Once a menthol smoker, always a menthol smoker? Results from The CARDIA longitudinal study, 1985–2011

Background: Public health concerns related to menthol cigarettes include that they may promote smoking initiation and prevent cessation.  It is well documented that among smokers, African Americans, youth, females, and people with lower education have a higher prevalence of menthol cigarette use than their counterparts. However, not much is known about lifetime course of menthol cigarettes use. This study adds 10 years of follow-up to a previous examination of menthol cigarettes in CARDIA. 

Methods: Using data from CARDIA, a community-based prospective cohort of young adults at baseline, we analyzed data in 2,028 smokers who provided cigarette brand information. The study assessed at each of its 8 exams if the current cigarette brand smoked was menthol or non-menthol. We plan to also determine if menthol cigarette use predicts quitting and relapse.

Results: A majority of smokers exclusively smoked either menthol or non-menthol cigarettes over the assessed 25 year period; approximately 13% switched types at some point. Among those who switched, 67% switched from a menthol to non-menthol brand while 33% switched from a non-menthol to menthol brand. Among smokers, smoking a menthol brand was highly associated with race (80% of African-Americans always smoked menthol) and education (64% with ≤ high school education always smoked menthol), but not age.

Conclusion: Switching from one type (menthol or non-menthol) of cigarette brand to another was rare among young and middle age adults in this cohort. Better understanding of switching patterns may inform smoking cessation efforts.