Short communicationMenthol cigarettes and indicators of tobacco dependence among adolescents
Introduction
Recently researchers have questioned whether menthol cigarettes, which represent approximately 27% of cigarettes sold in the US (U.S. FTC, 2005), may be more addictive than regular cigarettes. Thus far studies have focused predominately on adults with mixed findings (Ahijevych and Parsley, 1999, Hyland et al., 2002, Okuyemi et al., 2003). Few studies have attended to the issue of adolescent menthol use and dependence (Collins and Moolchan, 2006, Hersey et al., 2006). Collins and Moolchan (2006) found that in a sample of adolescent smokers seeking cessation treatment, menthol smokers were significantly more likely to smoke their first cigarette within 5 min of waking than non-menthol smokers. Hersey et al. (2006) found that among middle and high school current smokers, menthol smokers scored higher on a nicotine dependence scale than non-menthol smokers.
Given the paucity of data on the possible relationship between menthol use and dependence, in particular among adolescents, we further examined whether menthol cigarette smoking is associated with markers of increased nicotine dependence. We compared adolescent menthol and non-menthol smokers' responses to dependence-related questions on the 2004 National Youth Tobacco Survey. In contrast to previous work (Hersey et al., 2006), we focused our analysis on a subpopulation of high school students who were already current established smokers, as these smokers represent young people who have progressed from experimentation to a more regular pattern of smoking and are therefore more likely to already exhibit signs of dependence.
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Methods
We analyzed the 2004 National Youth Tobacco Survey (NYTS), an anonymous, self-administered school-based questionnaire of students in grades 6–12, conducted by the Centers for Disease Control and Prevention. The 2004 NYTS employed a multi-stage sampling design to produce a nationally representative sample: 13,738 students in grades 9–12 participated. Of these students, 2597 were current smokers and 1345 were current established smokers. Details of the survey methodology are reported elsewhere (
Results
Overall, 21.7% of 9–12th grade students were current cigarette smokers and 13.8% were current established cigarette smokers (see Table 1). Prevalence of smoking significantly increased by grade among both current and current established smokers and differed by race/ethnicity, with prevalence highest among whites. Approximately 24% of current established smokers indicated smoking a menthol exclusive brand (Newport or Kool) and 44% reported that the cigarettes they usually smoked were menthol
Discussion
This study found that high school menthol smokers were more likely to report symptoms of dependence compared to non-menthol cigarette smokers, even when controlling for race, age, and cigarette consumption. One question (i.e., how long before needing a cigarette) had a strong association with menthol use. This question resembles a commonly used dependence measure in adults, which asks respondents to indicate how soon they have their first cigarette in the morning after waking up (Fagerstrom,
Acknowledgements
We would like to thank Gary Giovino for initial conversations about measures used in this study. In addition, thanks to Jonathan Foulds and to Mary Hrywna for reading drafts and for their feedback and to Patrick Clifford for his support of this work.
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