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Study suggests menthol cigarette smokers may have more difficulty quitting smoking

September 26, 2006

Menthol and non-menthol cigarettes appear to be equally harmful to the arteries and to lung function, but smokers of menthols may be less likely to attempt or succeed at quitting, according to a report in the September 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Cigarette smoking causes about 440,000 deaths in the United States each year, according to background information in the article. African Americans tend to smoke less than European Americans, but have disproportionately high rates of cancer, cardiovascular disease and other smoking-related illnesses. "For a variety of historical and cultural reasons, including targeted advertising by the tobacco industry, African American smokers are much more likely to smoke menthol cigarettes than European American smokers (approximately 70 percent vs. 30 percent)," the authors write. Menthol is a mint-flavored compound derived from peppermint oil that could potentially increase the harm caused by cigarettes through a variety of biological mechanisms. "If menthol cigarettes were more harmful than non-menthol cigarettes, the higher exposure to menthol cigarette smoke among African American smokers could help explain racial/ethnic disparities in disease rates."

Mark J. Pletcher, M.D., M.P.H., University of California, San Francisco, and colleagues examined this hypothesis in 1,535 smokers who were part of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The researchers measured the association between exposure to menthol cigarettes and smoking cessation (quitting); coronary calcification, or a build-up of calcium in the arteries leading to the heart that is a sign of coronary artery disease; and change in pulmonary (lung) function over a 10-year period. Participants were women and men age 18 to 30 at the beginning of the study, in 1985. Each underwent a medical examination and answered questions about demographics and smoking habits in 1985 and again two, five, seven, 10 and 15 years later.

Among the smokers, 808 were women and 727 men. In 1985, 972 (63 percent) preferred menthol cigarettes and 563 (36 percent) preferred non-menthol cigarettes; 89 percent of African Americans, compared with 29 percent of European Americans, smoked menthol cigarettes. Menthol smokers were also more likely to be younger, female and unemployed, to have a lower level of education and a higher body mass index, and to drink less alcohol and smoke fewer cigarettes per day.

Those who smoked menthol cigarettes in 1985 were more likely to still be smoking at follow-up examinations-in 2000, for example, 69 percent were still smokers vs. 54 percent of non-menthol smokers. However, once the researchers factored in other social and demographic variables, most of this difference was explained by the fact that African Americans were both more likely to smoke menthols and less likely to quit smoking. "Among smokers who tried to quit, menthol seemed unrelated to quitting, but menthol was associated with a lower likelihood of trying to quit in the first place," the authors write. Analyzing the data over time, they found that menthol smokers were almost twice as likely to relapse after quitting and also were less likely to stop for a sustained period of time. Both coronary calcification and a decline in lung function over 10 years were associated with the number of cigarettes smoked, but whether the cigarettes were menthol or not did not appear to make a difference.

"Mentholation of cigarettes does not seem to explain disparities in ischemic heart disease and obstructive pulmonary disease between African Americans and European Americans in the United States but may partially explain lower rates of smoking cessation among African American smokers," the authors conclude. "It is possible, therefore, that switching from menthol cigarettes to non-menthol cigarettes might facilitate subsequent smoking cessation, especially in African Americans, and thereby reduce tobacco-related health disparities."

JAMA and Archives Journals