Menthol cigarettes increase smoking frequency, nicotine dependence in US youths

Use of menthol cigarettes was associated with increased smoking frequency and nicotine dependence among youths in the U.S., according to data published in JAMA Network Open.

However, researchers reported reduced smoking frequency and nicotine dependence among youths who switched from menthol cigarettes to nonmenthol cigarettes.

“One public health concern prompting recommendations to ban menthol cigarettes is that menthol may alter the biochemical profile of cigarette smoke in a manner that could increase smoking frequency and nicotine dependence, particularly among new smokers,” Eric C. Leas, PhD, assistant professor at the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, and colleagues wrote. ... “This process may be most critical during smoking initiation (when smoking is most aversive), which typically occurs before the age of 18 years.”

Using a pooled sample of U.S. youth cohorts (age 12-17 years) from the Population Assessment of Tobacco and Health (PATH) study conducted from September 2013 to November 2019, researchers identified 1,096 U.S. youth cigarette smokers (28.7% aged 12-14 years; 49.4% girls; 67.2% non-Hispanic white). All participants were past 30-day cigarette smokers at waves 2 to 5 of the PATH study and completed interviews and reported whether they used menthol cigarettes.

The primary outcomes were number of days smoked in the past 30 days; risk for frequent smoking, which was defined as 20 days or more; and nicotine dependency symptoms.

The most prevalent pattern of smoking use was transitioning from not smoking at baseline to smoking menthol cigarettes at the time of the follow-up survey, which occurred among 33.2% of youths.

Those who reported smoking menthol cigarettes at follow-up smoked more days (12.8 vs. 9.4 days) and were more frequent smokers (34.1% vs. 22.5%) compared with those who reported not smoking menthol cigarettes, according to the results.

Among the 61% of youths who switched from not smoking to smoking, smoking menthol cigarettes was associated with smoking 3.1 additional days, a 59% higher risk for frequent smoking (adjusted RR = 1.59; 95% CI, 1.23-2.06) and 10% higher nicotine dependence scores (adjusted mean difference = 1.09; 95% CI, 1.02-1.17).

Switching from smoking menthol cigarettes to smoking nonmenthol cigarettes was associated with smoking 3.6 fewer days and 47% lower risk for frequent smoking (aRR = 0.68; 95% CI, 0.5-0.92), according to the results.

The researchers concluded that these findings support conclusions of recent reviews of observational research on U.S. youth menthol use, as well as previously conducted longitudinal studies.

“These results provide strong support for recommendations to ban menthol as a characterizing flavor in cigarettes as a protection for youth,” the researchers wrote.