Do smokers of menthol cigarettes find it harder to quit smoking?

Department of Public Health Sciences & Cancer Institute, Penn State College of Medicine, Hershey, PA 17033-0850, USA.
Nicotine & Tobacco Research (Impact Factor: 2.81). 12/2010; 12 Suppl 2:S102-9. DOI: 10.1093/ntr/ntq166
Source: PubMed

ABSTRACT Menthol cigarette smokers may find it harder to quit smoking than smokers of nonmenthol cigarettes.
We conducted a systematic review of published studies examining the association between menthol cigarette smoking and cessation. Electronic databases and reference lists were searched to identify studies published through May 2010, and results were tabulated.
Ten studies were located that reported cessation outcomes for menthol and nonmenthol smokers. Half of the studies found evidence that menthol smoking is associated with lower odds of cessation, while the other half found no such effects. The pattern of results in these studies suggest that the association between smoking menthol cigarettes and difficulty quitting is stronger in (a) racial/ethnic minority populations, (b) younger smokers, and (c) studies carried out after 1999. This pattern is consistent with an effect that relies on menthol to facilitate increased nicotine intake from fewer cigarettes where economic pressure restricts the number of cigarettes smokers can afford to purchase.
There is growing evidence that certain subgroups of smokers find it harder to quit menthol versus nonmenthol cigarettes. There is a need for additional research, and particularly for studies including adequately powered and diverse samples of menthol and nonmenthol smokers, with reliable measurement of cigarette brands, socioeconomic status, and biomarkers of nicotine intake.

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    ABSTRACT: AimsTo assess the relations of menthol cigarette use with measures of cessation success in a large comparative effectiveness trial (CET). DesignParticipants were randomized to one of six medication treatment conditions in a randomized double-blind, placebo-controlled clinical trial. All participants received six individual counseling sessions. SettingCommunity-based smokers in two communities in Wisconsin, USA. ParticipantsA total of 1504 adult smokers who smoked at least 10 cigarettes per day during the past 6 months and reported being motivated to quit smoking. The analysis sample comprised 1439 participants: 814 white non-menthol smokers, 439 white menthol smokers and 186 African American (AA) menthol smokers. There were too few AA non-menthol smokers (n=16) to be included in the analyses. InterventionsNicotine lozenge, nicotine patch, bupropion sustained release, nicotine patch+nicotine lozenge, bupropion+nicotine lozenge and placebo. MeasurementsBiochemically confirmed 7-day point-prevalence abstinence assessed at 4, 8 and 26 weeks post-quit. FindingsIn longitudinal abstinence analyses (generalized estimating equations) controlling for cessation treatment, menthol smoking was associated with reduced likelihood of smoking cessation success relative to non-menthol smoking [model-based estimates of abstinence=31 versus 38%, respectively; odds ratio (OR)=0.71, 95% confidence interval (CI)=0.59, 0.86]. In addition, among menthol smokers, AA women were at especially high risk of cessation failure relative to white women (estimated abstinence=17 versus 35%, respectively; OR=2.63, 95% CI=1.75, 3.96; estimated abstinence rates for AA males and white males were both 30%, OR=1.06, 95% CI=0.60, 1.66). Conclusion In the United States, smoking menthol cigarettes appears to be associated with reduced cessation success compared with non-menthol smoking, especially in African American females.
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