November 18, 2011

Recent Trends in Menthol Cigarette Use

Cigarette smoking continues to be a leading cause of preventable illness and death in the United States. Each year, an estimated 8.6 million people live with a serious illness caused by smoking. More than 440,000 people die annually from smoking or secondhand smoke exposure.¹

Although efforts to reduce smoking continue, there is growing awareness and concern about menthol cigarette use. Recently, an advisory committee of the U.S. Food and Drug Administration (FDA) concluded that the cooling and numbing sensation produced by menthol reduces the harshness of smoking, which may increase the appeal of smoking. This could encourage young people to start smoking and may also make it more difficult for smokers to quit.² The FDA committee also found evidence that menthol may make smoking cigarettes more addictive. Given these negative health implications, the FDA is considering whether or not to recommend a ban on menthol cigarettes and add them to the list of flavored cigarettes already banned under the Family Smoking Prevention and Tobacco Control Act enacted in 2009.³

The National Survey on Drug Use and Health (NSDUH) asks persons aged 12 or older if they smoked part or all of a cigarette in the past 30 days. Follow-up questions then are asked about the brand of cigarettes used most often during the past 30 days and whether or not this brand contains menthol. Additionally, persons who had ever smoked a cigarette are asked how old they were when they first began smoking cigarettes. Responses are used to define recent initiates (i.e., persons who smoked cigarettes for the first time in the 12 months prior to the survey) and longer term smokers (i.e., persons who smoked for the first time more than 12 months prior to the survey).⁴

This issue of The NSDUH Report examines trends between 2004 and 2010 in past month use of menthol cigarettes among all persons aged 12 or older. In 2010, an estimated 20.7 million Americans were current smokers of menthol cigarettes, accounting for more than one third of all smokers in the Nation.

Between 2004 and 2010, the rate of past month cigarette use among persons aged 12 or older decreased from 24.9 to 23.0 percent.⁵ However, the rate of menthol cigarette use increased during those years from 7.7 to 8.2 percent (Figure 1). The rate of past month nonmenthol cigarette use decreased from 17.1 percent in 2004 to 14.6 percent in 2010.⁶

Figure 1. Past Month Menthol and Nonmenthol Cigarette Use among Persons Aged 12 or Older: 2004 to 2010

The increase in menthol cigarette use between 2004 and 2010 was evident for both males and females, although the difference between the 2004 and 2010 estimates was not statistically significant for either males or females (Figure 2). Also, although nonmenthol smoking rates have been higher for males than for females, there has been no gender difference in menthol smoking rates.

Figure 2. Past Month Menthol and Nonmenthol Cigarette Use among Persons Aged 12 or Older, by Gender: 2004 to 2010

Trends in past month menthol cigarette use varied by age group (Figure 3). Among adults aged 26 or older and adolescents aged 12 to 17, the percentages who smoked menthol cigarettes remained relatively stable over the 7-year period. Among young adults aged 18 to 25, however, the rate of menthol cigarette use increased over time, with 13.4 percent smoking menthol cigarettes in 2004 compared with 15.9 percent in 2010.

Figure 3. Past Month Menthol and Nonmenthol Cigarette Use among Persons Aged 12 or Older, by Age Group: 2004 to 2010

In contrast, the rate of past month nonmenthol cigarette use declined between 2004 and 2010 in each age group. The rate of nonmenthol cigarette use by adolescents decreased from 6.4 to 3.7 percent, and the rate for young adults decreased from 25.9 to 18.1 percent. Despite the decrease in nonmenthol cigarette use by young adults aged 18 to 25, the overall rate of cigarette use in this population remained higher than the rates of use for adolescents and adults aged 26 or older. More than one third of young adults smoked cigarettes within the past month in 2010.

Similar to trends by age, trends in menthol cigarette use were either stable or increased over time in each racial/ethnic group over the 7-year period. Rates of nonmenthol cigarette use generally declined between 2004 and 2010 (Figure 4).

Figure 4. Past Month Menthol and Nonmenthol Cigarette Use among Persons Aged 12 or Older, by Race/Ethnicity*: 2004 to 2010

Blacks had the highest rate of past month menthol cigarette use between 2004 and 2010. Almost one in five blacks smoked menthol cigarettes each year. The 2010 rate for blacks (19.1 percent) was close to triple that of whites (6.5 percent) and Hispanics (7.8 percent), and 5 times that of Asians (3.6 percent). By contrast, blacks had the lowest 2010 rate of nonmenthol cigarette use (3.5 percent).

Data from 2004 to 2006 and from 2007 to 2010 were combined to examine trends in menthol cigarette use by recency of cigarette initiation. Recent initiates are persons who smoked a cigarette for the first time within the 12 months prior to the survey interview. These data indicate that more than half (51.7 percent) of recent initiates during 2007 to 2010 smoked menthol cigarettes in the past month compared with 41.7 percent in 2004 to 2006 (Figure 5). Furthermore, the rate of past month menthol cigarette use was higher among recent initiates than among longer term smokers in both 2004 to 2006 (41.7 vs. 31.0 percent) and 2007 to 2010 (51.7 vs. 33.7 percent).

Figure 5. Past Month Menthol Cigarette Use among Persons Aged 12 or Older, by Recency of Cigarette Initiation: 2004 to 2006 and 2007 to 2010

Tobacco control efforts have resulted in an overall decline in cigarette smoking. However, this overall decline masks an increasing trend in menthol cigarette use. While the policy debate about banning menthol as a cigarette additive continues, prevention and intervention specialists may wish to consider strategies that focus on the initiation and appeal of menthol cigarettes, especially among youths under age 18 for whom cigarettes are illegal. Additionally, the increasing rate of menthol cigarette use among young adults and higher rates of use among blacks suggest the need for greater attention to improve these groups' access to smoking prevention and cessation programs. Professionals involved in smoking cessation programs may want to consider whether menthol cigarette smokers need different strategies and supports to become and remain smoke free.