https://orcid.org/0000-0001-8991-4148
Abstract
FDA’s Proposed Final Rule to ban menthol cigarettes asserts that “menthol cigarettes contribute to greater nicotine dependence in youth and young adults than non-menthol cigarettes.” However, none of the publications referenced included young adults. To provide empirical evidence on the subject, we examine smoking frequency and Heaviness of Smoking Index (HSI) dependence among 2,194 young adult (ages 18–25 years) menthol and non-menthol smokers from 31 online survey samples. Unpaired t-tests examined if daily smoking or the proportion of daily smokers who are low or high dependence on the HSI vary by menthol cigarette smoking status. Young adult menthol smokers were less likely to be daily smokers than young adult non-menthol smokers. There were no differences in the percentages of daily menthol and non-menthol smokers categorized as low or high dependence on the HSI. Smoking menthol cigarettes, therefore, does not appear to be associated with greater cigarette dependence among young adults than smoking non-menthol cigarettes.
Introduction
FDA has published a proposed final rule to ban menthol as a characterizing flavor in cigarettes stating that “menthol cigarettes contribute to greater nicotine dependence in youth and young adults than non-menthol cigarettes”.Citation1 Notably, however, none of the publications referenced included young adults (defined by FDA as ages 18–25 years old); instead, they focused on youth/adolescents. This report aims to answer the question, do menthol cigarettes contribute to greater cigarette dependence than non-menthol cigarettes in young adults by providing data for U.S. young adult smokers (ages 18–25 years old) on the Heaviness of Smoking Index (HSI).
The HSI is a validated measure of cigarette dependence that consists of two questions: the number of cigarettes smoked per day and time-to-first cigarette.Citation2 A recent publication (in this journal) observed that adults who smoke menthol cigarettes are less likely to be daily smokers than non-menthol smokers and they are less likely to be in the high dependence category on the HSI.Citation3 This analysis addresses whether a similar pattern is observed in the sub-sample of young adults in that dataset.
Materials and methods
Menthol and non-menthol cigarette smoking status, smoking frequency, and the HSI were collected from 31 online survey samples in studies conducted between 2017 and 2021. A total of 2,194 young adult (18–25 year-oldsFootnote1) current established smokers (reported smoking in the past 30 days smoking and at least 100 cigarettes in their lifetime) were combined for this analysis. Additional details about study recruitment and weighting have been previously reported.Citation3
Analyses presented here were based on four survey questions:
“In the past 30 days, on approximately how many days did you use cigarettes?” Respondents were categorized as daily smokers if they reported smoking on 30 days.
“Do you usually smoke menthol or non-menthol cigarettes?”
“How soon after you wake up do you smoke your first cigarette?”
“How many cigarettes do you typically smoke per day?”
The HSI was scored as low dependence (0-1), moderate (2-4), and high dependence (5+).Citation2,Citation4
Unpaired t-tests examine the effect of menthol cigarette smoking on: (a) the percentage of respondents who smoke daily; and (b) percentage of young adult daily smokers categorized as low, medium, or high dependence on the HSI. Effect sizes are provided. In addition, logistic regressions were conducted on the entire sample to determine if, after controlling for demographic differences between menthol and non-menthol smokers, menthol cigarette smoking predicts: (a) daily smoking; (b) HSI categorization as low; or (c) HSI categorization as high.
All studies were conducted in accordance with International Organization for Standardization (ISO 20252:2019) guidelinesCitation5. Study protocols were reviewed by Western Institutional Review Board prior to the start of each study.
Results
provides the weighted demographics of the sample overall and by menthol and non-menthol cigarette smoking status. Menthol cigarette smokers were less likely than non-menthol cigarette smokers to be non-Hispanic White (51.7% vs. 74.1%) and were more likely to be non-Hispanic Black (22.7% vs. 7.9%).
Table 1. Sample demographics.
presents data for the four dependent variables and the results of associated two-tailed unpaired t-tests. The only statistically significant effect is that menthol cigarette smokers are less likely to be daily smokers than non-menthol cigarette smokers (60.4% vs. 70.4%, p < .0001), although the effect size is small (d = 0.21). There are no significant differences in the percentage of daily menthol and non-menthol cigarette smokers categorized as low, medium, or high dependence on the HSI, and the effect sizes are all near zero.
Table 2. Percent of respondents (and 95% CIs) who are daily smokers, and among daily smokers proportions who are low dependence and high dependence on HSI.
Results of logistic regressions that control for demographic differences between menthol and nonmenthol cigarette smokers confirm those findings: Menthol cigarette smokers are less likely to be daily smokers than nonmenthol cigarette smokers (OR: 0.70, 95% CI: 0.57–0.86) and equally likely to be categorized as low (OR: 1.01, 95% CI: 0.72–1.42) or high (OR: 1.12, 95% CI: 0.69–1.80) cigarette dependence on the HSI. Cronbach’s alpha for the two question HSI measure in this study was less than .70, similar to other reports on the HSI in the literature.Citation6
Discussion
The cigarette dependence results reported in this paper contradict FDA’s assertion that menthol cigarettes contribute to greater dependence in young adults than non-menthol cigarettes. Compared to those who smoke non-menthol cigarettes, young adults who smoke menthol cigarettes are significantly less likely to be daily smokers (an indicator of dependenceCitation7) and there are no differences in the proportions of young adult menthol and non-menthol daily cigarette smokers who are categorized as low, medium, or high dependence on the HSI, even after controlling for demographic differences between the two groups. These results are similar to results in the adult sample overallCitation3: in both cases, menthol cigarette smokers are not more dependent than non-menthol cigarette smokers.
These findings align with young adult dataCitation8–10 presented in a recent comprehensive review of menthol cigarette dependence, which concluded that people who smoke menthol cigarette are not more dependent than those who smoke non-menthol cigarettes.Citation11
One potential limitation of this analysis is that respondents are classified as menthol non-menthol cigarette smokers based on self-report of what they “usually smoke” and some smokers may smoke both types of cigarettes. Another potential limitation is that this brief commentary focuses on one validated behavioral measure of cigarette dependence in young adult smokers – the HSI; physiological and mechanistic studies are beyond the scope of this commentary.Citation12–14
Acknowledgments
The authors would like to acknowledge Robyn Chae, Nicole Dianno and Dr. Jennifer Boldry for analytical support and feedback on this manuscript.
Declaration of interest statement
All study activities were executed by a provider external to RAI Services Company (Naxion). Naxion was financially compensated for services according to contractual terms with RAI Services Company. RAI Services Company is a wholly owned subsidiary of Reynolds American Inc, whose operating companies manufacture and market tobacco products. Reynolds American Inc was acquired by British American Tobacco in July 2017. K.F.P. is a full-time employee of RAI Services Company and M.P. is a full-time employee of Naxion.
Funding
The author(s) reported there is no funding associated with the work featured in this article.
Notes
1 Respondents ages 18–20 were surveyed prior to Tobacco21. See https://www.fda.gov/tobacco-products/retail-sales-tobacco-products/tobacco-21. Last accessed April 11, 2022.
References
- Food and Drug Administration. Proposed Final Rule: Tobacco Product Standard for Menthol in Cigarettes. Available online at: https://www.federalregister.gov/documents/2022/05/04/2022-08994/tobacco-product-standard-for-menthol-in-cigarettes. (accessed May 19, 2022).
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