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Keywords:

  • Menthol;
  • tobacco;
  • gender;
  • race;
  • epidemiology;
  • ethnic groups;
  • adult;
  • smoking;
  • survey;
  • prevalence

ABSTRACT

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

Aim  To examine the patterns and correlates of mentholated cigarette smoking among adult smokers in the United States.

Design  Cross-sectional data on adult current smokers (n = 63 193) were pooled from the 2003 and 2006/07 Tobacco Use Supplements to the Current Population Survey.

Measurements  The associations between socio-demographic and smoking variables were examined with gender- and race/ethnicity-stratified multivariate logistic regression models predicting current use of mentholated cigarettes.

Findings  Multivariate logistic regression analyses demonstrated that black smokers were 10–11 times more likely to smoke mentholated cigarettes than white smokers men: odds ratio (OR): 11.59, 99% confidence interval (CI): 9.79–13.72; women: OR: 10.12, 99% CI: 8.45–12.11). With the exception of American Indian/Aleut/Eskimo smokers, non-white smokers were significantly more likely to smoke mentholated cigarettes than were white smokers. Additional significant factors associated with mentholated cigarette smoking included being unmarried (never married: OR: 1.21, 99% CI: 1.09–1.34; divorced/separated: OR: 1.13, 99% CI: 1.03–1.23), being born in a US territory (OR: 2.01, 99% CI: 1.35–3.01), living in a non-metropolitan area (OR: 0.87, 99% CI: 0.80–0.96), being unemployed (OR: 1.24, 99% CI: 1.06–1.44) and lower levels of education. Race/ethnicity-stratified analyses showed that women were more likely than men to smoke mentholated cigarettes. Among black smokers, young adults (aged 18–24 years) were four times more likely to smoke mentholated cigarettes compared with individuals aged 65+.

Conclusions  Race/ethnicity, gender and age are significant correlates of mentholated cigarette smoking among current smokers. Given the importance of menthol in the cigarette market and the potential untoward health effects of this additive, continued surveillance of the prevalence and correlates of mentholated cigarette use among diverse socio-demographic groups is warranted to inform appropriate interventions.


INTRODUCTION

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

In the United States, cigarette smoking causes approximately 438 000 deaths each year, including deaths related to cancer, cardiovascular disease, respiratory disease and infant mortality [1]. The burden of tobacco-related diseases and conditions has been found to differ by gender and race/ethnicity [2–4]. For example, the morbidity and mortality rates associated with cancer of the lung/bronchus are substantially higher for men than for women and are disproportionately higher for black men [4], even though black men smoke fewer cigarettes per day [3,5–7], start smoking later in life [3,6] and have fewer pack years [5] than white men. Furthermore, the incidence of lung cancer for black women, who smoke fewer cigarettes per day and have fewer pack-years than non-Hispanic white women, is higher than that for non-Hispanic white women [3,5], and the mortality rate for the disease is equivalent for black and non-Hispanic white women [4].

Over the past decade, researchers have called attention to multiple factors that might explain the disproportionate burden of cancer and other tobacco-related health disparities, including the role of socio-economic status in tobacco consumption and exposure-related behaviors [5,8–15], environmental and occupational factors [8–10] and genetics [8,9,11,16]. Researchers have also speculated that menthol cigarette consumption may be a contributing factor to tobacco-related health disparities [17–32]. However, in studies comparing disease risk among menthol and non-menthol smokers, the data are not consistent. Several studies report no association between menthol cigarettes and lung cancer [21,23,25,26,32], while other studies suggest a slight increased risk of lung cancer associated with menthol cigarette use among males but not females [29], a marginally significant increased risk of oesophageal cancer associated with menthol cigarettes among females only [17] and a slight increase of cancer of the pharynx among men [31]. Some of this research also suggests that menthol may further impede cardiovascular functioning [18] and mask symptoms of respiratory distress potentially leading to delayed treatment and greater severity of illness [24].

Researchers hypothesize that the pathway for increased disease risk may be partially attributed to the ‘cooling’ sensory properties of the menthol additive which may alter breath-holding or other respiratory and smoking patterns that could expose smokers to higher levels of nicotine and tar than non-mentholated cigarettes [22,33,34]. Several studies support this claim revealing higher levels of cotinine and/or carbon monoxide levels associated with menthol cigarette use compared to non-menthol cigarettes [35–39]. Research also suggests that menthol may increase toxic exposure by inhibiting the metabolism of nicotine [40] and detoxification of tobacco-specific lung carcinogens [41]. Researchers also suggest that the sensory and physiological effects of menthol may increase the addiction potential of menthol cigarettes [35,42–45] and adversely impact quit attempts and successful smoking cessation [43,46–52].

Mentholated cigarettes contribute to about 20% of the tobacco industry sales market in the United States [53], and prior national-level data suggest that certain socio-demographic groups may bear a disproportionate burden of mentholated cigarette consumption. The most recent data among smokers 12 years and older show that the use of mentholated cigarettes is higher among female smokers than male smokers (36% versus 28%) and among all racial/ethnic minority groups than among the white population (nearly 83% for black smokers, 53% for Native Hawaiian/Pacific Islander smokers, 32% for Hispanic smokers and 31% for Asian smokers compared with 24% for white smokers) [54].

Despite the available data on the prevalence of mentholated cigarette smoking among various socio-demographic groups, there is a dearth of research on the specific socio-demographic and smoking-related factors associated with mentholated cigarette smoking. This study provides an overview of national prevalence rates and socio-demographic and smoking-related variables associated with mentholated cigarette smoking among adult current smokers. Because of the aforementioned gender and racial/ethnic differences in cigarette smoking patterns and cancer rates, this study also stratified the analyses by gender and race/ethnicity. Understanding socio-demographic and smoking-related variables associated with the use of mentholated cigarettes can help researchers to develop more targeted interventions to prevent the uptake of mentholated cigarettes and inform cessation interventions. Further, these data will inform the development and implementation of policies designed to reduce the burden of cigarettes and disproportionate harm caused by cigarettes among specific subpopulations in the United States.

METHODS

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

Study design

Cross-sectional data from the 2003 and the 2006/07 Tobacco Use Supplement to the Current Population Survey (TUS CPS) were examined for this analysis of adult smokers (at least 18 years old) (n = 69 193). The CPS, administered by the Census Bureau, uses a multi-stage probability design to collect data, in person and by telephone using computer-assisted interviewing, from about 50 000 families monthly to produce reliable national and state estimates on labor force characteristics among the civilian, non-institutionalized US population. Details of the sampling methods are published elsewhere [55]. The TUS is a supplement conducted with the CPS every 2–3 years to collect data on tobacco use, quitting behaviors, nicotine addiction and related attitudes and practices. Although data were obtained from self-respondents and proxies, our analyses were restricted to data from self-respondents because only they were eligible to answer questions on daily cigarette consumption, age at onset of smoking, number of cigarettes smoked per day, time to first cigarette (within waking) and use of other tobacco products. In 2003, the overall response rate was 82.9%, of which 64.6% were self-respondents and for 2006/07, the response rate was 82.6%, of which 75.1% were self-respondents.

Measures

Socio-demographic variables

To examine the socio-demographic patterns of mentholated cigarette use, gender, age, race/ethnicity, marital status, country of birth, geographic region and metropolitan status of residence, annual family income, highest educational level attained, employment status and occupation were collected from the CPS and were broken down into several categories (as listed in the tables) [56,57]. For these analyses, including the race-stratified logistic regression models, race/ethnicity categories included non-Hispanic white (white), non-Hispanic black/African American (black), Hispanic/Latino (Hispanic), American Indian/Alaska Native (AI/AN), and Asian/Pacific Islander (API).

Smoking behavior

Information on cigarette smoking status, menthol/non-menthol status of usual cigarette smoked, smoking frequency, age at onset of regular smoking, daily cigarette consumption, time to first cigarette of the day (used as a recommended measure of nicotine dependence [58–60]) and use of other tobacco products were collected using the TUS CPS. Data for the 3.5% of current smokers who reported no usual type of cigarette were deleted from the analyses.

Data analysis

The analysis was conducted using SUDAAN [61] to account for the complex sample design and the weights of the responses. Smoking prevalence estimates were based on weighted self-response variables and 95% confidence intervals (CIs) are provided to allow for within and between-group comparisons. Comparisons that included estimates with non-overlapping 95% CIs were considered to be significantly different. Logistic regression analyses were conducted to determine the association between socio-demographic and smoking behavior variables with the use of mentholated cigarettes among current smokers. Independent variables that were associated significantly with mentholated cigarette smoking in the bivariate logistic regression models (P < 0.05) were entered into the final multivariate models. Survey year was included in final models to control for differences between the survey administrations. Final multivariate logistic regression models were used to produce odds ratios (ORs) and 99% CIs and were stratified by gender and race/ethnicity. The sample sizes for respondents who self-identified as being of multiple races reporting unknown metropolitan status were removed from the regression analyses (<5% of the total sample of cigarette smokers). However, this did not have an effect on the results of the study.

RESULTS

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

Socio-demographic profile of mentholated versus non-mentholated cigarette smokers: gender and race/ethnicity (Table 1)

Table 1.  Characteristics of US current smokers (ages 18+ years) stratified by menthol cigarette use, Tobacco Use Supplements to the Current Population Survey (TUS CPS), 2003 and 2006/07 (n = 63 193a).
 Menthol%Non-menthol%
= 1 6294= 4 6899
  • a

    Table excludes those who reported ‘no usual type’ to the question regarding type of cigarette usually smoked. Also excludes those who did not smoke regularly and those with missing data to the following items: metropolitan status, age started smoking regularly, cigarettes per day, cigarette within first 30 minutes of waking and other tobacco use.

  • b

    b Employed: other: includes employed workers who did not provide occupation information (unknown/refused).

  • c

    Not in the labor force: other: ‘not in the labor force’ refers to people in the civilian non-institutionalized population who are neither employed nor unemployed. This group (other) includes discouraged workers and those who desire work but give other reasons for not searching (e.g. childcare problems, family responsibilities, school attendance or transportation problems).

Gender
 Male6 30545.223 75456.3
 Female9 98954.823 14543.7
Age (years)
 18–241 94917.34 73714.1
 25–446 58040.620 69643.7
 45–646 54336.417 27934.7
 65+1 2225.74 1877.5
Marital status
 Married (spouse present/absent)6 54937.321 94645.6
 Widowed8664.32 4254.4
 Divorced/separated3 96123.111 22722.5
 Never married4 91835.311 30127.6
Race/ethnicity
 White (non-Hispanic)10 41558.040 17682.6
 Black (non-Hispanic)3 78928.71 3863.9
 Hispanic1 1098.72 8448.5
 American Indian/Alaska Native (non-Hispanic)1800.77790.9
 Asian/Pacific Islander (non-Hispanic)4052.17502.3
 Multiple races3961.89641.8
Country of birth
 United States15 27492.343 49490.5
 US territory1361.11250.4
 Other/unknown8846.732809.1
US region
 Northeast3 41221.48 49115.9
 Midwest4 55227.212 96625.6
 South5 73239.214 31537.7
 West2 59812.211 12720.8
Metropolitan status
 Metropolitan12 52382.032 49877.2
 Non-metropolitan3 68917.614 04322.2
 Not identified820.43580.6
Annual family income (US dollars)
 <10 0002 11113.54 6349.6
 10–24 9993 47121.39 70920.0
 25–49 9994 60928.013 86429.1
 50 000 or more4 54827.214 43731.8
 Unknown1 55510.04 2559.5
Educational attainment (years)
 0–84822.91 8774.3
 9–112 54917.06 11713.6
 126 63740.818 79339.2
 13–154 83829.013 91129.4
 16+1 78810.46 20113.5
Employment/occupation
 Employed: management and professional2 41314.17 62516.2
 Employed: sales and related1 1687.33 5437.7
 Employed: office and administrative1 83710.64 3408.8
 Employed: service2 31813.75 69512.0
 Employed: blue-collar2 62317.99 76022.5
 Employed: otherb570.32900.6
 Unemployed1 2449.32 7816.4
 Not in labor force: retired1 4637.24 7748.8
 Not in labor force: disabled1 5759.44 1098.1
 Not in labor force: care of house/family1 1076.62 7655.8
 Not in labor force: otherc4893.71 2172.9
Smoking frequency
 Every day13 17278.838 58981.0
 Some days3 12219.78 31018.2
Age at onset of regular smoking (years)
 ≤142 79017.18 89218.6
 15–175 48334.816 83036.3
 18+7 62445.520 09942.6
 Never smoked regularly3972.61 0782.5
Daily cigarette consumption
 <108 16751.919 30842.3
 11–191 89811.25 56211.6
 20+5 84134.421 13344.0
 Unknown3882.58962.1
Cigarette within first 30 minutes after waking
 Yes8 13949.124 82351.1
 No7 67547.820 90746.2
 Varies4803.11 1692.7
Other tobacco product use
 Yes1 0627.64 1479.5
 No14 89790.341 89788.6
 Ref/DK/NR3352.18551.9
Survey year
 20038 57649.624 44149.5
 2006/077 71850.422 45850.5

Use of mentholated cigarettes was higher among women than among men, and the reverse was found for non-mentholated cigarettes. With respect to race/ethnicity, the proportion of non-mentholated cigarette smoking was higher for white individuals and the proportion of mentholated cigarette smoking was higher for black individuals.

Prevalence of mentholated cigarette smoking: total sample (Table 2)

Table 2.  Prevalence of menthol cigarette use among US current smokers (ages 18+ years) stratified by gender, Tobacco Use Supplements to the Current Population Survey (TUS CPS), 2003 and 2006/07 (n = 63 193a).
 TotalMale current smokers n = 30 059Female current smokers n = 33 134
%95% CI%95% CI%95% CI
  • a

    Table excludes those who reported ‘no usual type’ to the question regarding type of cigarette usually smoked. Also excludes those who did not smoke regularly and those with missing data to the following items: metropolitan status, age started smoking regularly, cigarettes per day, cigarette within first 30 minutes of waking and other tobacco use.

  • b

    b Employed: other: includes employed workers who did not provide occupation information (unknown/refused).

  • c

    Not in the labor force: other: ‘not in the labor force’ refers to people in the civilian non-institutionalized population who are neither employed nor unemployed. This group (other) includes discouraged workers and those who desire work but give other reasons for not searching (e.g. childcare problems, family responsibilities, school attendance or transportation problems). CI: confidence interval.

Total27.6(27.14–28.10)23.5(22.86–24.06)32.4(31.73–32.99)
Gender
 Male23.5(22.86–24.06)  
 Female32.4(31.73–32.99)    
Age (years)
 18–2432.0(30.53–33.47)29.8(27.94–31.75)34.5(32.55–36.59)
 25–4426.1(25.46–26.83)21.6(20.73–22.44)31.4(30.46–32.39)
 45–6428.6(27.89–29.30)23.6(22.61–24.51)34.5(33.41–35.50)
 65+22.5(21.21–23.74)20.4(18.54–22.33)24.3(22.62–25.98)
Marital status
 Married (spouse present/absent)23.8(23.12–24.50)20.2(19.34–21.06)28.0(27.14–28.96)
 Widowed27.3(25.44–29.19)23.5(19.69–27.77)28.7(26.80–30.73)
 Divorced/separated28.1(27.16–29.12)23.4(22.10–24.83)32.6(31.37–33.77)
 Never married32.8(31.87–33.83)27.8(26.53–29.06)40.3(38.90–41.63)
Race/ethnicity
 White (non-Hispanic)21.1(20.64–21.65)17.0(16.37–17.65)25.6(24.89–26.22)
 Black (non-Hispanic)73.6(71.97–75.16)68.9(66.61–71.18)78.7(76.76–80.59)
 Hispanic27.9(26.25–29.70)23.4(21.39–25.51)36.0(33.39–38.61)
 American Indian/Alaska Native (non-Hispanic)22.5(18.93–26.59)19.6(14.33–26.31)25.3(20.31–31.10)
 Asian/Pacific Islander (non-Hispanic)26.2(22.85–29.84)21.1(17.80–24.90)39.3(33.32–45.66)
 Multiple races28.3(25.28–31.48)24.7(20.54–29.35)32.7(28.71–36.91)
Country of birth
 United States28.0(27.51–28.51)23.8(23.17–24.47)32.5(31.86–33.13)
 US territory53.6(47.03–59.94)52.0(43.02–60.80)55.7(46.08–64.84)
 Other/unknown21.8(20.19–23.39)19.0(17.20–21.02)28.0(25.48–30.61)
US region
 Northeast33.9(32.66–35.23)29.6(27.91–31.27)38.7(37.05–40.28)
 Midwest28.9(27.87–29.84)23.8(22.60–24.98)34.3(33.06–35.65)
 South28.4(27.64–29.22)25.0(24.01–26.03)32.3(31.26–33.39)
 West18.2(17.29–19.23)14.7(13.55–15.85)22.8(21.51–24.24)
Metropolitan status
 Metropolitan28.8(28.29–29.41)24.4(23.72–25.12)33.9(33.24–34.65)
 Non-metropolitan23.2(22.19–24.25)19.9(18.68–21.16)26.8(25.52–28.20)
Annual family income (US dollars)
 <10 00034.9(33.28–36.60)30.9(28.40–33.40)38.3(36.34–40.34)
 10–24 99928.9(27.94–29.96)24.3(23.12–25.58)33.8(32.41–35.20)
 25–49 99926.9(26.00–27.73)23.2(22.09–24.43)31.1(29.98–32.21)
 50 000 or more24.6(23.83–25.33)20.5(19.55–21.54)29.9(28.83–30.99)
 Unknown28.6(27.30–30.02)25.2(23.13–27.40)32.5(30.62–34.34)
Educational attainment (years)
 0–820.4(18.43–22.58)17.0(14.81–19.47)26.5(23.26–29.98)
 9–1132.2(30.86–33.56)28.4(26.70–30.22)36.7(34.82–38.53)
 1228.4(27.73–29.14)24.7(23.76–25.62)32.7(31.79–33.69)
 13–1527.3(26.51–28.16)22.4(21.34–23.49)32.2(31.14–33.36)
 16+22.7(21.66–23.79)18.7(17.24–20.24)27.8(26.29–29.36)
Employment/occupation
 Employed: management and professional24.8(23.78–25.89)18.9(17.47–20.37)31.0(29.50–32.51)
 Employed: sales and related26.6(25.03–28.22)21.9(19.78–24.26)31.1(28.94–33.43)
 Employed: office and administrative31.4(29.98–32.82)26.7(23.66–30.07)33.0(31.54–34.49)
 Employed: service30.3(28.99–31.61)24.3(22.44–26.34)34.6(33.04–36.23)
 Employed: blue-collar23.3(22.30–24.22)22.0(20.99–23.04)31.5(29.20–33.90)
 Employed: otherb17.9(13.45–23.40)15.8(11.10–22.05)30.5(18.67–45.65)
 Unemployed35.6(33.83–37.45)31.6(29.14–34.08)41.5(38.69–44.26)
 Not in labor force: retired23.7(22.60–24.80)20.7(19.13–22.46)26.3(24.66–27.91)
 Not in labor force: disabled30.7(29.13–32.26)27.9(25.74–30.16)33.7(31.81–35.71)
 Not in labor force: care of house/family30.1(28.27–31.91)29.0(23.21–35.60)30.2(28.42–32.02)
 Not in labor force: otherc32.5(29.69–35.47)30.6(26.39–35.17)34.9(31.26–38.65)
Smoking frequency
 Every day27.2(26.63–27.68)22.9(22.27–23.61)31.9(31.25–32.63)
 Some days29.6(28.51–30.65)25.6(24.23–27.05)34.2(32.71–35.70)
Age at onset of regular smoking (years)
 ≤1425.9(24.80–27.02)22.9(21.39–24.38)30.0(28.43–31.54)
 15–1726.8(26.03–27.55)23.3(22.33–24.28)30.9(29.77–31.95)
 18+29.0(28.28–29.67)23.9(22.96–24.83)34.3(33.36–35.19)
Daily cigarette consumption
 ≤530.9(29.93–31.96)26.2(24.85–27.66)35.8(34.41–37.16)
 6–1032.8(31.82–33.77)29.5(28.09–30.92)35.5(34.33–36.73)
 11–1927.0(25.74–28.24)23.7(22.01–25.44)30.5(28.69–32.33)
 20+23.0(22.27–23.67)19.5(18.65–20.36)28.1(27.07–29.06)
Cigarette within first 30 minutes after waking
 Yes26.8(26.17–27.48)22.9(22.04–23.73)31.6(30.72–32.41)
 No28.3(27.61–29.01)24.1(23.20–24.99)32.8(31.90–33.77)
 Varies31.4(27.60–35.40)25.4(20.70–30.83)39.2(33.97–44.59)
Other tobacco product use
 Yes (every day or some days)23.4(22.03–24.84)21.6(20.08–23.16)35.8(31.83–40.07)
 No28.0(27.49–28.51)23.8(23.13–24.45)32.2(31.53–32.81)
Survey year
 200327.7(27.03–28.29)23.7(22.90–24.54)32.1(31.35–32.93)
 2006/0727.6(26.86–28.31)23.2(22.34–24.08)32.6(31.61–33.57)

Twenty-seven per cent of current smokers smoked mentholated cigarettes. The prevalence of smoking mentholated cigarettes was highest in the following socio-demographic categories (in order of proportion): black race, birth in a US territory, unemployed, annual family income of less than $10 000, residence in the Northeast, never married, consumption of less than 10 cigarettes per day (cpd), education level of 9–11 years, 18–24-year-old age group, female gender, smoking on some days, start of regular smoking after age 18, residence in a metropolitan area and no use of other forms of tobacco. In contrast, rates of mentholated cigarette use were significantly lower in the following categories: age 65 years or older, married, birth outside the United States, residence in the West, residence in a non-metropolitan area, annual family income of $50 000 or more, education level of 0–8 years, employed: blue-collar, smoking within first 30 minuts consumption of 20 cpd or more and use of other forms of tobacco.

National rates of mentholated cigarette smoking by gender (Table 2)

Men

The rates of mentholated cigarette use were highest in the following categories: black, born in a US territory, annual family income of less than $10 000, 18–24 years old, living in the Northeast and smoking ≤5 or 6–10 cpd. In contrast, the lowest rates of mentholated cigarette use were associated with living in the West, birth outside the United States, age 65 years or older, or age 45–64 smoking 20 or more cpd, and annual family income of $50 000 or more and smoking every day.

Women

The rates of mentholated cigarette use were highest for the categories of black, born in a US territory, never married, living in the Northeast, an annual family income of less than $10 000, educational level of 9–11 years, 18–24 or 45–64 years old, started smoking after age 18, smoking ≤5 or 6–10 cpd and smoking on some days. The lowest rates were among smokers who lived in the West, were aged 65 years or older, attained educational levels of 0–8 years or 16 years or more, were born outside the United States.

When the data were stratified according to gender, the socio-demographic groups with the highest rates of mentholated cigarette use were the same for both men and women: age 18–24 years, never married, black race, birth in a US territory, Northeast region, annual family income of less than $10 000, educational level of 9–11 years, smoking habit of some days and consuming less than 10 cpd (Table 2). However, for every age category, country of birth, geographic region, income category and education level, the rate of mentholated cigarette use was significantly higher among women than among men. When the data for men and women were compared, the two main differences were related to age and daily cigarette consumption.

National rates of mentholated cigarette smoking by race/ethnicity (Table 3)

Table 3.  Prevalence of menthol cigarettes use among US current smokers (ages 18+ years) stratified by race/ethnicity, Tobacco Use Supplements to the Current Population Survey (TUS CPS), 2003 and 2006/07 (n = 61 833a).
 White only (NH)Black only (NH)HispanicAI/AN (NH)API (NH)
= 50 591= 5175= 3953= 959= 1155
%95% CI %95% CI%95% CI%95% CI%95% CI
  • a

    Table excludes those respondents in the ‘multiple race’ category and those who responded ‘no usual type’ to the question regarding type of cigarette usually smoked. Also excludes those who did not smoke regularly and those with missing data to the following items: metropolitan status, age started smoking regularly, cigarettes per day, cigarette within first 30 minutes of waking and other tobacco use.

  • b

    b Employed: other: includes employed workers who did not provide occupation information (unknown/refused).

  • c

    Not in the labor force: other: ‘not in the labor force’ refers to people in the civilian non-institutionalized population who are neither employed nor unemployed. This group (other) includes discouraged workers and those who desire work but give other reasons for not searching (e.g. childcare problems, family responsibilities, school attendance or transportation problems). AI/AN: Indian/Alaska Native; API: Asian/Pacific Islander; CI: confidence interval; NH: non-Hispanic.

Total21.1(20.64–21.65)73.6(71.97–75.16)27.9(26.25–29.70)22.5(18.93–26.59)26.2(22.85–29.84)
Gender          
 Male17.0(16.37–17.65)68.9(66.61–71.18)23.4(21.39–25.51)19.6(14.33–26.31)21.1(17.80–24.90)
 Female25.6(24.89–26.22)78.7(76.76–80.59)36.0(33.39–38.61)25.3(20.31–31.10)39.3(33.32–45.66)
Age (years)          
 18–2425.1(23.51–26.66)81.5(76.85–85.39)35.5(30.88–40.31)25.7(16.47–37.85)30.7(21.82–41.31)
 25–4418.7(17.98–19.34)79.2(76.92–81.32)26.9(25.02–28.91)21.4(16.57–27.15)23.9(20.13–28.21)
 45–6422.7(21.99–23.45)69.4(67.18–71.47)26.2(23.10–29.64)23.2(17.00–30.90)29.0(23.12–35.70)
 65+19.8(18.52–21.07)45.8(40.58–51.09)23.0(16.94–30.54)14.9(6.29–31.47)20.0(11.45–32.62)
Marital status          
 Married20.1(19.43–20.82)70.8(67.87–73.52)21.8(19.61–24.18)22.6(16.94–29.53)26.8(22.81–31.11)
 Widowed22.0(20.16–23.89)57.0(50.94–62.84)33.8(24.81–44.15)20.7(9.27–40.07)14.1(6.48–28.13)
 Divorced/separated21.5(20.58–22.46)71.3(68.21–74.20)30.5(26.99–34.30)23.4(17.10–31.11)27.2(19.02–37.21)
 Never married22.4(21.36–23.52)78.6(76.08–80.89)34.6(31.50–37.84)22.0(16.25–29.11)25.7(20.27–31.96)
Country of birth          
 United States21.3(20.78–21.82)74.3(72.61–75.87)31.2(28.93–33.54)22.4(18.75–26.47)30.2(24.53–36.64)
 US territory27.0(9.61–56.19)62.7(15.80–93.75)55.4(48.20–62.31) 47.1(25.62–69.77)
 Other/unknown16.9(14.82–19.29)56.4(46.56–65.68)20.2(17.66–22.96)35.8(9.05–75.75)24.3(20.55–28.51)
US region          
 Northeast27.2(25.86–28.53)72.8(68.06–77.06)54.4(49.71–59.00)43.4(26.01–62.52)18.4(12.09–27.04)
 Midwest22.9(21.96–23.91)79.9(76.81–82.74)32.9(28.51–37.54)25.7(17.64–35.80)23.2(16.37–31.80)
 South20.0(19.26–20.82)73.9(71.89–75.84)24.2(21.65–26.96)19.1(14.25–25.14)19.1(13.95–25.47)
 West14.1(13.14–15.01)56.3(50.24–62.24)17.5(15.28–20.03)19.3(13.92–26.12)32.5(28.02–37.35)
Metropolitan status          
 Metropolitan21.6(21.08–22.21)73.7(71.85–75.43)29.2(27.39–31.12)25.5(20.05–31.81)25.0(21.59–28.82)
 Non-metropolitan19.7(18.67–20.79)72.7(68.61–76.38)16.8(13.44–20.72)19.4(14.95–24.86)58.6(46.26–69.86)
Annual family income (US dollars)          
 <10 00019.2(17.70–20.80)76.3(73.45–78.94)35.5(30.66–40.58)26.1(19.17–34.46)24.6(15.26–37.19)
 10–24 99920.9(19.82–21.91)73.4(70.36–76.31)26.7(23.66–29.91)17.0(11.53–24.43)32.0(22.99–42.68)
 25–49 99921.0(20.16–21.91)75.4(72.42–78.09)27.1(24.22–30.09)28.4(21.20–36.78)23.7(18.30–30.13)
 50 000 or more21.9(21.09–22.76)68.1(63.77–72.14)25.3(22.07–28.91)16.3(9.85–25.80)26.3(21.53–31.62)
 Unknown21.1(19.59–22.60)71.4(67.18–75.21)29.7(24.15–35.88)24.0(11.89–42.45)25.1(18.03–33.69)
Educational attainment (years)          
 0–816.0(13.65–18.63)51.0(42.76–59.12)18.3(15.20–21.84)13.0(4.20–33.59)28.4(15.54–45.99)
 9–1121.2(19.79–22.58)75.7(72.44–78.59)30.6(27.25–34.16)20.9(14.24–29.70)36.8(25.35–49.92)
 1221.9(21.14–22.58)75.0(72.73–77.22)31.2(28.38–34.18)25.1(18.79–32.71)29.0(23.58–35.12)
 13–1521.5(20.63–22.37)74.3(71.52–76.81)28.8(25.46–32.47)20.9(15.05–28.18)27.7(22.13–34.08)
 16+19.1(18.17–20.14)67.6(61.32–73.32)25.7(20.30–31.92)28.9(15.93–46.46)20.6(16.30–25.69)
Employment/occupation          
 Employed: management and professional21.0(20.02–22.10)70.7(65.44–75.52)25.9(21.43–31.02)22.3(12.89–35.73)20.9(15.92–27.03)
 Employed: sales and related22.1(20.48–23.82)75.8(68.42–81.90)29.8(24.22–35.94)24.8(8.77–53.07)33.4(21.72–47.42)
 Employed: office and administrative25.6(24.13–27.19)74.6(69.13–79.36)40.0(34.34–45.96)21.1(10.37–38.21)40.6(29.32–52.87)
 Employed: service22.2(20.82–23.68)75.7(72.38–78.72)28.2(24.45–32.28)25.5(16.70–36.76)25.5(18.50–34.08)
 Employed: blue-collar18.1(17.16–19.15)73.0(69.54–76.14)19.6(16.81–22.76)17.3(10.40–27.49)24.6(18.56–31.84)
 Employed: otherb15.4(10.21–22.58)70.2(39.88–89.28)15.0(7.14–28.67) 22.0(3.87–66.44)
 Unemployed22.5(20.63–24.53)83.7(79.28–87.35)35.6(30.18–41.37)26.3(16.36–39.43)31.8(20.25–46.19)
 Not in labor force: retired20.1(19.09–21.22)54.5(49.42–59.41)27.0(20.48–34.62)18.0(8.59–34.00)17.9(10.46–28.93)
 Not in labor force: disabled19.2(17.79–20.61)70.0(66.25–73.57)35.5(29.47–42.09)25.0(16.70–35.65)17.7(8.87–32.31)
 Not in labor force: taking care of house/family23.5(21.74–25.37)79.4(73.73–84.15)32.5(26.23–39.43)28.4(16.33–44.61)34.9(22.98–48.94)
 Not in labor force: otherc23.2(20.58–26.04)80.5(73.10–86.21)32.4(23.37–42.97)9.9(2.17–35.18)21.9(13.64–33.26)
Smoking frequency          
 Every day21.1(20.57–21.67)73.5(71.88–75.13)29.4(27.47–31.49)21.9(18.06–26.36)25.4(21.62–29.57)
 Some days21.3(20.20–22.38)73.8(70.58–76.74)25.2(22.48–28.16)24.6(17.63–33.09)28.4(22.41–35.19)
Age of onset of regular smoking (years)          
 ≤1420.4(19.34–21.58)72.1(67.88–76.03)32.3(28.71–36.07)22.7(16.32–30.71)39.1(26.61–53.11)
 15–1720.8(20.05–21.66)73.4(70.79–75.79)30.1(27.13–33.31)24.0(17.73–31.66)30.0(23.84–37.01)
 18+21.8(21.12–22.44)74.4(72.26–76.46)25.1(22.78–27.65)21.6(16.53–27.59)22.9(19.25–27.04)
 Never smoked regularly20.5(16.23–25.54)68.0(46.39–83.88)26.5(18.08–37.12)15.2(2.79–52.81)40.5(19.51–65.65)
Daily cigarette consumption          
 ≤521.8(20.63–22.91)75.0(72.22–77.63)27.4(24.93–30.11)24.1(17.44–32.33)26.1(21.29–31.53)
 6–1023.5(22.59–24.40)76.4(73.85–78.80)29.9(26.54–33.40)24.5(17.22–33.52)29.0(23.96–34.60)
 11–1922.5(21.28–23.76)72.8(67.66–77.37)26.6(21.34–32.67)16.9(9.90–27.41)28.1(19.22–38.97)
 20+19.5(18.77–20.16)69.7(66.53–72.66)28.4(24.66–32.41)21.4(15.72–28.31)22.2(16.11–29.73)
 Unknown22.9(19.42–26.76)64.3(55.01–72.62)22.6(16.13–30.69)26.1(10.04–52.77)23.6(12.62–39.70)
Cigarette within first 30 minutes after waking          
 Yes20.7(20.04–21.30)74.3(72.12–76.26)31.2(28.43–34.19)20.9(16.28–26.33)28.8(23.47–34.74)
 No21.7(20.94–22.42)73.5(71.10–75.77)26.8(24.66–28.97)23.3(18.36–29.19)23.6(20.07–27.47)
 Varies22.4(18.69–26.70)72.5(63.60–79.94)22.8(13.36–36.03)46.6(16.20–79.76)30.1(14.37–52.56)
Other tobacco product use          
 Yes17.9(16.47–19.36)71.3(65.04–76.76)29.7(24.19–35.97)14.0(7.06–25.86)31.8(16.97–51.58)
 No21.4(20.91–21.95)74.2(72.45–75.85)27.9(26.11–29.77)23.5(19.60–27.95)26.1(22.62–29.85)
Survey year          
 200321.1(20.36–21.79)74.5(72.09–76.67)27.3(24.94–29.80)23.3(18.43–29.02)27.1(22.07–32.70)
 2006/0721.2(20.51–21.94)72.7(70.48–74.90)28.6(26.17–31.07)21.7(16.67–27.77)25.4(21.08–30.22)

When the national prevalence rates of mentholated cigarette smoking were stratified by race/ethnicity, the prevalence was highest for black individuals across all socio-demographic and smoking-related categories. The rates of mentholated cigarette smoking were significantly higher for women than men across all racial/ethnic groups, except for the AI/AN group, and the prevalence was highest in the 18–24-year-old age group compared with the other age groups (Table 3). For white, and Hispanic smokers, this age difference in the rates among 18–24-year-olds was significantly higher than the other age groups.

The prevalence of mentholated cigarette smoking varied for each racial/ethnic group by region. For example, the rates among white, Hispanic and AI/AN smokers were highest in the Northeast; however, for black smokers, the highest prevalence was found in the Midwest, and for API smokers, the highest prevalence was in the West. Across all racial/ethnic groups, except for AI/AN and API smokers, the prevalence of mentholated cigarette smoking was significantly higher in metropolitan areas.

Correlates of mentholated cigarette smoking

After controlling for other socio-demographic and smoking behavior variables, mentholated cigarette smoking was associated significantly with gender, age, marital status, race/ethnicity, country of birth, region, metropolitan status, annual family income, educational level, employment status and daily cigarette consumption (Table 4). The most significant factor was race/ethnicity, with black smokers being nearly 11 times more likely to use mentholated cigarettes than white smokers, and Hispanic and API smokers being approximately twice as likely. Women were 1.6 times more likely to smoke mentholated cigarettes than were men, and smokers in the 18–24 and 45–64-year age groups were approximately 1.4 and 1.3 times as likely, respectively, than smokers in the 65 years or more age group.

Table 4.  Multivariate logistic regression models predicting menthol use among US current smokers stratified by gender, Tobacco Use Supplements to the Current Population Survey (TUS CPS), 2003 and 2006/07 (n = 58 389a).
 All current smokersCurrent male smokersCurrent female smokers
= 58 389= 27 729= 30 660
AOR99% CIAOR99% CIAOR99% CI
  • a

    Excludes those who reported ‘no usual type’ to question regarding type of cigarette usually smoked. Also excludes those who did not smoke regularly and those with missing data to the following items: metropolitan status, age started smoking regularly, cigarettes per day, cigarette within first 30 minutes of waking and other tobacco use.

  • b

    b Employed: other: includes employed workers who did not provide occupation information (unknown/refused).

  • c

    Not in the labor force: other: ‘not in the labor force’ refers to people in the civilian non-institutionalized population who are neither employed nor unemployed. This group (other) includes discouraged workers and those who desire work but give other reasons for not searching (e.g. childcare problems, family responsibilities, school attendance or transportation problems). AOR: adjusted odds ratio; CI: confidence interval; NA: not applicable; NH: non-Hispanic.

Gender      
 Male1.00(1.00–1.00)NANANANA
 Female1.64(1.53–1.76)NANANANA
Age (years)      
 18–241.39(1.12–1.73)1.46(1.05–2.02)1.31(0.98–1.75)
 25–441.07(0.89–1.28)0.92(0.69–1.23)1.21(0.97–1.52)
 45–641.29(1.09–1.53)1.08(0.82–1.44)1.48(1.19–1.84)
 65+1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
Marital status      
 Married (spouse present/absent)1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 Widowed0.99(0.83–1.19)1.17(0.79–1.73)0.94(0.78–1.13)
 Divorced/separated1.13(1.03–1.23)1.12(0.98–1.29)1.12(1.00–1.25)
 Never married1.21(1.09–1.34)1.15(0.99–1.32)1.27(1.12–1.44)
Race/ethnicity      
 White only (NH)1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 Black only (NH)10.92(9.58–12.44)11.59(9.79–13.72)10.12(8.45–12.11)
 Hispanic1.92(1.66–2.21)1.97(1.59–2.44)1.84(1.54–2.19)
 American Indian, Aleut, Eskimo only (NH)1.19(0.87–1.63)1.31(0.76–2.26)1.09(0.70–1.69)
 Asian/Pacific Islander only (NH)2.07(1.57–2.73)1.90(1.35–2.68)2.47(1.64–3.74)
 Two or more race (NH)1.61(1.29–2.01)1.74(1.25–2.43)1.49(1.13–1.94)
Country of birth      
 United States1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 US outlying/PR2.01(1.35–3.01)2.22(1.29–3.81)1.76(0.99–3.14)
 Other/unknown0.71(0.60–0.83)0.69(0.55–0.88)0.75(0.61–0.92)
US region      
 Northeast1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 Midwest0.81(0.72–0.91)0.77(0.65–0.90)0.84(0.74–0.97)
 South0.68(0.61–0.75)0.68(0.58–0.79)0.67(0.59–0.76)
 West0.43(0.38–0.49)0.39(0.33–0.47)0.46(0.40–0.54)
Metropolitan status      
 Metropolitan1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 Non-metropolitan0.87(0.80–0.96)0.90(0.78–1.03)0.85(0.77–0.94)
Annual family income (US dollars)      
 <$10 0000.85(0.74–0.98)0.88(0.70–1.10)0.84(0.71–0.99)
 $10 000–24 9990.90(0.81–1.00)0.86(0.73–1.02)0.93(0.81–1.06)
 $25 000–49 9990.95(0.87–1.04)0.98(0.85–1.12)0.93(0.83–1.05)
 $50 000+1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 Unknown0.91(0.81–1.03)0.97(0.80–1.19)0.86(0.74–1.01)
Educational attainment (years)      
 0–80.84(0.67–1.06)0.69(0.48–0.97)1.04(0.78–1.38)
 9–111.23(1.07–1.42)1.18(0.95–1.46)1.27(1.05–1.53)
 121.23(1.10–1.38)1.19(1.00–1.41)1.26(1.09–1.47)
 13–151.15(1.02–1.29)1.07(0.90–1.28)1.22(1.05–1.41)
 16+1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
Employment/occupation      
 Employed: management, bus and financial/professional and related1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 Employed: sales and related1.07(0.93–1.22)1.14(0.91–1.42)1.02(0.84–1.23)
 Employed: office and administrative support1.13(0.98–1.30)1.30(0.99–1.71)1.03(0.88–1.21)
 Employed: service0.98(0.86–1.11)0.98(0.80–1.21)0.97(0.83–1.15)
 Employed: blue-collar0.99(0.88–1.12)1.09(0.92–1.29)0.86(0.70–1.06)
 Employed: otherb0.89(0.53–1.48)0.89(0.47–1.67)1.10(0.46–2.66)
 Unemployed1.24(1.06–1.44)1.32(1.03–1.68)1.19(0.98–1.43)
 Not in labor force: retired0.97(0.83–1.14)0.98(0.76–1.27)0.96(0.77–1.19)
 Not in labor force: disabled0.96(0.83–1.12)1.10(0.85–1.42)0.86(0.71–1.04)
 Not in labor force: taking care of house or family1.03(0.88–1.19)1.32(0.80–2.17)0.96(0.81–1.15)
 Not in labor force: otherc1.09(0.88–1.34)1.25(0.91–1.71)0.95(0.72–1.26)
Smoking frequency      
 Every day1.06(0.94–1.19)1.03(0.85–1.24)1.09(0.93–1.29)
 Some days1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
Age at onset of regular smoking      
 ≤140.99(0.90–1.09)1.10(0.95–1.28)0.89(0.79–1.01)
 15–170.95(0.89–1.02)1.01(0.91–1.12)0.90(0.82–0.99)
 18+1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
Daily cigarette consumption      
 ≤51.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 6–101.03(0.91–1.16)1.09(0.90–1.31)0.98(0.84–1.15)
 11–190.96(0.84–1.11)1.00(0.81–1.25)0.93(0.77–1.12)
 20+0.84(0.74–0.96)0.85(0.69–1.03)0.84(0.71–1.00)
Cigarettes within 1st 30 minutes of waking      
 Yes1.05(0.96–1.14)1.05(0.92–1.19)1.04(0.95–1.15)
 No1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
Other tobacco product use      
 Yes1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 No0.98(0.87–1.11)1.02(0.88–1.17)0.88(0.68–1.14)
Survey year      
 20030.99(0.92–1.06)1.03(0.93–1.15)0.95(0.87–1.04)
 2006–071.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)

Mentholated cigarette smoking stratified by gender (Table 4)

Men

The factors associated significantly with mentholated cigarette smoking among men included age, race/ethnicity, country of birth, region educational level, and employment/occupation. The most significant factor associated with use of mentholated cigarettes was race/ethnicity, with black men almost 12 times (OR: 11.59, 99% CI: 9.79–13.72) more likely to smoke mentholated cigarettes than white men and Hispanic, API or multiple-race men almost twice as likely as white men.

Women

After controlling for other variables, several factors were associated significantly with mentholated cigarette smoking. As with men, race/ethnicity was the most significant factor; compared with white women, black women were 10 times (OR: 10.12, 99: C1: 8.45–12.11) more likely to smoke mentholated cigarettes and API women were 2.5 times more likely. Additional significant factors associated with mentholated cigarette use were younger age (age 45–64 versus age 65+), marital status (never married versus married), geographic region (Northeast versus all other regions), metropolitan status of residence (metropolitan versus non-metropolitan), annual family income ($50 000 or more versus less than $10 000), educational level (16 years versus 9–15 years) and age at start of regular smoking (age 18+ versus age 15–17).

Logistic regression stratified by race/ethnicity (Table 5)

Table 5.  Multivariate logistic regression models predicting menthol use among US current smokers stratified by race/ethnicity, Tobacco Use Supplements to the Current Population Survey (TUS CPS), 2003 and 2006/07 (n = 57 655a).
 WhiteBlackHispanicAmerican Indian/Alaska NativeAsian/Pacific Islander
(non-Hispanic)(non-Hispanic) (non-Hispanic)(non-Hispanic)
= 47 103= 4829= 3658= 959= 1106
AOR(99% CI)AOR(99% CI)AOR(99% CI)AOR(99% CI)AOR(99% CI)
  • a

    Table excludes those respondents in the ‘multiple race’ category and those who responded ‘no usual type’ to the question regarding type of cigarette usually smoked. Also excludes those who did not smoke regularly and those with missing data to the following items: metropolitan status, age started smoking regularly, cigarettes per day, cigarette within first 30 minutes of waking and other tobacco use. NS: variables not found to be significant in the bivariate logistic regression analysis predicting menthol cigarette use were not included in the multivariate logististic regression.

  • b

    b Employed: other: includes employed workers who did not provide occupation information (unknown/refused).

  • c

    Not in the labor force: other: ‘not in the labor force’ refers to people in the civilian non-institutionalized population who are neither employed nor unemployed. This group (other) includes discouraged workers and those who desire work but give other reasons for not searching (e.g. childcare problems, family responsibilities, school attendance or transportation problems). AOR: adjusted odds ratio; CI: confidence interval.

Gender
 Male1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00) NS1.00(1.00–1.00)
 Female1.67(1.53–1.82)1.57(1.26–1.96)1.51(1.19–1.91)  2.16(1.35–3.46)
Age (years)
 18–241.17(0.94–1.47)3.93(2.06–7.51)2.02(0.83–4.94) NS NS
 25–440.82(0.68–1.00)3.77(2.28–6.22)1.50(0.65–3.46)    
 45–641.13(0.95–1.35)2.40(1.51–3.82)1.45(0.63–3.36)    
 65+1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)    
Marital status
 Married (spouse present/absent)1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00) NS NS
 Widowed1.06(0.88–1.28)0.69(0.43–1.09)1.62(0.75–3.48)    
 Divorced/separated1.16(1.04–1.29)0.98(0.74–1.31)1.32(0.97–1.80)    
 Never married1.20(1.06–1.36)1.04(0.77–1.41)1.40(1.04–1.89)    
Country of birth
 United States1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00) NS NS
 US outlying/PR0.96(0.15–6.00)1.30(0.08–22.39)1.55(0.95–2.52)    
 Other/unknown0.78(0.62–0.97)0.49(0.26–0.94)0.71(0.53–0.95)    
Region
 Northeast1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
 Midwest0.80(0.70–0.90)1.41(0.94–2.10)0.50(0.34–0.73)0.45(0.13–1.62)1.40(0.53–3.71)
 South0.68(0.61–0.77)1.06(0.75–1.50)0.32(0.23–0.46)0.32(0.10–1.02)0.88(0.36–2.15)
 West0.43(0.37–0.50)0.45(0.28–0.72)0.20(0.14–0.28)0.33(0.10–1.07)2.02(0.93–4.38)
Metropolitan status
 Metropolitan1.00(1.00–1.00) NS1.00(1.00–1.00) NS1.00(1.00–1.00)
 Non-metropolitan0.89(0.81–0.99)  0.52(0.36–0.76)  3.96(1.93–8.13)
Annual family income (US dollars)
 <$10 0000.73(0.61–0.87)1.15(0.75–1.76)1.22(0.78–1.92)1.77(0.76–4.13) NS
 $10 000–24 9990.87(0.77–0.98)1.05(0.73–1.51)1.16(0.81–1.66)1.11(0.42–2.97)  
 $25 000–49 9990.92(0.83–1.01)1.25(0.88–1.78)1.18(0.84–1.67)1.98(0.79–4.96)  
 $50 000+1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)  
 Unknown0.87(0.75–1.01)1.04(0.68–1.60)1.21(0.72–2.01)1.59(0.42–6.07)  
Educational attainment (years)
 0–80.97(0.73–1.29)0.63(0.31–1.27)0.73(0.39–1.34) NS1.44(0.46–4.49)
 9–111.20(1.03–1.39)1.13(0.66–1.93)1.09(0.59–2.00)  2.17(0.91–5.18)
 121.19(1.06–1.34)1.05(0.64–1.73)1.13(0.64–2.02)  1.31(0.71–2.40)
 13–151.13(1.00–1.28)1.08(0.66–1.76)0.98(0.56–1.72)  1.36(0.73–2.54)
 16+1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)  1.00(1.00–1.00)
Employment/occupation
 Employed: management, bus and financial/professional and related1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00) NS1.00(1.00–1.00)
 Employed: sales and related1.03(0.88–1.20)1.15(0.61–2.19)1.27(0.72–2.22)  1.58(0.57–4.39)
 Employed: office and administrative support1.07(0.92–1.25)1.10(0.63–1.90)1.84(1.09–3.11)  2.35(0.97–5.69)
 Employed: service0.98(0.84–1.14)1.10(0.69–1.77)1.06(0.64–1.76)  1.03(0.48–2.21)
 Employed: blue-collar0.99(0.87–1.13)1.20(0.78–1.85)0.91(0.57–1.44)  1.08(0.50–2.34)
 Employed: otherb0.80(0.41–1.58)3.23(0.46–22.64)1.34(0.36–5.05)  0.63(0.06–6.21)
 Unemployed1.12(0.94–1.35)2.04(1.18–3.55)1.26(0.72–2.19)  1.16(0.39–3.42)
 Not in labor force: retired0.92(0.77–1.10)1.07(0.62–1.83)1.75(0.73–4.21)  0.50(0.18–1.38)
 Not in labor force: disabled0.94(0.79–1.11)1.12(0.69–1.83)1.27(0.69–2.33)  0.58(0.15–2.22)
 Not in labor force: taking care of house or family1.01(0.85–1.19)1.18(0.65–2.12)1.12(0.63–1.99)  0.99(0.38–2.63)
 Not in labor force: otherc1.12(0.89–1.42)1.34(0.70–2.57)1.11(0.54–2.28)  0.92(0.35–2.38)
Smoking frequency
 Every day NS NS1.07(0.81–1.40) NS NS
 Some days    1.00(1.00–1.00)    
Age at onset of regular smoking (years)
 ≤140.98(0.88–1.09)0.91(0.65–1.27)1.23(0.91–1.67) NS1.88(0.82–4.31)
 15–170.95(0.87–1.03)0.92(0.74–1.15)1.11(0.83–1.48)  1.42(0.85–2.37)
 18+1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)  1.00(1.00–1.00)
Daily cigarette consumption
 ≤51.00(1.00–1.00)1.00(1.00–1.00) NS NS NS
 6–101.07(0.95–1.21)1.07(0.84–1.35)      
 11–191.05(0.91–1.22)0.94(0.63–1.39)      
 20+0.90(0.79–1.03)0.81(0.60–1.10)      
Cigarettes within first 30 minutes of waking
 Yes1.03(0.94–1.12) NS0.98(0.75–1.29) NS NS
 No1.00(1.00–1.00)  1.00(1.00–1.00)    
Other tobacco product use
 Yes1.00(1.00–1.00) NS NS NS NS
 No0.99(0.85–1.15)        
Survey year
 20030.99(0.91–1.08)1.04(0.82–1.32)0.87(0.67–1.13)1.11(0.61–2.04)1.16(0.70–1.91)
 2006/071.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)1.00(1.00–1.00)
White smokers

Among white smokers, mentholated cigarette use was associated most significantly with gender. Women were approximately 1.7 times more likely to smoke mentholated cigarettes than men. Smokers aged 25–44 years were less likely to smoke mentholated cigarettes than smokers 65 years or older. Other socio-demographic variables associated significantly with smoking mentholated cigarettes were marital status, country of birth, geographic region, metropolitan status, annual family income and highest educational level attained.

Black smokers

For black smokers, mentholated cigarette use was also associated most significantly with gender and age. Women were almost 1.6 times more likely to smoke mentholated cigarettes than were men, and individuals who were 18–24 or 25–44 years old were almost four times more likely to smoke mentholated cigarettes than were individuals who were 65 years or older. Smokers aged 45–64 years were 2.4 times more likely to smoke mentholated cigarettes. Employment/occupation was also a significant variable, with black unemployed smokers being twice as likely to smoke mentholated cigarettes as employed managerial/professional individuals.

Hispanic smokers

Among Hispanic respondents, women were 1.5 times more likely than men to smoke mentholated cigarettes. Individuals employed in office/administration occupations were 1.8 times more likely to use mentholated cigarettes compared with individuals employed in management/professional occupations. Mentholated cigarette use was associated significantly with marital status, with never married individuals being more likely to smoke mentholated cigarettes compared with married individuals.

AI/AN smokers

In the race-stratified logistic regression models, none of the socio-demographic or smoking variables were associated significantly with mentholated cigarette use among AI/AN smokers.

API smokers

Among API smokers, women were twice as likely to smoke mentholated cigarettes than men. Metropolitan status was also a significant variable; a smoker living in a non-metropolitan area had a 4 times greater likelihood of smoking mentholated cigarettes compared with a smoker living in a metropolitan area.

DISCUSSION

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

This study is one of the few in which correlates of mentholated cigarette smoking were examined according to both smoking factors and socio-demographic factors, including gender and race/ethnicity, in a nationally representative sample. The data indicate that socio-demographic factors are associated more strongly with mentholated cigarette use than smoking-related factors among both men and women. The findings also demonstrate similarities in correlates of smoking among men and women; for example, age, race/ethnicity, marital status, country of birth, geographic region, metropolitan status, annual family income, education level attained, employment/occupation and daily cigarette consumption were all associated with mentholated cigarette smoking for both genders.

Among racial/ethnic groups, differences in correlates of mentholated cigarette use were more pronounced; gender was the variable associated significantly with mentholated cigarette use across most of the racial/ethnic groups. Across all the racial/ethnic groups, except for AI/AN smokers, the likelihood of smoking mentholated cigarettes was significantly higher for women than men, with ORs ranging from 1.51 to 2.16.

To our knowledge, we are the first to report several findings related to the use of mentholated cigarettes in the United States. First, our results indicated that geography (region, metropolitan status of residence and country of birth) plays an important role in mentholated cigarette smoking, although its role differed according to race/ethnicity. Region was associated significantly with mentholated cigarette use for white, black, Hispanic and API smokers but the relationship was not the same. White and Hispanic smokers in the Midwest, South and West were significantly less likely to smoke mentholated cigarettes compared with white and Hispanic smokers in the Northeast. However, for black smokers, the likelihood of mentholated cigarette use was higher in the Midwest than in the Northeast. Mentholated smoking was significantly less likely among smokers living in the West than those in the Northeast for white, black and Hispanic smokers, but not in the West API smokers who were twice as likely to smoke as those in the Northeast. Regarding metropolitan area, use of mentholated cigarettes was significantly less likely among individuals living in non-metropolitan areas. In the race/ethnicity-stratified analyses, white and Hispanic smokers living in a metropolitan area had significantly lower odds of smoking mentholated cigarettes compared to their counterparts in non-metropolitan areas; however, the reverse was true for API smokers, with those living in the non-metropolitan areas being more likely to smoke mentholated cigarettes. The use of mentholated cigarettes was significantly less likely among individuals born outside the United States, but country of birth did not have a significant effect on mentholated cigarette smoking for women or in the race-stratified models. More surveillance research is needed to better understand usage patterns across the United States and outside the country as well as the advertising of mentholated cigarettes in different geographic areas inside and outside the United States.

We are also the first to report that the prevalence of menthol use is significantly higher among individuals who smoke on some days than among individuals who smoke every day. These may be social smokers who could prefer a less harsh cigarette because they do not smoke every day. Compared to daily smokers, light and intermittent smokers have reported fewer signs of dependence, and their smoking experience is associated primarily with positive rather than negative reinforcement [62,63]. In this analysis, time to first cigarette was not found to be a significant predictor of menthol cigarette smoking. It is possible that the 30-minute time interval is too wide, and perhaps 0–5 minutes after waking should be investigated to measure dependence accurately. Given that researchers have speculated that menthol cigarettes may contribute to the addictiveness of cigarettes, the relationship between menthol, cigarette consumption and dependence needs further exploration. Other novel findings include a significant association between mentholated cigarette use and age of smoking onset for women, unemployment among black individuals, and unmarried status among white (divorced/separated, never married) and Hispanic (never married) individuals. More research should be conducted to explore these associations with mentholated cigarettes smoking to better inform the development of culturally appropriate prevention and cessation interventions.

Previous studies have shown that the rate of mentholated cigarette smoking is higher among individuals with lower income level, but in the present analysis the likelihood of mentholated cigarette use according to income varied across racial/ethnic groups. An annual family income of at least $50 000 was the income category associated with the highest rate of mentholated cigarette use among white individuals but not in the other racial/ethnic groups. Further research is needed to better understand the association between annual family income and mentholated cigarette use for various socio-demographic groups.

Most factors shown to have a significant relationship with mentholated cigarette smoking in the total sample also retained a significant relationship in the gender-stratified models. However, the relationships of the factors associated with mentholated cigarette use were not the same for men and women. For example, among men, mentholated cigarette use was more likely only for 18–24-year-olds (compared with men 65 years or older), but among women, use of mentholated cigarettes was higher in all age groups compared with 65 years or older, with 45–64-year-old women being 1.5 times more likely to smoke mentholated cigarettes. As mentioned previously, the age of smoking onset was associated significantly with mentholated cigarette use among women but not among men or among the total sample. The reason for this is not clear. It is possible that the smokers of color initiated earlier and make up a larger proportion of the female smokers. The odds of menthol cigarette use among male smokers with an educational level of 0–8 years was significantly less than male smokers with 16+ years of education. This effect was not seen among female smokers.

Our findings of higher rates of mentholated cigarette use among black individuals (and other minority races/ethnicities), women and young adults (18–24 years old) are consistent with the findings of other studies [54,64–66], and may be the result of the tobacco industry's use of advertising and marketing targeted to these demographic subgroups. The strongest association with mentholated cigarette smoking was race/ethnicity, with black smokers being 10–11 times as likely to smoke mentholated cigarettes as white smokers. Research has shown that mentholated cigarettes were marketed specifically to the black population through such strategies as increased billboard advertisements in predominantly black neighborhoods (compared with white neighborhoods) and a greater number of print advertisements for mentholated cigarettes publications with primarily black audiences [67–70]. In addition, previous studies have shown that young smokers are most likely to use the most heavily marketed cigarette brands, one of which is a menthol brand (Newport) [64]. The high rates of mentholated cigarette smoking among these demographic subgroups suggest that targeted advertising and marketing succeeded. However, several unanswered research questions remain about the patterns of mentholated cigarette use and whether smoking menthol cigarettes contributes to racial/ethnic and gender disparities, such as higher incidence of lung cancer and mortality rates in the black population [3,5,6,8,10].

Several limitations should be considered when interpreting these results. First, because it is a cross-sectional study, we know only the use of mentholated cigarettes at the time of the survey and thus do not know temporal effects; such as when respondents started smoking mentholated cigarettes, if this brand of cigarette was their choice at the time of smoking initiation, and whether they switched back-and-forth between mentholated and non-mentholated cigarettes during their smoking history. Secondly, because the sample sizes for the AI/AN and API are very small, caution must be taken when interpreting these results.

FUTURE DIRECTIONS

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

Menthol is unique among tobacco additives in that manufacturers have built strong promotional campaigns based on the ‘cool’ and ‘refreshing’ properties of menthol. It has been hypothesized that menthol's cooling and anesthetic properties may lead to more puffs per cigarette, deeper inhalation or longer retention in the lungs, all of which could result in increased exposure to tobacco-related carcinogens [25]. However, results from studies examining menthol's effect on topography remain inconsistent. Additionally, it has been reported that the tobacco industry modified the menthol content of cigarettes, and this strategy may have been successful in attracting youth and young adult smokers [71,72]. An analysis of menthol per cigarette and menthol per tobacco demonstrated that menthol content (or yield) per cigarette and tobacco were significantly greater in cigarettes labeled ‘ultralight’ or ‘light’[73]. This finding suggests that menthol may be used to offset reductions in smoke delivery or impact and to facilitate compensatory smoke inhalation behaviors in smokers [74].

Given the tobacco industry's dynamic flexibility and successful advertising, current surveillance systems need to continue to monitor the use of mentholated cigarettes in the United States. Surveillance combined with research on product formulation and marketing would better inform patterns of use and potentially identify effective prevention and cessation strategies. In addition, methods to link data collected for US cancer registries to information on tobacco and mentholated cigarette use should be explored so that investigators can better understand the relationship between national disease incidence and mortality and smoking, including mentholated cigarette smoking. While this research, using TUS CPS data, provides new information regarding the heterogeneous characteristics of menthol smokers, a longitudinal study would be better suited to assess the role of menthol in tobacco initiation, consumption patterns, addiction, longevity of use and cessation behavior by socio-demographic characteristics such as gender and race/ethnicity.

Declarations of interest

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

Drs Fagan and Backinger, Mr Gibson and Ms Rose have no conflicts of interest to declare. Dr Moolchan is an employee of Alkermes Inc., a pharmaceutical company. Dr Lawrence is currently an employee of Pinney Associates, Inc., a scientific consulting company that provides services to pharmaceutical companies.

Acknowledgements

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

Drs Lawrence, Fagan and Backinger, Mr Gibson and Ms Rose are funded by the National Cancer Institute. This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract no. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the US Government. The authors thank Lori Alexander, MTPW, ELS, for her assistance in editing this manuscript and Dr William Klein for his review of the manuscript.

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  2. ABSTRACT
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUTURE DIRECTIONS
  8. Declarations of interest
  9. Acknowledgements
  10. References
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