"In the United States, African Americans bear a disproportionate burden of smoking-related illnesses. It has been speculated that cigarette mentholation may increase health risks by enhancing tobacco dependence in menthol smokers
[15,24-26]. Even though African Americans smoke fewer cigarettes per day than Whites, they have higher rates of tobacco-related cancers, heart disease, and stroke
[14,27,28] and may be more nicotine-dependent
[Show abstract][Hide abstract] ABSTRACT: Background
The question of whether mentholation of cigarettes enhances tobacco dependence has generated conflicting findings. Potential mediating factors in a putative relationship between menthol use and tobacco dependence may include race and gender. While an association between menthol use and dependence is mixed, research on the role of race solely among women smokers is scarce. This study examined whether women menthol smokers have higher tobacco use and dependence than non-menthol smokers. Further, the study investigated differences between White and African American smokers.
A cross-sectional study was conducted among 928 women seeking tobacco dependence treatment in Boston, Massachusetts. Measures obtained included preferred brand and menthol content, dependence markers (cigarettes per day (CPD); time to first cigarette in the morning; number of and longest previous quit attempts) and smoking history (age of initiation; years smoking; menthol or non-menthol cigarette preference). Analysis of variance (ANOVA) was used to detect interactions between menthol preference by race for continuous variables, and Pearson’s chi-squared test was used for analyses with dichotomous variables.
A greater proportion of menthol smokers smoked their first cigarette within five minutes of waking (p < 0.01) and were less likely to have a previous quit attempt longer than 90 days (p < 0.01). ANOVAs revealed no main effects for menthol preferences. However, African American smokers smoked fewer CPD (p<.001), started smoking later in life (p= .04), and had been smoking the same brand for longer (p= .04).
Women menthol smokers showed signs of greater tobacco dependence than non-menthol smokers. African Americans smoked fewer CPD but nevertheless had evidence of greater dependence.
"Menthol cigarettes have higher tar and nicotine content, show greater nicotine dependence and nicotine intake per cigarette smoked. Because of the cooling effect that possibly leads to greater depth of inhalation (Ahijevych & Garrett, 2004; Garten & Falkner, 2004), menthol may facilitate the absorption of tobacco specific carcinogens (Henningfield et al., 2003; Okuyemi et al., 2003; Squier, Mantz, & Wertz). Furthermore, while some studies have not found an association between menthol cigarette smoking and quitting (Cropsey et al., 2009; Fu et al., 2008; Hyland, Garten, Giovino, & Cummings, 2002; Muscat, Richie, & Stellman, 2002; Pletcher et al., 2006; Royce, Hymowitz, Corbett, Hartwell, & Orlandi, 1993; Trinidad, Pérez-Stable, Messer, White, & Pierce, 2010), others have reported lower quit rates among African American menthol cigarette smokers compared to non-menthol cigarette smokers (Gandhi, Foulds, Steinberg, Lu, & Williams, 2009; Gundersen, Delnevo, & Wackowski, 2009; Harris et al., 2004; Okuyemi, Ebersole-Robinson, Nazir, & Ahluwalia, 2004; Okuyemi, Faseru, Cox, Bronars, & Ahluwalia, 2007; Pletcher et al., 2006). "
[Show abstract][Hide abstract] ABSTRACT: Smoking menthol cigarettes is more prevalent among African Americans (AA) compared to Whites. Menthol has been found to be inversely related to smoking cessation among AA, yet little is known about the factors associated with menthol smoking among AA light smokers. This study examines baseline demographic, psychological, and smoking factors associated with smoking menthol cigarettes among AA light smokers (≤10 cigarettes per day).
Participants (n=540) were enrolled in a double blind, placebo-controlled randomized trial of bupropion in combination with health education counseling for smoking cessation. Bivariate differences between menthol and non-menthol smokers were explored and baseline factors associated with smoking menthol cigarettes were identified.
Participants averaged 46.5 years in age, predominantly female (66.1%), and smoked an average of 8.0 cpd (SD=2.5). The majority (83.7%) smoked menthol cigarettes. In bivariate analysis, menthol cigarette smokers were younger (mean age: 45 vs. 52 years p<0.0001), were more likely to be female (68% vs. 52% p=0.003) and had smoked for shorter duration (28 vs. 34 years p<0.0001) compared to non-menthol smokers. While depression and withdrawal scores were slightly higher and exhaled carbon monoxide values were lower among menthol smokers, the differences were not statistically significant.
Among AA light smokers, younger individuals and females were more likely to smoke menthol cigarettes and may be more susceptible to the health effects of smoking. Appropriately targeted health education campaigns are needed to prevent smoking uptake in this high-risk population.
"Estimates of spontaneous cessation vary widely from about 4% to 6% for daily smokers to about 21% to 33% for occasional smokers (US DHHS, 1994; American Legacy Foundation, 2003). Nonetheless, the seriousness of persisting tobacco use has led to strong calls for youth treatment development and utilization (US DHHS, 1994; Lynch & Bonnie, 1994; Jacobson et al., 2001; American Legacy Foundation, 2003; Henningfield et al., 2003a,2003b). It does appear that the amount of smoking is a key factor, but there is not a well validated algorithm for guiding treatment selection or use at this point. "
[Show abstract][Hide abstract] ABSTRACT: Several pharmacotherapies for tobacco dependence and withdrawal have been approved by the Food and Drug Administration to aid smoking cessation. These medicines double to triple the odds of cessation compared to placebo, with the diversity in chemical entity (e.g., nicotine, varenicline, bupropion) and route (e.g., nicotine gum and transdermal patch) providing options for people who find a given medication unacceptable or ineffective. Treatments in development include vaccines, combinations of existing products, and new indications, such as reduced tobacco use and exposure. These therapies have been developed on the foundation of research on the neuropharmacology of tobacco dependence and withdrawal. Ongoing research is expected to contribute to more efficacious use of existing therapies and the development of new approaches. This article addresses these developments as well as the challenges to medication development. Challenges include understanding the population-based and individual differences in the vulnerability to dependence and responsiveness to various treatment options, which could contribute to effective treatment to patient matching. Research on the CNS effects of administration and withdrawal of nicotine and other tobacco product constituents is expanding, providing the basis for more effective therapeutic approaches and new medications development. Additionally, whereas medications are approved on the basis of standardized assessments of efficacy and safety in clinical trials, the public health impact of medications depends also on their appeal to smokers and their effectiveness in actual use settings. Research on more effective medication use along with policies that support improved access and utilization are vital to conquering the tobacco epidemic.
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