Epidemiology of menthol cigarette use

Abstract

Approximately one-fourth of all cigarettes sold in the United States are mentholated. An understanding of the consequences, patterns, and correlates of menthol cigarette use can guide the development and implementation of strategies to reduce smoking prevalence and smoking-attributable morbidity and mortality. This paper summarizes the literature on the health effects of mentholated cigarettes and describes various patterns of use as indicated by consumption and survey data from the United States and other nations. The epidemiological literature on menthol cigarettes and cancer risk is inconclusive regarding whether these cigarettes confer a risk for cancer above that of nonmentholated varieties. Available data indicate that mentholated cigarettes are at least as dangerous as their nonmentholated counterparts. In addition, because mentholation improves the taste of cigarettes for a substantial segment of the smoking population and appears to mask disease symptoms, this additive may facilitate initiation or inhibit quitting. Menthol market share is high in the Philippines (60%), Cameroon (35%-40%), Hong Kong (26%), the United States (26%), and Singapore (22%). Newport has become the leading menthol brand in the United States. Surveys from four nations indicate that menthol use among adult smokers is more common among females than males. Among U.S. smokers, 68.9% of Blacks, 29.2% of Hispanics, and 22.4% of Whites reported smoking a mentholated variety. Research is needed to better explain factors that may influence menthol preference, such as marketing, risk perceptions, brand formulation, and taste preferences. Such research would guide the development of potentially more effective programs and policies.

The effect of mentholated cigarette use on interleukin-6 responses across different HIV positive race/ethnic subgroups

“…Menthol is a cigarette additive that probably increases health risk by enhancing exposure to tobacco smoke toxins. [14][15][16] Menthol use predicts heavy smoking, depresses respiratory activity, and increases risk of respiratory infections. 6 Because there is little data evaluating its potential immune effects, mechanistic studies would seem important for directly assessing possible menthol risks, given that patients with chronic inflammation constitute a major clinical hurdle, due to the threat of disease progression, medical complications, and increased mortality risks.…”

“…It has been argued and debated that the increased nicotine, tar, carbon monoxide, and various carcinogenetic compounds in menthol brands could result in increased medical problems. [12][13][14][15][16] Specifically, tar and carbon monoxide have been linked with an increased proinflammatory response including IL-6. 17 Further, this national study used either stored serum or plasma, which are problematic for measuring cytokine levels, that depend on clearance for accurate assessment.…”

The lingering question of menthol in cigarettes

“…The disparate use of menthol cigarettes by smokers of different gender, race, or ethnicity is thought to contribute, at least, partly to the uneven distribution of tobacco-attributable diseases across populations [18][19][20][21][22]. In support of this theory, over 70 % of African-Americans smoke menthol cigarettes as compared to 30 % of Whites [13, 23, 24], which is consistent with the higher incidence and mortality rates of lung cancer (36 and 31 %, respectively) in African-American men than in White counterparts [20, 25]. Also, the death rates from cerebrovascular disease, for which smoking is a major risk factor, are nearly twice as high among African-American men and women as those among White counterparts [21].…”

“…Menthol cigarettes are manufactured by spraying this additive on tobacco, applying it to the packaging foil, or introducing it into the filter [12]. Menthol cigarettes account for a substantial portion of market share in the USA and many parts of the world; current market shares for mentholated brands include 26 % in the USA, 60 % in the Philippines, 35-40 % in Cameroon, 26 % in Hong Kong, 22 % in Singapore, and 5-10 % in other countries surveyed [13,14]. Menthol cigarettes are disproportionally used by certain segments of the population [15].…”

“…In addition, these studies may have been underpowered to detect the effects of menthol, especially, within sub-populations of menthol and nonmenthol cigarette smokers [51,59]. Altogether, the emerging picture from the majority of the initial investigations and the most recent large-scale studies is that menthol is associated with smoking initiation in children and young adults and a heightened risk of cessation failure among habitual smokers [7,13,50].…”