The 13th World Conference on Tobacco OR Health

Objective: To discuss the effects of menthol in cigarettes on smokers' nicotine intake and ability to quit smoking.

Methods: Recent research has suggested that smokers of mentholated cigarettes may be less successful in stopping smoking, and may obtain higher nicotine levels per cigarette smoked. We conducted a literature review on this topic, analyzed the effect of menthol on smoking cessation outcomes in over 1600 consecutive patients making a quit attempt at our tobacco dependence clinic, and also re-analyzed the effects of menthol on nicotine, cotinine and carbon-monoxide levels in a recent study that was designed to compare absorption in people with schizophrenia and controls.

Results: In our ethnically mixed clinic sample, African American and Latino smokers were significantly more likely to smoke menthols than white (non-Latino) smokers. In multivariate analyses controlling for all other significant predictors of outcome such as time to first smoke and employment status, menthol smokers were significantly less likely to remain abstinent at 4 week follow-up. This menthol effect remained significant within both the African American and Latino smokers at six month follow-up. In our lab study of biochemical measures, menthol smokers had significantly higher levels of nicotine, cotinine and carbon-monoxide, after controlling for other significant predictors of these measures (eg. Schizophrenia diagnosis). These results suggest that menthol cigarettes result in higher nicotine levels per cigarette and may be more addictive than non-menthol cigarettes. The effects of mentholation on cigarette addiction and its interaction with ethnicity, gender and other factors deserves more attention.