Intersection of gender, race/ethnicity, and socioeconomic position in smoking behaviors among menthol and non-menthol smokers

Background. Differences in smoking behaviors between menthol vs. non-menthol smokers are not well known; socioeconomic gradients--less harmful smoking behaviors with each level of increase in socioeconomic position--according to cigarette choice have not been systematically examined overall or for specific gender and racial/ethnic groups. Methods. Data from the 2005 National Health Interview Survey and Cancer Control Supplement were used to examine smoking behaviors by cigarette choice among Black, Hispanic, and White women and men aged 25-64. For each group, stratified by income or education, we examined (1) proportion of menthol smokers (comparing current and former smokers); (2) age of initiation, cigarettes smoked per day, and quit attempt in the past year (comparing menthol and non-menthol current smokers); and (3) time since quitting (comparing menthol and non-menthol former smokers). Results. The results do not support the hypothesis that menthol smokers initiate earlier, smoke more, or have a harder time quitting compared with non-menthol smokers. Furthermore, there is little consistency in income and education gradients by cigarette choice. White men who smoke non-menthol cigarettes appear to be the only group who consistently adheres to the sharp gradients in smoking behavior by socioeconomic position. Conclusions. Our results are in contrast to previous literature suggesting that mentholated cigarettes might encourage initiation and hinder cessation. The overall socioeconomic gradient in smoking may be primarily driven by White men. The implications of this work suggest that smoking-related health disparities may have more to do with health care access/quality and environmental conditions than with cigarette choice.