Current Menthol Research Articles

The Association Between Menthol Perceptions and Support for a Policy Ban Among US Smokers.

To examine the relationship between menthol perceptions and support for a national menthol ban. Data were collected from a nationally representative probability-based panel of adults aged ≥18 years during June 21, 2016 through July 18, 2016. A total of 1,303 respondents, including an oversample of 300 African Americans, completed the survey. Weighted logistic regression models examined the relationship between menthol perceptions, specifically related to health and addiction, and the outcome measure: support for a menthol ban, by menthol smoking status. All models controlled for age, sex, education level, and race/ethnicity. The association between reporting accurate menthol health perceptions differed by menthol preference. Among non-menthol smokers, there was no association between accurate menthol health perceptions and support of a menthol ban while more accurate menthol perceptions of addiction were associated with greater support of a menthol ban (aOR=2.83, CI=1.19-6.72). Among menthol smokers, more accurate health-related menthol perceptions were associated with increased odds of supporting a menthol ban (aOR=3.90, CI=1.02-14.79) while more accurate menthol addiction perceptions were not. Fewer current menthol smokers support a menthol ban than current non-menthol smokers given its effect on their preferred product. Given the large proportions of smokers who have misperceptions of the health consequences and addictive properties of menthol, there is a moral imperative to inform those who use these products. Findings suggest the need for tailored messaging strategies targeted to reach menthol smokers who will be most impacted by a ban, but also have the most to gain from such a policy change.

Co-occurring vulnerabilities and menthol use in U.S. young adult cigarette smokers: Findings from Wave 1 of the PATH Study, 2013–2014

This study incorporates intersectionality theory to address potential effects of age on other documented risk factors for current smoking and menthol cigarette use in young adults aged 18–34 using Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study (2013–2014). We explored known correlates of current cigarette and menthol cigarette smoking and interaction analyses by age group (18–24 vs. 25–34), accounting for survey weighting. Use of non-cigarette tobacco products and e-cigarettes was characterized among current cigarette smokers. Young adults experience multiple vulnerabilities to smoking beyond age and some of these known risk factors for smoking place those aged 18–24 at different risk of cigarette smoking compared to their 25–34 year old counterparts. These include lower odds of cigarette smoking by age for sex (female; AOR = 0.62 in those aged 18–24 vs. 0.72 in those aged 25–34) and Hispanic ethnicity (vs. White; AOR = 0.77 vs. 0.45), and higher odds of smoking among past 30-day alcohol users aged 18–24 vs. 25–34 (AOR = 1.62 vs. 1.32). Correlations between lower education and smoking were nearly two-fold higher in 25–34 than 18–24 year olds. Having any medical comorbidity had opposite effects on current smoking by age (18–24 positive correlation, AOR = 1.17; 25–34 negative correlation, AOR = 0.84). Lower education was correlated with menthol cigarette use among young adult smokers. This study suggests that higher smoking prevalence among young adults is associated with the intersection of multiple vulnerabilities to smoking.

Assessing racial differences in lifetime and current smoking status & menthol consumption among Latinos in a nationally representative sample

ABSTRACT Objective: To examine the relationship between race and smoking behaviors among Latinos/Hispanics. Design: Using data from the National Adult Tobacco Survey (NATS), we implemented Log-Poisson regression models for each dependent variable (smoking pattern and menthol cigarette use). Each analysis adjusted for age, gender, marital status, employment status, and socioeconomic status (SES). Final pooled cross-sectional sample included 505 Black-Latinos and 9078 White-Latinos. Results: While no racial differences were found in lifetime smoking status among Latinos, Black-Latinos had a 16.6% (95% CI: 0.274, 0.057) increased risk of menthol smoking compared to White-Latinos. Conclusions: The results indicate that menthol consumption is influenced by race among Hispanics/Latinos. To comprehensively address racial disparities among Latinos/Hispanics, further attention needs to be given to racial differences in smoking-related risks among Latinos/Hispanics.

Accuracy of the Smoking Questionnaire

Summary The smoking questionnaire (SQ), a multidimensional questionnaire covering the major dimensions of cigarette smoking, was developed to address the heterogeneity in the assessment of smoking exposure. It consists of eight questions and can be completed within a few minutes. Test-retest reliability of the SQ and concurrent validity with the Behavior Risk Factor Surveillance System (BRFSS) 2011 questionnaire were examined in a clinical study conducted in adult US current menthol cigarette smokers. The SQ and the BRFSS were self-administrated twice before and after randomization with a 6-day interval. The inter-temporal analyses included current smokers aged 22 to 66 years who completed the SQ at both timepoints. The percent agreement of items and 95% confidence intervals were calculated for the comparisons between the two timepoints and between the SQ and the BRFSS questionnaire. To evaluate the feasibility of the SQ and to capture subjects’ opinions about the SQ, a meta-questionnaire was administrated. High test-retest reliability levels (percent agreement of > 70 to 100% between the two timepoints) were found for SQ smoking behavior items, in particular for items related to current smoking status, 100-cigarettes lifetime, regular smoking, age of initiation and preferred brand. Moderate (55% agreement) to high test-retest reliability (84% agreement) was found for daily consumption of manufactured cigarettes. The comparison between the SQ and the BRFSS 2011 showed a high concurrent validity (98 to 100% agreement). The SQ was completed on average in 3 to 4 min and was assessed as easy to use. The findings demonstrate that the SQ is reliable in smokers and a practical tool to assess smoking exposure in clinical studies.

Correlates of current menthol cigarette and flavored other tobacco product use among U.S. young adults

BackgroundFlavored and menthol tobacco products are particularly appealing to young adults. However, little is known about factors associated with their use in this population. PurposeTo examine characteristics associated with using menthol cigarettes, flavored other tobacco products (OTP), and flavored e-cigarettes among young adults. MethodsUsing a nationally representative online sample of young adults (n=4239) from the Truth Initiative Young Adult Cohort Study, mutually exclusive groups were created from the subset of current tobacco users (N=1037) for users of menthol cigarettes (N=311; 30%), non-menthol cigarettes (N=426; 41%), flavored OTP only users (N=114; 11%), and non-flavored OTP only users (N=186; 18%) to examine factors of being in any one group. Data were collected in July 2012. ResultsIn the full multivariable model, significant correlates of current menthol cigarette use were female gender (AOR=2.08), Black race (AOR=5.31), other race (AOR=2.72), Hispanic ethnicity (AOR=2.46) and self-identifying as a smoker, social smoker, or occasional smoker (AOR=10.42). Significant correlates of current flavored OTP use were younger age (18–24; AOR=3.50), self-identifying as a smoker, social smoker, or occasional smoker (AOR=30) and generalized anxiety (AOR=0.30). ConclusionsThis study highlights female gender, Blacks/other race/Hispanics, smokers, social smokers and sexual minorities as correlates of menthol cigarette use and younger age as a predictor of flavored OTP use. Restricting access to flavored tobacco products may be one intervention to help slow the tobacco epidemic, particularly among many of the most vulnerable groups—young women and racial and/or ethnic minorities.

Correlates of current menthol cigarette and flavored other tobacco product use among U.S. young adults

Correlates of current menthol cigarette and flavored other tobacco product use among U.S. young adults

Menthol Content in US Marketed Cigarettes.

In 2011 menthol cigarettes accounted for 32 percent of the market in the United States, but there are few literature reports that provide measured menthol data for commercial cigarettes. To assess current menthol application levels in the US cigarette market, menthol levels in cigarettes labeled or not labeled to contain menthol was determined for a variety of contemporary domestic cigarette products. We measured the menthol content of 45 whole cigarettes using a validated gas chromatography/mass spectrometry method. In 23 cigarette brands labeled as menthol products, the menthol levels of the whole cigarette ranged from 2.9 to 19.6mg/cigarette, with three products having higher levels of menthol relative to the other menthol products. The menthol levels for 22 cigarette products not labeled to contain menthol ranged from 0.002 to 0.07mg/cigarette. The type of packaging (soft vs. hard pack) for a given cigarette product does not appear to affect menthol levels based on the current limited data. Menthol levels in cigarette products labeled as containing menthol are approximately 50- to 5000-fold higher than those in cigarette products not labeled as containing menthol. In general, menthol content appears to occur within discrete ranges for both mentholated and nonmentholated cigarettes. This study shows that menthol may be present in non-mentholated cigarettes and adds to the understanding of how menthol may be used in cigarette products. It is the first systematic study from the same laboratory which will readily enable comparison among menthol and non-menthol cigarettes.

Patterns of Longitudinal Transitions in Menthol Use Among US Young Adult Smokers.

Menthol is the only characterizing flavor in cigarettes that was not banned as part of the 2009 Family Smoking Prevention and Tobacco Control Act. This longitudinal study explores the role of menthol in smoking initiation and progression. Purpose (a) to examine young adult patterns of menthol cigarette use including switching between menthol and non-menthol and (b) to describe associations between these patterns of menthol use and cessation related intentions and behaviors. Additional data on the role of menthol in cigarettes on smoking uptake and maintenance is needed to inform proposed policy making at the local, state, and national levels. Using 3 time points from a longitudinal national sample of young adults aged 18-34 years (N = 267 smokers), patterns of menthol use over 1 year were defined among smokers as: (a) remained menthol smoker; (b) remained non-menthol smoker; (c) switched from menthol to non-menthol; and (d) switched from non-menthol to menthol. Associations were assessed between current menthol cigarette use and cessation intentions and behaviors. Significant predictors of current menthol cigarette use at 1 year included initiation with menthol (OR = 8.26), Black race (OR = 23.60), and higher scores on the Allen menthol taste subscale (OR = 1.53). Menthol smokers were more likely to report intention to quit but no differences existed between menthol and non-menthol users in ever making a quit attempt. Most young adults stay with the product that they start smoking with. Menthol smokers were interested in quitting, but less interested in next 30-day action than non-menthol smokers.

Menthol cigarette smoking among lesbian, gay, bisexual, and transgender adults.

Menthol can mask the harshness and taste of tobacco, making menthol cigarettes easier to use and increasing their appeal among vulnerable populations. The tobacco industry has targeted youth, women, and racial minorities with menthol cigarettes, and these groups smoke menthol cigarettes at higher rates. The tobacco industry has also targeted the lesbian, gay, bisexual, and transgender (LGBT) communities with tobacco product marketing. To assess current menthol cigarette smoking by sexual orientation among a nationally representative sample of U.S. adults. Data were obtained from the 2009-2010 National Adult Tobacco Survey, a national landline and cellular telephone survey of non-institutionalized U.S. adults aged ≥18 years, to compare current menthol cigarette smoking between LGBT (n=2,431) and heterosexual/straight (n=110,841) adults. Data were analyzed during January-April 2014 using descriptive statistics and logistic regression adjusted for sex, age, race, and educational attainment. Among all current cigarette smokers, 29.6% reported usually smoking menthol cigarettes in the past 30 days. Menthol use was significantly higher among LGBT smokers, with 36.3% reporting that the cigarettes they usually smoked were menthol compared to 29.3% of heterosexual/straight smokers (p<0.05); this difference was particularly prominent among LGBT females (42.9%) compared to heterosexual/straight women (32.4%) (p<0.05). Following adjustment, LGBT smokers had greater odds of usually smoking menthol cigarettes than heterosexual/straight smokers (OR=1.31, 95% CI=1.09, 1.57). These findings suggest that efforts to reduce menthol cigarette use may have the potential to reduce tobacco use and tobacco-related disease and death among LGBT adults.

Measures of initiation and progression to increased smoking among current menthol compared to non-menthol cigarette smokers based on data from four U.S. government surveys

There are no large-scale, carefully designed cohort studies that provide evidence on whether menthol cigarette use is associated with a differential risk of initiating and/or progressing to increased smoking. However, questions of whether current menthol cigarette smokers initiated smoking at a younger age or are more likely to have transitioned from non-daily to daily cigarette use compared to non-menthol smokers can be addressed using cross-sectional data from U.S. government surveys. Analyses of nationally representative samples of adult and youth smokers indicate that current menthol cigarette use is not associated with an earlier age of having initiated smoking or greater likelihood of being a daily versus non-daily smoker. Some surveys likewise provide information on cigarette type preference (menthol versus non-menthol) among youth at different stages or trajectories of smoking, based on number of days smoked during the past month and/or cigarettes smoked per day. Prevalence of menthol cigarette use does not appear to differ among new, less experienced youth smokers compared to established youth smokers. While there are limitations with regard to inferences that can be drawn from cross-sectional analyses, these data do not suggest any adverse effects for menthol cigarettes on measures of initiation and progression to increased smoking.

Young Adults' Behavioral Intentions Surrounding a Potential Menthol Cigarette Ban

Menthol cigarette smoking is more prevalent among young adults, who are a known target of tobacco industry marketing. This study explores young adults' menthol use and behavioral intentions in the event of a ban on menthol cigarettes. Data from 2,871 respondents of the 2011 National Young Adult Health Survey were examined to estimate young adults' current smoking, current menthol smoking, and behavioral intentions in the event of a menthol cigarette ban. Of all respondents, 23.8% were current smokers, and 40.3% of the current smokers were menthol smokers. Menthol use was significantly higher among 18- to 24-year-olds versus 25- to 34-year-olds (51% vs. 34.3%, p = .02) and was significantly associated with race/ethnicity (p < .0001), with prevalence highest among Black smokers (82.0%). Among menthol smokers, 65.7% indicated they would quit tobacco use altogether if menthol cigarettes were no longer sold, while 18.4% said they would switch to nonmenthol cigarettes, and 16.0% said they would switch to some other tobacco product (OTP). Behavioral intention was significantly associated with race/ethnicity (p = .02), where intention to quit tobacco was most prevalent among Black menthol smokers (79.3%), and concurrent use of OTPs (p = .03), where intention to switch to an OTP was more prevalent among menthol smokers who indicated concurrent OTP use (35.3% vs. 5.5%). A majority of young adult menthol smokers stated they would quit smoking if menthol cigarettes were no longer sold, which builds on research finding public support for such a policy and on work modeling the public health impact such a ban could have.

Smoking, Menthol Cigarettes and All-Cause, Cancer and Cardiovascular Mortality: Evidence from the National Health and Nutrition Examination Survey (NHANES) and a Meta-Analysis

BackgroundThe U.S. Food and Drug Administration has the authority to regulate tobacco product constituents, including menthol, if the scientific evidence indicates harm. Few studies, however, have evaluated the health effects of menthol cigarette use.ObjectiveTo investigate associations of cigarette smoking and menthol cigarette use with all-cause, cancer and cardiovascular risk in U.S. adults.MethodsWe studied 10,289 adults ≥ 20 years of age who participated in the National Health and Nutrition Examination Survey from 1999-2004 and were followed through December 2006. We also identified studies comparing risk of all-cause mortality, cardiovascular disease and cancer for menthol and nonmenthol cigarette smokers and estimates were pooled using random-effects models.ResultsFifty-five percent of participants were never smokers compared to 23%, 17% and 5% of former, current nonmenthol and current menthol cigarette smokers, respectively. The adjusted hazard ratios (95% CI) for former, current nonmenthol and current menthol cigarette smokers compared to never smokers were 1.24 (0.96, 1.62), 2.40 (1.56, 3.71) and 2.07 (1.20, 3.58), respectively, for all-cause mortality; 0.92 (0.62, 1.37), 2.10 (1.02, 4.31) and 3.48 (1.52, 7.99) for cardiovascular mortality; and 1.91 (1.21, 3.00), 3.82 (2.19, 6.68) and 2.03 (1.00, 4.13) for cancer mortality. Using data from 3 studies of all-cause mortality, 5 of cardiovascular disease and 13 of cancer, the pooled relative risks (95% CI) comparing menthol cigarette smokers to nonmenthol cigarette smokers was 0.94 (0.85, 1.05) for all-cause mortality, 1.28 (0.91, 1.80) for cardiovascular disease and 0.84 (0.76, 0.92) for any cancer.ConclusionsIn a representative sample of U.S. adults, menthol cigarette smoking was associated with increased all-cause, cardiovascular and cancer mortality with no differences compared to nonmenthol cigarettes. In the systematic review, menthol cigarette use was associated with inverse risk of cancer compared to nonmenthol cigarette use with some evidence of an increased risk for cardiovascular disease.

Abstract P184: Smoking, Menthol Cigarettes and All Cause, Cancer and Cardiovascular Mortality: Evidence from the National Health and Nutrition Examination Survey (NHANES)

Introduction: Cigarette flavorings, with the exception of menthol, have been banned under the Family Smoking Prevention and Tobacco Control Act. The U.S. Food and Drug Administration has the authority to regulate tobacco product constituents, including the use of menthol, if the scientific evidence indicates harm; however few studies have evaluated the health effects of menthol as compared to nonmenthol cigarette use. Objective: To investigate the prospective associations of cigarette smoking and menthol cigarette use with all cause, cancer and cardiovascular mortality in U.S. adults. Methods: We studied 10,158 adults 20 years of age and older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999-2004 and were followed for an average of 4.7 years. Results: Fifty-five percent of participants were never smokers compared to 23%, 17% and 5% of former, current nonmenthol and current menthol cigarette smokers, respectively. The multivariable adjusted hazard ratios (95% confidence intervals [CI]) for former, current nonmenthol cigarette smokers and current menthol cigarette smokers compared to never smokers were 1.21 (0.93, 1.56), 2.46 (1.57, 3.83) and 2.10 (1.21, 3.66), respectively, for all-cause mortality, 0.86 (0.58, 1.27), 2.10 (1.05, 4.21) and 3.53 (1.55, 8.02) for cardiovascular mortality, 1.32 (0.73, 2.38), 4.04 (1.96, 8.35) and 5.50 (1.90, 15.88) for heart disease mortality and 1.94 (1.23, 3.05), 3.88 (2.21, 6.80) and 2.08 (1.01, 4.28) for cancer mortality. Compared to current nonmenthol cigarette smokers, adjusted hazard ratios (95% CI) for current menthol cigarette smokers were 0.87 (0.54, 1.42) for all-cause mortality, 1.66 (0.75, 3.68) for cardiovascular mortality, 1.39 (0.52, 3.67) for heart disease mortality and 0.57 (0.28, 1.18) for cancer mortality. Conclusions: In a representative sample of U.S. adults, menthol cigarette smoking was associated with increased all-cause, cardiovascular and cancer mortality with no differences compared to nonmenthol cigarettes, except maybe an increased risk for cardiovascular disease.

Menthol Cigarettes, Race/Ethnicity, and Biomarkers of Tobacco Use in U.S. Adults: The 1999–2010 National Health and Nutrition Examination Survey (NHANES)

In the United States, cigarette flavorings are banned, with the exception of menthol. The cooling effects of menthol could facilitate the absorption of tobacco toxicants. We examined levels of biomarkers of tobacco exposure among U.S. smokers of menthol and nonmenthol cigarettes. We studied 4,603 White, African-American, and Mexican-American current smokers 20 years of age or older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2010 and had data on cigarette type and serum cotinine, blood cadmium, and blood lead concentrations. Urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) (NNAL) was studied in 1,607 participants with available measures. A total of 3,210 (74.3%) participants smoked nonmenthol cigarettes compared with 1,393 (25.7%) participants who smoked menthol cigarettes. The geometric mean concentrations comparing smokers of nonmenthol with menthol cigarettes were 163.1 versus 175.9 ng/mL for serum cotinine; 0.95 versus 1.02 μg/L for blood cadmium; 1.87 versus 1.75 μg/dL for blood lead; and 0.27 versus 0.23 ng/mL for urine NNAL. After multivariable adjustment, the ratios [95% confidence interval (CI)] comparing smokers of menthol with nonmenthol cigarettes were 1.03 (0.95-1.11) for cotinine, 1.10 (1.04-1.16) for cadmium, 0.95 (0.90-1.01) for lead, and 0.81 (0.65-1.01) for NNAL. In a representative sample of U.S. adult smokers, current menthol cigarette use was associated with increased concentration of blood cadmium, an established carcinogen and highly toxic metal, but not with other biomarkers. These findings provide information regarding possible differences in exposure to toxic constituents among menthol cigarette smokers compared with nonmenthol cigarette smokers.

Smoking, Menthol Cigarettes, and Peripheral Artery Disease in U.S. Adults

Cigarette flavorings, with the exception of menthol, have been banned in the United States under the Family Smoking Prevention and Tobacco Control Act. Given the large number of menthol cigarette smokers in the United States, we investigated whether cigarette type (nonmenthol or menthol) is associated with peripheral artery disease (PAD). The authors studied 5,973 adults, 40 years of age and older, who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Smoking status and cigarette type were derived from self-reported questionnaires. PAD was defined as an ankle-brachial blood pressure index <0.9 in at least 1 leg. Fifty percent of participants were never-smokers compared to 31%, 14%, and 5% of former, current nonmenthol, and current menthol cigarette smokers, respectively. The weighted prevalence of PAD in the study population was 5%. After multivariable adjustment, the odds ratios for PAD were 1.44 (95% CI: 0.97, 2.15), 3.65 (95% CI: 1.57, 8.50), and 2.51 (95% CI: 1.09, 5.80) comparing former, current nonmenthol cigarette smokers, and current menthol cigarette smokers to never-smokers. The associations between smoking and PAD were similar for smokers of nonmenthol and menthol cigarettes (p value for heterogeneity = .59). In a representative sample of the U.S. population, current use of both menthol and nonmenthol cigarettes was associated with increased prevalence of PAD, with no difference in risk between cigarette types.

What would menthol smokers do if menthol in cigarettes were banned? Behavioral intentions and simulated demand

The US Food and Drug Administration must consider whether to ban the use of menthol in cigarettes. This study examines how current smokers might respond to such a ban on menthol cigarettes. Convenience sample of adolescent and adult smokers recruited from an online survey panel. United States, 2010. A total of 471 adolescent and adult current cigarette smokers. Respondents were asked a series of questions about how they might react if menthol cigarettes were banned. In addition, participants completed a simulation purchase task to estimate the demand for menthol and non-menthol cigarettes across a range of prices. Overall, 36.1% of respondents said they always (18.9%) or usually (17.2%) smoked menthol cigarettes. When asked how they might respond to a ban on menthol cigarettes, 35% of current menthol smokers said they would stop smoking, and 25% said they would 'find a way to buy a menthol brand'. Those who reported they might quit tended to have greater current intentions to quit [odds ratio (OR) = 4.47], while those who reported that they might seek illicit menthol cigarettes were far less likely to report current intentions to quit (OR = 0.06). Estimates for demand elasticity for preferred cigarette type were similar for menthol (α = 0.0051) and non-menthol (α = 0.0049) smokers. Demand elasticity and peak consumption were related to usual cigarette type and cigarettes smoked per day, but did not appear to differ by race, gender or age. Preliminary evidence suggests that a significant minority of smokers of menthol cigarettes in the United States would try to stop smoking altogether if such cigarettes were banned.

Abstract P144: Smoking, Menthol Cigarettes and Peripheral Arterial Disease in the 1999– 2004 National Health and Nutrition Examination Survey (NHANES)

Introduction: Cigarette flavorings, with the exception of menthol, have been banned under the Family Smoking Prevention and Tobacco Control Act. Previous studies have found strong associations between active smoking and peripheral arterial disease. While there is substantial interest in evaluating the health effects of menthol as compared to regular cigarette use, no information is available on the influence of cigarette type (non-menthol or menthol) on the risk of peripheral arterial disease. Objective: To investigate the association of cigarette smoking, menthol cigarette use and the prevalence of peripheral arterial disease in US adults Methods: We studied 5,978 adults 40 years of age and older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999–2004. Information on participant smoking status and cigarette type were derived from self-reported questionnaire data. Peripheral arterial disease was defined as an ankle-brachial blood pressure index &lt;0.9 in at least one leg. Results: The weighted prevalence of peripheral arterial disease in the study population was 4.9%. Fifty percent of participants were never smokers compared to 31%, 14% and 5% of former, current non-menthol and current menthol cigarette smokers, respectively. After adjustment for demographics and cardiovascular risk factors, the odds ratio for peripheral arterial disease was 1.98 (95% CI: 1.41, 2.80), 5.24 (95% CI: 3.41, 8.05), 3.37 (95% CI: 1.86, 6.10) comparing former, current regular cigarette smokers and current menthol cigarette smokers to never smokers. After further adjustment for pack-years and serum cotinine, the odds ratio for peripheral arterial disease was 1.44 (95% CI: 0.97, 2.15), 3.65 (95% CI: 1.57, 8.50) and 2.51 (95% CI: 1.09, 5.80) comparing former, current regular cigarette smokers and current menthol cigarette smokers to never smokers. The significant association between smoking and peripheral arterial disease was similar for smokers of non-menthol and menthol cigarettes (p-value for heterogeneity= 0.53). Conclusions: In a representative sample of the US population, current menthol cigarette use was associated with increased prevalence of peripheral arterial disease with no difference compared to smoking non-menthol cigarettes.

Health profile differences for menthol and non‐menthol smokers: findings from the national health interview survey

Although the adverse effects of smoking are well known, limited information exists about the overall health profiles of menthol smokers when compared to their non-menthol smoking counterparts. Using a well-known nationally representative survey, this study examines differences between self-reported health characteristics for menthol and non-menthol smokers. Cross-sectional data from the 2005 National Health Interview Survey and its cancer control supplement were used to analyze responses for current and former smokers (n = 12,004) independently. All analyses were conducted using SAS version 9.2 and SAS callable SUDAAN version 9.0.3. Multiple logistic regression analysis was used to model menthol smoking. After controlling for sex, age and race, we found that in current smokers the mean number of cigarettes smoked per day is significantly lower for menthol smokers when compared to non-menthol smokers [odds ratio (OR): 0.99; 95% confidence interval (CI): 0.98, 1.00]. Also, we found that former menthol smokers had higher body mass indices (BMIs) (OR: 1.01; 95% CI: 1.00, 1.02) and were more likely to have visited the emergency room due to asthma (OR: 2.30, 95% CI: 1.04, 5.09). Overall, current menthol and non-menthol smokers have similar health profiles. However, menthol smokers reported smoking fewer cigarettes per day than their non-menthol counterparts. While these findings are supportive of other published data, future studies may need to tease out the health-related significance of smoking fewer menthol cigarettes per day but having similar health outcomes to those who smoke more non-menthol cigarettes per day. Additionally, our findings suggest that there may be some differences between the former menthol and non-menthol smoker.

Risk perceptions of menthol cigarettes compared with nonmenthol cigarettes among New Jersey adults

Menthol cigarettes were historically marketed as "healthier" cigarettes, and menthol possesses cooling qualities that may reduce the perceived harshness of cigarette smoke. As such, it is possible that smokers may perceive menthol cigarettes to be safer when, in fact, some research suggests that menthols may be more addictive than regular cigarettes. Research shows that smokers have a faulty understanding of the risks of cigarettes in general, but little is known about smokers' risk perceptions for these particular products. We examined data from the 2005 New Jersey Adult Tobacco Survey, a statewide random-digit-dial telephone survey monitoring tobacco-use behavior, knowledge, and attitudes and which asked participants to compare how risky (somewhat less risky, about the same, or somewhat more risky) menthol cigarettes were with nonmenthol cigarettes. Few menthol smokers (2.4%) and survey respondents overall (4.0%) believed menthol cigarettes to be less risky than nonmenthol cigarettes. In contrast, 30.2% of menthol smokers and 25.9% of all respondents (including nonsmokers) believed menthols to be more risky than nonmenthol cigarettes. Compared with never-smokers, nonmenthol smokers were most likely to believe this (AOR = 4.51), followed by former smokers (AOR = 1.77) and current menthol smokers (AOR = 1.58). Among current smokers, Blacks (AOR = 2.17) were more likely than Whites to indicate menthols as being more risky and young adults (18- to 24-year-olds) were the age group most likely to hold this belief (AOR = 3.30). Future research should explore whether these perceptions exist in broader population groups as well as their development and association with smoking-related behaviors.