Menthol Cigarette Use Research Articles

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.

Menthol Cigarette Use Predicts Treatment Outcomes of Weight-Concerned Smokers

Studies have shown that individuals who smoke menthol cigarettes are less likely to quit smoking and more likely to relapse during a quit attempt. The current study investigated menthol cigarette use as a potential predictor of smoking cessation outcomes in a sample of treatment-seeking smokers. This is a secondary analysis of data from a randomized controlled trial of low-dose naltrexone augmentation of nicotine replacement designed to examine smoking cessation and postcessation weight gain in weight-concerned smokers. Analyses revealed that menthol use predicted lower quit rates. Among menthol smokers (N = 61), 13% were abstinent at week 26, and among nonmenthol smokers (N = 105), 30% were abstinent (Wald = 4.15, p = .04; odds ratio [OR] = 2.47; 95% CI = 1.04-5.90). Further, menthol smokers who quit smoking gained significantly more weight at week 26 (M = 14.87 lbs, SD = 9.08; t(37) = -2.22, p = .03) than nonmenthol smokers who quit (M = 7.95 lbs, SD = 7.53). Menthol cigarette use has not typically been evaluated as a predictor of smoking cessation outcomes, but emerging evidence suggests that consumption of menthol may make cessation more difficult. This study adds to the literature supporting the claim that smoking menthol cigarettes can have adverse effects on smoking cessation efforts and on other cessation-related outcomes, such as postcessation weight gain.

Associations of Menthol Use with Motivation and Confidence to Quit Smoking

To examine associations of menthol cigarette use with motivation and confidence to quit smoking, and potential moderation by race, among adult current smokers (N = 1067; 85% White, 15% Black). Regression analyses, adjusted for sociodemographics and tobacco dependence, examined associations of menthol use with motivation and confidence to quit smoking with and without an interaction term for race. Main effects were not significant; however, there was a significant interaction for confidence to quit smoking (p = .02). Stratified analyses indicated that Black menthol users were more confident about quitting than Black non-menthol users (p = .01). Given their relatively lower quit rates as cited in previous literature, Black menthol users appear overly confident about their ability to quit smoking.

Differential trends in cigarette smoking in the USA: is menthol slowing progress?

IntroductionMentholated cigarettes are at least as dangerous to an individual's health as non-mentholated varieties. The addition of menthol to cigarettes reduces perceived harshness of smoke, which can facilitate initiation. Here,...

Menthol Cigarette and Marijuana Use Among Adolescents

Menthol cigarette and marijuana use among adolescents is high; however, little is known about dual use in this age. Thus, we examined these rates among 2 samples of adolescents in Connecticut. Study 1 examined a school-wide survey assessing variables related to cigarettes and marijuana among high school students (N = 837 [13% smokers]), and Study 2 examined these factors using baseline data of high school-aged, treatment-seeking, daily cigarette smokers prior to quitting (N = 132). In Study 1, lifetime marijuana use among all adolescents was 33% and past 30-day marijuana use was 21%. Among cigarette smokers, 55% reported smoking menthol cigarettes, 84% reported lifetime marijuana use, and 66% reported past 30-day marijuana use. Multivariate-adjusted logistic regression models indicated that cigarette smokers, when compared with nonsmokers, had greater rates of lifetime (odds ratio [OR] = 10.91) and past 30-day marijuana use (OR = 10.44). Among smokers, use of menthol cigarettes, when compared with use of nonmenthol cigarettes, was associated with greater lifetime (OR = 5.05) but not past 30-day marijuana use. In Study 2 with daily smokers, 59% of adolescents reported use of menthol cigarettes and 66% reported past 30-day marijuana use. Compared with nonmenthol cigarette smokers, menthol cigarette smokers were more likely to report past 30-day marijuana use (OR = 2.44). Cigarette smoking is associated with marijuana use, and among smokers, menthol cigarette smoking further increased the odds of marijuana use. More research on the dual use of marijuana and tobacco is needed to inform prevention and treatment of substance use.

Up-regulation of nicotinic acetylcholine receptors in menthol cigarette smokers

One-third of smokers primarily use menthol cigarettes and usage of these cigarettes leads to elevated serum nicotine levels and more difficulty quitting in standard treatment programmes. Previous brain imaging studies demonstrate that smoking (without regard to cigarette type) leads to up-regulation of β(2)*-containing nicotinic acetylcholine receptors (nAChRs). We sought to determine if menthol cigarette usage results in greater nAChR up-regulation than non-menthol cigarette usage. Altogether, 114 participants (22 menthol cigarette smokers, 41 non-menthol cigarette smokers and 51 non-smokers) underwent positron emission tomography scanning using the α(4)β(2)* nAChR radioligand 2-[(18)F]fluoro-A-85380 (2-FA). In comparing menthol to non-menthol cigarette smokers, an overall test of 2-FA total volume of distribution values revealed a significant between-group difference, resulting from menthol smokers having 9-28% higher α(4)β(2)* nAChR densities than non-menthol smokers across regions. In comparing the entire group of smokers to non-smokers, an overall test revealed a significant between-group difference, resulting from smokers having higher α(4)β(2)* nAChR levels in all regions studied (36-42%) other than thalamus (3%). Study results demonstrate that menthol smokers have greater up-regulation of nAChRs than non-menthol smokers. This difference is presumably related to higher nicotine exposure in menthol smokers, although other mechanisms for menthol influencing receptor density are possible. These results provide additional information about the severity of menthol cigarette use and may help explain why these smokers have more trouble quitting in standard treatment programmes.

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.

Race Moderates the Effect of Menthol Cigarette Use on Short-Term Smoking Abstinence

The Food and Drug Administration is in the process of reviewing evidence of the impact of mentholated cigarettes on smoking behaviors and smoking cessation in order to determine if these products should be removed from the market. More empirical research is needed to inform those decisions. The goal of this study was to examine associations of menthol cigarette use with biochemically verified continuous short-term smoking abstinence, and potential moderation by race, among adult current smokers enrolled in a cohort study (N = 183; 57.4% female; 48.1% non-Hispanic Black, 51.9% non-Hispanic White). Continuation ratio logit models, adjusted for age, race, gender, total annual household income, educational level, employment status, and partner status, were used to examine associations of menthol use with smoking abstinence with and without an interaction term for race. Menthol cigarette use was not significantly associated with smoking abstinence in the sample as a whole; however, there was a significant interaction of menthol use with race (p = .03). Follow-up analyses stratified by race indicated that among White participants, menthol users had significantly lower odds of maintaining continuous abstinence than nonmenthol users (p = .05). Exploratory analyses suggested that tobacco dependence may lie along the causal pathway and partially explain this effect. White menthol smokers in this sample were at increased risk of smoking relapse relative to White nonmenthol smokers, at least partially due to greater tobacco dependence. Results should be replicated among other treatment-seeking samples with a greater representation of White menthol and Black nonmenthol 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.

NNAL exposure by race and menthol cigarette use among U.S. smokers.

Researchers have recently suggested that nicotine and carcinogen exposure as measured by biomarkers such as cotinine and NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) does not vary with cigarettes smoked per day (CPD) among Black smokers. Researchers have also suggested that nicotine exposure does not differ between menthol and nonmenthol smokers. In this study, we examine NNAL exposure for U.S. smokers by race, CPD, and menthol cigarette use. We analyzed urinary NNAL concentrations for more than 1500 everyday smokers participating in the National Health and Nutrition Examination Survey from 2007-2010. For purposes of comparison, we also analyzed serum cotinine concentrations for these smokers. We used linear regression analysis to estimate mean biomarker concentrations by CPD and race/ethnicity group and to examine the association between biomarker concentrations and menthol cigarette use by race/ethnicity group, controlling for other demographic and smoking characteristics. Biomarker concentrations increased with CPD for White, Black, and Hispanic smokers although NNAL concentrations leveled off for Black smokers at lower CPD levels compared with other smokers. Mean NNAL concentrations were lower among menthol smokers compared with nonmenthol smokers among smokers overall (β = -0.165, p = .032) and White smokers (β = -0.207, p = .048). We find evidence in national health survey data that nicotine and carcinogen exposure generally increases with CPD across race/ethnicity groups although the pattern of NNAL exposure differs by race/ethnicity group at high CPD levels. We also find evidence of differences in NNAL exposure for menthol smokers compared with nonmenthol smokers among smokers overall and White smokers.

A Ban on Menthol Cigarettes: Impact on Public Opinion and Smokers' Intention to Quit

We assessed support for a ban by the Food and Drug Administration on menthol in cigarettes and behavioral intentions among menthol smokers in the event of such a ban. We surveyed 2649 never, former, and current smokers and used ordinal logistic regression to calculate weighted point estimates and predictors of support for a menthol ban among the adult population and menthol smokers only. For menthol smokers, we also calculated weighted point estimates and predictors of behavioral intentions. Overall, 28.2% of adults opposed, 20.0% supported, and 51.9% lacked a strong opinion about a menthol ban. Support was highest among Hispanics (36.4%), African Americans (29.0%), never smokers (26.8%), and respondents with less than a high school education (28.8%). Nearly 40% of menthol smokers said they would quit if menthol cigarettes were no longer available, 12.5% would switch to a nonmenthol brand, and 25.2% would both switch and try to quit. Support for a menthol ban is strongest among populations with the highest prevalence of menthol cigarette use. A menthol ban might motivate many menthol smokers to quit.

Menthol Brand Switching Among Adolescents and Young Adults in the National Youth Smoking Cessation Survey

This study examines patterns of menthol and nonmenthol cigarette use from 2003 to 2005 in a cohort of smokers, aged 16 to 24 years in the National Youth Smoking Cessation Survey. At follow-up, 15.0% of baseline menthol smokers had switched to nonmentholated cigarettes; by contrast, 6.9% of baseline nonmenthol smokers had switched to mentholated cigarettes. Differences in switching patterns were evident by gender, race/ethnicity, parental education, and smoking frequency. These data support previous evidence that young smokers start with mentholated cigarettes and progress to nonmentholated cigarettes.

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.

Underestimation of Menthol Cigarette Use Among Young U.S. Black Smokers: Comment on the Article by Rock et al.

Underestimation of Menthol Cigarette Use Among Young U.S. Black Smokers: Comment on the Article by Rock et al.

Menthol Cigarette Use: The Challenge to Improve Measurement and Monitoring Among Adolescent Smokers

Menthol Cigarette Use: The Challenge to Improve Measurement and Monitoring Among Adolescent Smokers

Race/ethnicity moderates the effect of prepartum menthol cigarette use on postpartum smoking abstinence.

Little is known about the influence of prepartum menthol cigarette use on postpartum smoking abstinence or how race/ethnicity might moderate this relationship. The current study addressed that gap by testing these relationships among racially/ethnically diverse women who quit smoking during pregnancy (N = 244; 33% African American, 31% Latina, 36% White). Continuation ratio logit models were used to examine the effects of prepartum menthol cigarette use on biochemically confirmed, continuous abstinence through 26 weeks postpartum using an intent-to-treat approach. Analyses controlled for age, race/ethnicity, partner status, income, education, treatment, number of prequit cigarettes smoked per day, time to the first cigarette of the day, and time (Week 8 or 26 data collection timepoint). An additional model tested the moderating effects of race/ethnicity by including an interaction term. Prepartum menthol cigarette use was not significantly associated with postpartum smoking abstinence in the overall sample. However, the interaction between menthol use and race/ethnicity was significant (p = .02). Among White women, menthol use was associated with significantly lower odds of maintaining postpartum smoking abstinence (p = .03; odds ratio = .19 [.04-.89]), and the effect approached significance among African American women (p = .08). This study provides the first evidence that prepartum menthol cigarette use may increase the risk of postpartum smoking relapse among White, and possibly African American, women who quit smoking during or immediately before pregnancy. Results suggest that White and African American prepartum menthol users may require different or more intensive cessation services to aid in the maintenance of postpartum smoking abstinence. Replication with larger samples, and a focus on understanding the mechanisms that underlie these relationships, are warranted.

Epidemiology of menthol cigarette use in the United States

BackgroundApproximately one-fourth of all cigarettes sold in the United States have the descriptor “menthol” on the cigarette pack. It is important to determine what socio-demographic factors are associated with smoking menthol cigarettes if indeed these types of cigarettes are related to smoking initiation, higher exposure to smoke constituents, nicotine dependence, or reduced smoking cessation.MethodsThe National Cancer Institute (NCI) conducted a review of the scientific literature on this topic which we completed by adding more recently published articles via PubMed. We also conducted further data analyses using the National Survey on Drug Use and Health, the National Youth Tobacco Survey, the Monitoring the Future Survey, and the National Health and Nutrition Examination Survey to provide up-to-date information on this topic.ResultsMenthol cigarettes are disproportionately smoked by adolescents, blacks/African Americans, adult females, those living in the Northeast of the United States and those with family incomes lower than $50,000. Based on self-reports of menthol cigarette use, menthol cigarette use among smokers have increased from 2004 to 2008. However, no increase was observed during these years for predominantly menthol brands like Newport™, Kool,™ and Salem™, however, this lack of significant trend may be due, at least in part, due to smaller numbers of smokers of specific brands or sub-brands, which provide estimates which are less precise.ConclusionMenthol cigarettes are disproportionately smoked by groups of U.S. cigarette smokers. It is likely that other disparities in menthol cigarette use exist that we have not covered or have not been studied yet.

Introduction: Mentholated cigarettes and public health

The Food and Drug Administration’s Center for Tobacco Products (CTP) oversees the implementation of the Family Smoking Prevention and Tobacco Control Act, H.R. 1256. Among its many provisions, section 907(a) of the Tobacco Control Act banned the use of characterizing flavors, specifically excluding only tobacco and menthol flavors from the ban. According to section 907(e)(2), “[n]ot later than 1 year after its establishment, the Tobacco Product Scientific Advisory Committee shall submit to the Secretary the report and recommendations required pursuant to [menthol],” which, according to section 907(e)(1), is “the issue of the impact of the use of menthol in cigarettes on the public health, including such use among children, African-Americans, Hispanics, and other racial and ethnic minorities.” The inaugural meeting of the Food and Drug Administration’s Tobacco Products Scientific Advisory Committee (TPSAC) was held March 30–31, 2010 in Washington, DC. In preparation for this meeting, CTP reviewed peer-reviewed literature on menthol and tobacco as indentified by the National Cancer Institute’s “Bibliography of literature on menthol and tobacco”, and seven scientific presentations were made, including the use of menthol cigarettes (epidemiology), smoking topography and sensations associated with menthol cigarettes, marketing of menthol cigarettes, menthol cigarettes and initiation of smoking behavior, menthol cigarettes and nicotine dependence, menthol cigarettes and cessation of tobacco use, and the health effects of menthol cigarettes as compared to non-menthol cigarettes. Following this initial presentation, additional information was collected through FDA investigation, as well as recommendations from the public, research community and tobacco industry, resulting in comprehensive reviews. Thus, this supplement brings together the extant peer-reviewed information on these seven topics.

Menthol cigarettes and smoking cessation behavior

Although much is known about smoking cessation behavior, the vast majority of research has not assessed menthol as an independent factor. The objective of this review is to assess the effects, if any, that use of menthol cigarettes has on smoking cessation success in adults and youth. A total of 20 articles are included in this review. Although some studies have found that menthol smokers have less success in quitting smoking, others fail to find significant differences between menthol and non-menthol smokers. Some clinical trials evaluating the efficacy of various cessation treatments have suggested that menthol smokers have poorer outcomes, however two secondary data analysis studies (which used the same original dataset) failed to find any difference in success rate associated with particular treatments. Although there is some suggestion that smoking menthol cigarettes is associated with worse cessation outcomes, differences are not always found. However, if there was a difference, it was always in the direction of worse outcomes for menthol smokers. Given that Black/African American smokers prefer menthol cigarettes more than White smokers, possible interactions with race/ethnicity are discussed.