Smoking Cessation in Smokers Who Smoke Menthol and Non-menthol Cigarettes

Aims: To assess the relations of menthol cigarette use with measures of cessation success in a large comparative effectiveness trial (CET).

Design: Participants were randomized to one of six medication treatment conditions in a randomized double-blind, placebo-controlled clinical trial. All participants received six individual counseling sessions.

Setting: Community-based smokers in two communities in Wisconsin, USA.

Participants: A total of 1504 adult smokers who smoked at least 10 cigarettes per day during the past 6 months and reported being motivated to quit smoking. The analysis sample comprised 1439 participants: 814 white non-menthol smokers, 439 white menthol smokers and 186 African American (AA) menthol smokers. There were too few AA non-menthol smokers (n = 16) to be included in the analyses.

Interventions: Nicotine lozenge, nicotine patch, bupropion sustained release, nicotine patch + nicotine lozenge, bupropion + nicotine lozenge and placebo.

Measurements: Biochemically confirmed 7-day point-prevalence abstinence assessed at 4, 8 and 26 weeks post-quit.

Findings: In longitudinal abstinence analyses (generalized estimating equations) controlling for cessation treatment, menthol smoking was associated with reduced likelihood of smoking cessation success relative to non-menthol smoking [model-based estimates of abstinence = 31 versus 38%, respectively; odds ratio (OR) = 0.71, 95% confidence interval (CI) = 0.59, 0.86]. In addition, among menthol smokers, AA women were at especially high risk of cessation failure relative to white women (estimated abstinence = 17 versus 35%, respectively; OR = 2.63, 95% CI = 1.75, 3.96; estimated abstinence rates for AA males and white males were both 30%, OR = 1.06, 95% CI = 0.60, 1.66).

Conclusion: In the United States, smoking menthol cigarettes appears to be associated with reduced cessation success compared with non-menthol smoking, especially in African American females.