Use of Menthol Cigarettes

Among past month smokers, the rate of smoking menthol cigarettes increased from 31.0 percent in 2004 to 33.9 percent in 2008; increases were most pronounced for adolescents aged 12 to 17 (43.5 percent in 2004 vs. 47.7 percent in 2008), young adults aged 18 to 25 (34.1 vs. 40.8 percent), and males (26.9 vs. 30.8 percent)
Past month smoking of menthol cigarettes was more likely among those who were recent smoking initiates (i.e., began smoking in the past year) than among those who were longer term smokers (i.e., initiated use more than a year ago) (44.6 vs. 31.8 percent, respectively); this pattern was consistent for persons aged 12 to 17 and those aged 18 to 25, for both genders, and for whites and Hispanics
For blacks, past month use of menthol cigarettes was less likely among past month smokers who were recent smoking initiates than among their counterparts who were longer term smokers (73.9 vs. 82.8 percent)

Menthol is an additive to cigarettes that stimulates cold receptors, giving the sensation of coolness in the mouth, pharynx, and lungs. Menthol may mask the harshness of cigarette smoke and thereby make it easier for adolescents to start smoking.¹ Use of menthol cigarettes traditionally has been more common among blacks, other minorities, and younger users. It has been suggested that this differential use of menthol cigarettes may contribute to health disparities between white and black smokers. The effect of menthol on the initiation, progression, and cessation of tobacco use, however, is unclear, although recent research suggests that menthol cigarettes are more difficult to quit than other types of cigarettes.² The Family Smoking Prevention and Tobacco Control Act (H.R. 1256)—which bans all cigarette flavorings except menthol—calls for research on the impact of the use of menthol in cigarettes on the public health.

The National Survey on Drug Use and Health (NSDUH) asks persons aged 12 or older about whether or not they smoked part or all of a cigarette in the past 30 days. Respondents who answered affirmatively are asked whether or not the cigarettes they smoked during the past 30 days were menthol and how many days they smoked during the past month.³ Additionally, persons who had ever smoked a cigarette are asked how old they were when they first began smoking cigarettes; responses are used to identify recent initiates (i.e., persons who used cigarettes for the first time in the 12 months prior to the survey).⁴

This issue of The NSDUH Report examines the prevalence of use of menthol cigarettes among past month smokers. The first section presents data on trends in use between 2004 and 2008. Findings in the remainder of the report are annual averages based on combined 2004 to 2008 NSDUH data.

Overall, the rate of smoking menthol cigarettes among past month smokers increased from 31.0 percent in 2004 to 33.9 percent in 2008. Rates of menthol use increased from 43.5 to 47.7 percent among adolescents aged 12 to 17 and from 34.1 to 40.8 percent among young adults aged 18 to 25 (Figure 1). Rates also generally increased among males, from 26.9 to 30.8 percent (Figure 2).

Combined 2004 to 2008 data indicate that nearly one third (32.0 percent) of past month smokers aged 12 or older smoked menthol cigarettes in the past month. The prevalence of menthol cigarette use among past month smokers decreased with age (44.8 percent among smokers aged 12 to 17, 36.5 percent among those aged 18 to 25, and 30.1 percent among those aged 26 or older) (Figure 3), and it was more likely among females than males (36.4 vs. 28.3 percent). Rates of menthol cigarette use varied greatly by race/ethnicity, ranging from 82.6 percent among blacks to 23.8 percent among whites (Figure 4).

Over three fifths of past month smokers (62.1 percent) smoked daily, and they were less likely than less frequent smokers to have used menthol cigarettes in the past month (30.1 vs. 35.1 percent).

Figure 1 Table. Trends in Past Month Menthol Cigarette Use among Past Month Cigarette Smokers Aged 12 or Older, by Age Group: 2004 to 2008
Age Group	2004	2005	2006	2007	2008
Aged 12 to 17	43.5%	41.5%	44.5%	47.7%	47.7%
Aged 18 to 25	34.1%	34.0%	35.6%	38.5%	40.8%
Aged 26 or Older	29.3%	29.4%	29.9%	30.4%	31.5%

Figure 2 Table. Trends in Past Month Menthol Cigarette Use among Past Month Cigarette Smokers Aged 12 or Older, by Gender: 2004 to 2008
Gender	2004	2005	2006	2007	2008
Male	26.9%	26.5%	28.1%	29.2%	30.8%
Female	35.9%	36.0%	35.8%	36.7%	37.5%

Figure 3 Table. Past Month Menthol Cigarette Use among Past Month Cigarette Smokers Aged 12 or Older, by Age Group and Gender: 2004 to 2008
Age Group	Percent
Aged 12 to 17	44.8%
Aged 18 to 25	36.5%
Aged 26 or Older	30.1%
Gender
Male	28.3%
Female	36.4%

Figure 4 Table. Past Month Menthol Cigarette Use among Past Month Cigarette Smokers Aged 12 or Older, by Race/Ethnicity: 2004 to 2008
Race/Ethnicity	Percent
Black or African American	82.6%
Native Hawaiian or Other Pacific Islander	53.2%
Two or More Races	36.9%
Hispanic or Latino	32.3%
Asian	31.2%
American Indian or Alaska Native	24.8%
White	23.8%

Source: 2004 to 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

Most past month smokers (98.3 percent) initiated cigarette smoking more than 12 months before the survey (i.e., were longer term smokers). Past month use of menthol cigarettes was more likely among smokers who started in the past 12 months than among longer term smokers (44.6 vs. 31.8 percent) (Figure 5). This pattern was consistent for persons aged 12 to 17 and those aged 18 to 25, for both genders, and for whites and Hispanics.

For blacks, however, this pattern was reversed. Past month use of menthol cigarettes was less likely among recent smoking initiates than among longer term smokers (73.9 vs. 82.8 percent). Blacks who were recent initiates of cigarette smoking were about 1.9 times more likely than whites to have used menthol cigarettes in the past month; in comparison, blacks who were longer term smokers were 3.5 times more likely than whites to have done so.

Figure 5 Table. Past Month Menthol Cigarette Use among Past Month Cigarette Smokers Aged 12 or Older, by Recency of Cigarette Initiation and Demographic Characteristics: 2004 to 2008
Demographic Characteristic	Past Year Initiate	Initiated Use More than 1 Year Ago
Total
Aged 12 or Older	44.6%	31.8%
Age Group*
Aged 12 to 17	49.2%	43.8%
Aged 18 to 25	40.2%	36.4%
Gender
Male	42.6%	28.1%
Female	46.6%	36.2%
Race/Ethnicity*
Black	73.9%	82.8%
Hispanic	42.9%	32.1%
White	39.9%	23.6%

* Data for those aged 26 or older and for other racial/ethnic groups are not presented because of low precision.

Source: 2004 to 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

Since the 1964 publication of the first Surgeon General's Report on Smoking,⁵ the Nation's level of awareness on the adverse health consequences of cigarettes has steadily increased. Federal, State, and local laws have increasingly restricted sales of tobacco products, raised taxes on these products, and curtailed the venues in which these products can be used. The data from NSDUH point out, however, that the initiation of tobacco products—particularly cigarettes—continues to be a public health problem. This appears to be especially true for menthol cigarettes and adolescents. Although research continues into the effects of menthol, prevention specialists may wish to consider prevention strategies for adolescents that are more targeted at the initiation of menthol cigarette use and the attractions of a "cooler" taste. Similarly, professionals involved in smoking cessation programs may want to consider whether or not menthol cigarette smokers need different or ancillary strategies and supports to become smoke-free.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2002 to 2007 data used in this report are based on information obtained from 340,476 persons aged 12 or older. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Office of Applied Studies. (2009). Results from the 2008 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 09-4434, NSDUH Series H-36). Rockville, MD: Substance Abuse and Mental Health Services Administration. Also available online: http://oas.samhsa.gov.

The NSDUH Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov

Use of Menthol Cigarettes

In Brief