically, the number of cigarettes smoked per day was higher among young adults who lived in households without any smoking rules (0.199; P < 0.001) as well as among those who lived in households where smoking was allowed in some places (0.074; P < 0.01), compared to young adults who lived in households where no smoking was allowed.

Table 3 presents the findings of the multivariate analyses for both of the smoking behaviors among the sample of young adult non-daily smokers. In relation to timing of first cigarette, menthol users were found to be significantly more likely to smoke within 30 minutes of waking compared to those who smoked non-menthol cigarettes (0.709, P < 0.05). However, non-daily smokers who lived in states with more strict clean air laws were more likely to smoke within 30 minutes of waking compared to those who lived in states with less strict laws (0.031, P < 0.05). No significant cross-level interactions were found with state tobacco control policies and associations between menthol brand preference and timing to first cigarette. Among control variables, Hispanic participants were less likely than non-Hispanic whites to smoke within 30 minutes of waking (−1.41, P < 0.05), as were males compared to females (0.727, P < 0.01).

Table 3.  Random effects models of menthol brand preference and smoking behaviors of young adult non-daily smokers; 2006–07 Tobacco Use Supplement to the Current Population Survey (n = 688)a,b.
 First cigarette within 30 minutes of wakingAverage number of cigarettes smoked daily
Binary logit modelPoisson model
Coefficient (SE)Coefficient (SE)
  • *

    P < 0.05;

  • **

    P < 0.01;

  • ***

    P < 0.001.

  • a

    a Unweighted analyses.

  • b

    b Final models. Cross-level interactions non-significant, thus not depicted in model. Available upon request. SE: standard error.

Level I fixed effects
Menthol brand preference0.709(0.317)*−0.018(0.110)
Race    
 Black0.262(0.457)−0.022(0.165)
 Hispanic−1.41(0.574)*−0.445(0.064)***
 Other−0.298(0.567)−.140(0.119)
 White (reference)ref ref 
Foreign birth−0.245(0.495)−0.054(0.120)
Socio-economic position    
 Household income    
  Missing0.545(0.746)0.218(0.151)
  $0–24 9990.697(0.383)−0.106(0.114)
  $25–49 9990.244(0.506)0.100(0.117)
  $50 000+ (reference)ref ref 
 Lower education0.498(0.317)0.123(0.093)
 Employment    
  Unemployed−0.485(0.507)0.070(0.137)
  Not in labor force0.326(0.347)0.239(0.086)**
  Employed (reference)ref ref 
 Age−0.052(0.083)−0.002(0.018)
 Male0.727(0.257)**0.234(0.074)**
 Married0.032(0.553)−0.299(0.091)**
 Lives with parent0.056(0.376)0.051(0.086)
 Number of days smoked per month0.050(0.027)0.022(0.005)***
 Home smoking rules    
  Smoking allowed0.620(0.427)0.199(0.097)*
  Some smoking allowed0.330(0.359)0.225(0.081)**
  No smoking allowed (reference)ref ref 
Level II fixed effects
State youth access laws−0.025(0.024)−0.004(0.005)
State clean air laws0.031(0.015)*−0.007(0.004)
State logged cigarette excise tax $−0.153(0.257)0.018(0.049)
State prevalence of current smoking0.007(0.034)0.006(0.006)
Random effects
Intercept−3.63(0.422)***1.26(0.109)***

In relation to the average number of cigarettes smoked among non-daily smokers, no significant differences in number of cigarettes smoked were found based on menthol brand preferences or state smoking policies. In addition, no significant cross-level interactions were found with state tobacco control policies and associations between menthol brand preference and timing to first cigarette. Among control variables, Hispanic participants smoked fewer cigarettes per day on the days that they smoked than white participants (−0.445, P < 0.001), while males smoked more cigarettes than females (0.234, P < 0.01). In relation to socio-economic status, young adults who were not in the labor force smoked more cigarettes than those who were employed (0.239, P < 0.01). In addition, young adult non-daily smokers who were married smoked fewer cigarettes than those who were not married (−0.299, P < 0.01). Household smoking rules were associated significantly with smoking, with a greater number of cigarettes smoked among young adults who lived in households without any smoking rules (0.199; P < 0.05) as well as among those who lived in households where smoking was allowed in some places (0.225; P < 0.01), compared to young adults who lived in households where no smoking was allowed. Finally, non-daily smokers who smoked more days per month smoked more cigarettes per day on average than those who smoked fewer days per month (0.022, P < 0.001).

DISCUSSION

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. Declarations of interest
  8. References

The purpose of this study was to examine associations between menthol brand preference and smoking behaviors among young adult daily and non-daily smokers, including the extent to which state tobacco control policies moderated these associations. We found that menthol cigarettes were associated significantly with shorter time to first cigarette in non-daily smokers, but not among daily smokers. According to previous research, menthol cigarette use is more common among younger and less experienced smokers and greater nicotine dependence occurs among adolescent menthol smokers [6]. The findings among non-daily smokers are in accordance with those of a laboratory study of adolescent smokers in which those who smoked menthol cigarettes had a significantly shorter time to first cigarette upon waking compared to non-menthol smokers (45% versus 29% smoking within the first 5 minutes of the day, respectively), although no significant differences in the number of cigarettes per day were found between the two groups [21]. Others report similar findings, as African American and white women smoking menthol cigarettes daily had a significantly shorter time to first cigarette compared to non-menthol smokers of both races [22]. Potential explanations for different effects of menthol cigarettes and TTF between daily and non-daily smokers may be due to differences in the measurement of time to first cigarette and laboratory settings versus survey design. Specifically, we used a categorical measure of having smoked the first cigarette within the first 30 minutes of waking in accordance with Fagan et al. [23], while the two aforementioned studies utilized continuous measures. Secondly, in relation to menthol exposure, research has found brand variability in the amount of menthol contained in cigarettes [24]. Because menthol additive masks harshness and discomfort of inhaling smoke, differences in the amount of menthol in a cigarette in combination with variation in smoking topography behaviors may yield variability in menthol exposure. This may not be captured adequately in the categorical measure of menthol versus non-menthol cigarette information.

No significant variations in smoking behaviors were found between menthol users and non-menthol users based on differences in state tobacco control policies, which suggests that policies may have similar effects on smoking behaviors between these two groups. State policies related to clean air, youth access and cigarette excise tax had few significant associations with the smoking behaviors of both daily and non-daily young adult smokers in our study overall. However, among non-daily smokers, clean air laws were associated with shorter time to first cigarette. In this case, individuals may smoke earlier in the day in anticipation of being in clean air facilities. Cigarette tax was the only state policy that had an effect on cigarettes per day, albeit a very slight reduction. The limited effect of state tobacco control policies in our study warrants further examination. First, in relation to cigarette taxes, price-sensitive smokers may use high price avoidance strategies such as a low or untaxed venue, discount or generic cigarette brands and coupons, which dampen the health impact of higher cigarette prices [25]. Secondly, policy effectiveness may vary based on psychosocial factors, as in one national study finding that adolescents who had low self-control were largely unresponsive to cigarette price [26]. Consequently, further study on how individual locus of control influences smoking behaviors and the effectiveness of additional state tobacco control policies are warranted. Thirdly, young adults may be more responsive to social control measures against smoking if they occur in their immediate environment. Specifically, home smoking bans had a significant impact on smoking behaviors among our sample of young adults, which is in accordance with previous research [27]. Thus, increased emphasis on home smoking bans by peers, parents or partner may be an effective strategy to modify smoking behavior in the 18–24-year-old age group of daily and non-daily smokers. Lastly, further research examining other contextual factors should be considered. For example, social norms related to menthol brand preference, tobacco industry marketing of menthol cigarettes, and anti-smoking media, including menthol messages may have more of an influence on the smoking behaviors of young adults.

Several of our findings related to our control variables and smoking behaviors of young adult daily and non-daily smokers warrant further discussion. First, socio-economic disparities were found with lower educational attainment associated with shorter time to first cigarette among daily smokers, while non-daily smokers who were not in the work force smoked more cigarettes on average when they smoked compared to their employed peers. These findings are in accordance with previous research [9,15,28–30] and highlight the need to direct smoking cessation interventions to socio-economically disadvantaged populations. Additionally, we found that minorities, particularly young adult Hispanic smokers and those of foreign birth, were less likely than their white peers to be more dependent on nicotine, consistent with previous research [31]. However, more detailed investigations of Hispanics are needed, as previous research has found that health behaviors and health outcomes vary across Hispanics based on their country of origin, socio-economic opportunities and acculturation [32,33].

Our study had several limitations. First, the study is cross-sectional, which precludes causal inferences. Longitudinal analyses on associations between menthol brand preference and lag effects of tobacco policies on smoking behaviors may yield more robust findings. Secondly, a proportion of the TUS CPS respondents were accessed using random digit dialing computer-assisted telephone surveys, which may under-represent low-income populations and those engaging in higher risk behaviors, including smoking [33]. In both our samples, approximately 50% of the young adults were interviewed in person using computer-assisted devices, 43% were interviewed via telephone and 7% were missing on the response to type of interview. Increasingly, young adults are more likely than any other age group to have cell phone service only, thus the use of land-line telephone surveys for this population should be used with caution. Thirdly, our measures of time to first cigarette and menthol use were limited to those in the TUS CPS, which did not include measures of smoking topography, exhaled carbon monoxide, plasma nicotine or cotinine concentrations. Consequently, our ability to detect significant associations may have been restricted, and future studies should consider more refined measures. Despite these limitations, this study enhances our understanding of the role of menthol brand preference in the smoking behaviors of young adult daily and non-daily smokers, including no significant differences in smoking behaviors between menthol and non-menthol users based on state tobacco control policies. Future research that examines the role of menthol cigarettes as starter-products to greater nicotine dependence are needed, including policy analyses of state tobacco control efforts targeting menthol use.

References

  1. Top of page
  2. ABSTRACT
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. Declarations of interest
  8. References