Kids who experiment with menthol cigarettes are more likely to become habitual smokers than their peers who start out with the regular variety, new research findings suggest.

In a study of tens of thousands of U.S. students, researchers found that kids who were dabbling with menthol cigarettes were 80 percent more likely to become regular smokers over the next few years, versus those experimenting with regular cigarettes.

Menthol is added to cigarettes to give them a minty “refreshing” flavor. Critics have charged that menthol makes cigarettes more palatable to new smokers - many of whom are kids - and may be especially likely to encourage addiction.

“This study adds additional evidence that menthol cigarettes are a potential risk factor for kids becoming established, adult smokers,” said study leader James Nonnemaker, of the research institute RTI International in Research Triangle Park, North Carolina.

Still, the findings, which appear in the journal Addiction, do not prove that menthol cigarettes are to blame.

“The study’s subject to a number of limitations,” Nonnemaker said. “This shows an association, not cause-and-effect.”

One issue, he said, is that the study was not set up specifically to answer the question of whether menthol might encourage habitual smoking.

The findings come from three years’ worth of surveys of over 47,000 U.S. middle school and high school students. That included almost 1,800 kids who had just started smoking during the first or second survey - one-third of whom had opted for menthol cigarettes.

By the third-year survey, more than half of those experimenters had quit smoking. Another third were still occasional smokers, and 15 percent had become habitual smokers.

The odds of becoming a regular smoker, the study found, were 80 percent higher for kids who’d started off with menthol cigarettes. That was with the kids’ age, gender and race taken into account.

The results are consistent with the idea that menthol cigarettes encourage kids to get hooked because of menthol’s “sensory properties,” according to Nonnemaker.

But, he said, more studies are needed. One question is whether the findings might vary by race. This study included mostly white students. But it’s known that young African Americans and Asian Americans are especially likely to smoke menthol varieties.

Last year, an advisory committee to the U.S. Food and Drug Administration said taking mentholated cigarettes off the shelves may benefit public health.

But studies have varied on the possible effects of the cigarettes versus regular ones.

One recent study found that menthol smokers had a higher stroke rate than those who favored the non-menthol variety. Another, however, found no higher risk of lung cancer, and no evidence that menthol fans had a harder time kicking the smoking habit.

Of course, not smoking at all is the wisest choice. The risks of the habits go beyond lung cancer, and include a range of other cancers, emphysema and heart disease - the number-one killer of Americans.

According to the U.S. Centers for Disease Control and Prevention, smoking any type of cigarettes increases a person’s risk of heart disease two- to four-fold compared to non-smokers.

SOURCE: Addiction, online October 18, 2012.

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Initiation with menthol cigarettes and youth smoking uptake

Findings

Initiating smoking with menthol cigarettes was associated with progression to established smoking [odds ratio (OR) = 1.80, confidence interval (CI): 1.02–3.16] and higher levels of nicotine dependence (β = 1.25, CI: 0.1–2.4).
Conclusion

Young people in the United States who start smoking menthol cigarettes are at greater risk of progression to regular smoking and nicotine dependence than are young people who start smoking non-menthol cigarettes.

  James Nonnemaker,
  James Hersey,
  Ghada Homsi,
  Andrew Busey,
  Jane Allen,
  Donna Vallone

Article first published online: 18 OCT 2012

DOI: 10.1111/j.1360-0443.2012.04045.x