Tobacco control environment in the United States and individual consumer characteristics in relation to continued smoking: Differential responses among menthol smokers?

Highlights

• Menthol cigarette smokers are less likely to quit compared to non-menthol cigarette smokers.

• African Americans are more likely to smoke menthol cigarettes and less likely to quit smoking.

• Menthol and non-menthol smokers are not differentially affected by tobacco control policies.

Abstract

Objective

We used a consumer panel augmented with state-specific measures of tobacco control activities to examine the main effects and interactions among consumer behaviors, particularly menthol cigarette smoking, and tobacco control environment on cessation over a six-year period.

Methods

We used the Nielson Homescan Panel, which tracks consumer purchasing behaviors, and tobacco control information matched to panelist zip code. We focused on 1582 households purchasing ≥ 20 packs from 2004 to 2009. Our analysis included demographics; purchasing behavior including menthol versus nonmenthol use (≥ 80% of cigarettes purchased being menthol), quality preferences (average price/pack), purchase recency, and nicotine intake (nicotine levels of cigarettes purchased); and tobacco control metrics (taxation, anti-tobacco advertising, smoke-free policies).

Results

Menthol smoking (Hazard Ratio [HR] = 0.79, 95% Confidence Interval [CI] 0.64, 0.99), being African American (HR = 0.67, CI 0.46, 0.98), being male (HR = 0.46, CI 0.28, 0.74), higher quality premium preferences (HR = 0.80, CI 0.77, 0.91), lower recency (HR = 1.04, CI 1.02, 1.05), and higher nicotine intake rates (HR = 0.99, CI 0.99, 0.99) were related to continued smoking. No significant interactions were found.

Conclusion

While there were no interactions between menthol use and effects of tobacco control activities, we did find additional support for the decreased cessation rates among menthol cigarette smokers, particularly in the African American population.

Introduction

Menthol is a popular and controversial additive in cigarettes. A preliminary evaluation of the literature by the Food and Drug Administration's (FDA) Center for Tobacco Products (Tobacco Products Scientific Advisory Committee, 2011) indicated that menthol's cooling and anesthetic effects are related to reduced harshness of cigarette smoke, deeper inhalation, increased nicotine absorption (Ahijevych, 1999, Ahijevych and Parsley, 1999), increased addiction (Ahijevych, 1999, Ahijevych and Parsley, 1999), and greater difficulty quitting (Ahijevych and Garrett, 2004). Moreover, despite recent decreases in smoking prevalence, the proportion of menthol smokers has increased, particularly among youth and minority smokers, particularly African Americans (Tobacco Products Scientific Advisory Committee, 2011), contributing to smoking-related health disparities.

Contextual factors, particularly tobacco control activities, play a role in continued smoking versus cessation. Some of the most common and effective tobacco control practices include excise taxes on cigarettes, anti-smoking advertising, and smoke-free air policies (Centers for Disease Control and Prevention [CDC], 2012). It is plausible that these tobacco control activities and policies may influence some population subgroups differentially. However, no research has examined if these activities differentially affect menthol versus nonmenthol cigarette smokers.

Using the Socio Ecological Model (McLeroy et al., 1988, Richards et al., 1996, Stokols, 1996) as a framework, we examined individual consumer behaviors, particularly menthol cigarette smoking, and tobacco control environment in relation to cessation. Specifically, we used consumer panel data augmented with state-specific measures of tobacco control activities to examine the main effects and potential interactions among consumer behaviors and tobacco control environment on smoking cessation, as indicated by discontinued cigarette purchasing for at least a year among smokers in the panel. This information is particularly timely and relevant, given the recent FDA-issued Advance Notice of Proposed Rulemaking to gather information and input from the public on menthol as a cigarette additive.