Menthol Cigarettes, Time to First Cigarette, and Smoking Cessation

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The goal of the present work is to determine if menthol and non-menthol cigarette smokers differ with respect to time to first cigarette (TTFC) and successful smoking cessation via a meta-analysis of published results. For 13 independent estimates, menthol smokers were slightly but statistically significantly more likely to exhibit TTFC ≤ 5 min (random-effects odds ratio (OR) = 1.12; 95% confidence interval (CI), 1.04–1.21), while 17 independent estimates provided a non-significant difference for TTFC ≤ 30 min (random-effects OR = 1.06; 95% CI, 0.96–1.16). For cessation studies, meta-analysis of 30 published estimates indicated a decreased likelihood for menthol cigarette smokers to quit (random-effects OR = 0.87; 95% CI, 0.80–0.96). There was no difference between cessation rates for Caucasian menthol and non-menthol cigarette smokers, but the results support that African American menthol cigarette smokers find it more difficult to quit. Adjustment of cessation for socioeconomic status eliminated any statistically significant advantage for smoking cessation in non-menthol smokers. In conclusion, these results suggest that the observed differences in cessation rates between menthol and non-menthol cigarette smokers are likely explained by differences in socioeconomic status and also suggest that TTFC may not be a robust predictor of successful smoking cessation.

1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. A Report of the Surgeon General; Atlanta, GA, USA, 2010.

2. Fagerström, K.: The Epidemiology of Smoking: Health Consequences and Benefits of Cessation; Drugs 62 (Suppl. 2) (2002) 1–9.

3. Food and Drug Administration (FDA): Reference Addendum: Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol Versus Nonmenthol Cigarettes; 2013. Available at: (accessed November 2016).

4. Foulds, J., M.W. Hooper, M.J. Pletcher, and K.S. Okuyemi: Do Smokers of Menthol Cigarettes Find it Harder to Quit Smoking?; Nicotine Tob. Res. 12 (S2) (2010) S102–S109. DOI: 10.1093/ntr/ntq166

5. Hoffman, A.C. and D. Miceli: Menthol Cigarettes and Smoking Cessation Behavior; Tob. Induc. Dis. 9 (S1) (2011) S6. DOI: 10.1186/1617-9625-9-S1-S6

6. Heatherton, T.F., L.T. Kozlowski, R.C. Frecker, W. Rickert, and J. Robinson: Measuring the Heaviness of Smoking: Using Self-Reported Time to the First Cigarette of the Day and Number of Cigarettes Smoked per Day; Br. J. Addict. 84 (1989) 791–799.

7. Heatherton, T.F., L.T. Kozlowski, R.C. Frecker, and K.O. Fagerström: The Fagerström Test for Nicotine Dependence: A Revision of the Fagerström Tolerance Questionnaire; Br. J. Addict. 86 (1991) 1119–1127.

8. Weitkunat, R. and M. Wildner: Exploratory Causal Modeling in Epidemiology: Are All Factors Created Equal?; J. Clin. Epidemiol. 55 (2002) 436–444.

9. Schisterman, E.F., S.R. Cole, and R.W. Platt: Overadjustment Bias and Unnecessary Adjustment in Epidemiologic Studies; Epidemiology 20 (2009) 488–495. DOI: 10.1097/EDE.0b013e3181a819a1

10. Normand, S.L.: Meta-Analysis: Formulating, Evaluating, Combining, and Reporting; Stat. Med. 18 (1999) 321–359.

11. VanderWeele, T.J. and O.A. Arah: Bias Formulas for Sensitivity Analysis of Unmeasured Confounding for General Outcomes, Treatments, and Confounders; Epidemiology 22 (2011) 42–52. DOI: 10.1097/EDE.0b013e3181f74493

12. Hyland, A., S. Garten, G.A. Giovino, and K.M. Cummings: Mentholated Cigarettes and Smoking Cessation: Findings from COMMIT. Community Intervention Trial for Smoking Cessation; Tob. Control 11 (2002) 135–139.

13. Sulsky, S.I., W.G. Fuller, C. Van Landingham, M.W. Ogden, J.E. Swauger, and G.M. Curtin: Evaluating the Association between Menthol Cigarette Use and the Likelihood of Being a Former versus Current Smoker; Regul. Toxicol. Pharmacol. 70 (2014) 231–241. DOI: 10.1016/j.yrtph.2014.07.009

14. Cokkinides, V., P. Bandi, C. McMahon, A. Jemal, T. Glynn, and E. Ward: Tobacco Control in the United States - Recent Progress and Opportunities; CA Cancer J. Clin. 59 (2009) 352–365. DOI: 10.3322/caac.20037

15. Reid, J.L., D. Hammond, C. Boudreau, G.T. Fong, M. Siahpush, and ITC Collaboration: Socioeconomic Disparities in Quit Intentions, Quit Attempts, and Smoking Abstinence among Smokers in Four Western Countries: Findings from the International Tobacco Control Four Country Survey; Nicotine Tob. Res. 12 (Suppl.) (2010) S20–S33. DOI: 10.1093/ntr/ntq051

16. Dimou, A., K.N. Syrigos, and M.W. Saif: Disparities in Colorectal Cancer in African-Americans vs Whites: Before and after Diagnosis; World J. Gastroenterol. 15 (2009) 3734–3743. DOI: 10.3748/wjg.15.3734

17. Baker, T.B., M.E. Piper, D.E. McCarthy, D.M. Bolt, S.S. Smith, S.-Y. Kim, S. Colby, D. Conti, G.A. Giovino, D. Hatsukami, A. Hyland, S. Krishnan-Sarin, R. Niaura, K.A. Perkins, and B.A. Toll: Time to First Cigarette in the Morning as an Index of Ability to Quit Smoking: Implications for Nicotine Dependence; Nicotine Tob. Res. 9 (Suppl. 4) (2007) S555–S570. DOI: 10.1080/14622200701673480

18. Haddock, C.K., H. Lando, R.C. Klesges, G.W. Talcott, and E.A. Renaud: A Study of the Psychometric and Predictive Properties of the Fagerström Test for Nicotine Dependence in a Population of Young Smokers; Nicotine Tob. Res. 1 (1999) 59–66.

19. Toll, B.A., T.S. Schepis, S.S. O’Malley, S.A. McKee, and S. Krishnan-Sarin: Subjective Reactivity to the First Cigarette of the Day as a Predictor of Smoking Relapse: A Preliminary Study; Drug Alcohol Depend. 89 (2007) 302–305.

20. Sweitzer, M.M., R.L. Denlinger, and E.C. Donny: Dependence and Withdrawal-Induced Craving Predict Abstinence in an Incentive-Based Model of Smoking Relapse; Nicotine Tob. Res. 15 (2013) 36–43. DOI: 10.1093/ntr/nts080

21. Fidler, J.A., L. Shahab, and R. West: Strength of Urges to Smoke as a Measure of Severity of Cigarette Dependence: Comparison with the Fagerström Test for Nicotine Dependence and its Components; Addiction 106 (2011) 631–638. DOI: 10.1111/j.1360-0443.2010.03226.x

22. Courvoisier, D.S. and J.F. Etter: Comparing the Predictive Validity of Five Cigarette Dependence Questionnaires; Drug Alcohol Depend. 107 (2010) 128–133. DOI: 10.1016/j.drugalcdep.2009.09.011

23. Rohsenow, D.J., R.A. Martin, J.W. Tidey, P.M. Monti, and S.M. Colby: Comparison of the Cigarette Dependence Scale with Four Other Measures of Nicotine Involvement: Correlations with Smoking History and Smoking Treatment Outcome in Smokers with substance Use Disorders; Addict. Behav. 38 (2013) 2409–2413. DOI: 10.1016/j.addbeh.2013.03.019

24. Foulds, J., K.K. Gandhi, M.B. Steinberg, D.L. Richardson, J.M. Williams, M.V. Burke, and G.G. Rhoads: Factors Associated with Quitting Smoking at a Tobacco Dependence Treatment Clinic; Am. J. Health Behav. 30 (2006) 400–412.

25. Steinberg, M.B., M.T. Bover, D.L. Richardson, A.C. Schmelzer, J.M. Williams, and J. Foulds: Abstinence and Psychological Distress in Co-Morbid Smokers Using Various Pharmacotherapies; Drug Alcohol Depend. 114 (2011) 77–81. DOI: 10.1016/j.drugalcdep.2010.06.022

26. Faseru, B., N.L. Nollen, M.S. Mayo, R. Krebill, W.S. Choi, N.L. Benowitz, R.F. Tyndale, K.S. Okuyemi, J.S. Ahluwalia, and L. Sanderson Cox: Predictors of Cessation in African American Light Smokers Enrolled in a Bupropion Clinical Trial: Addict. Behav. 38 (2013) 1796–1803. DOI: 10.1016/j.addbeh.2012.11.010

27. Marino, M.G., E. Fusconi, R. Magnatta, A. Panà, and M. Maurici: Epidemiologic Determinants Affecting Cigarette Smoking Cessation: A Retrospective Study in a National Health System (SSN) Treatment Service in Rome (Italy); J. Environ. Public Health 2010 (2010) 183206. DOI: 10.1155/2010/183206

28. Khan, N., J.R. Anderson, J. Du, D. Tinker, A.M. Bachyrycz, and R. Namdar: Smoking Cessation and its Predictors: Results from a Community-Based Pharmacy Tobacco Cessation Program in New Mexico; Ann. Pharmacother. 46 (2012) 1198–1204. DOI: 10.1345/aph.1P146

29. Etter, J.F., M.M. Bergman, J.P. Humair, and T.V. Perneger: Development and Validation of a Scale Measuring Self-Efficacy of Current and Former Smokers; Addiction 95 (2000) 901–913.

30. Gwaltney, C.J., J. Metrik, C.W. Kahler, and S. Shiffman: Self-Efficacy and Smoking Cessation: A Meta-Analysis; Psychol. Addict. Behav. 23 (2009) 56–66. DOI: 10.1037/a0013529

31. Okuyemi, K.S., J.S. Ahluwalia, M. Ebersole-Robinson, D. Catley, M.S. Mayo, and K. Resnicow: Does Menthol Attenuate the Effect of Bupropion Among African American Smokers?; Addiction 98 (2003) 1387–1393.

32. Collins, C.C. and E.T. Moolchan: Shorter Time to First Cigarette of the Day in Menthol Adolescent Cigarette Smokers; Addict. Behav. 31 (2006) 1460–1464.

33. Fu, S.S., K.S. Okuyemi, M.R. Partin, J.S. Ahluwalia, D.B. Nelson, B.A. Clothier, and A.M. Joseph: Menthol Cigarettes and Smoking Cessation During an Aided Quit Attempt; Nicotine Tob. Res. 10 (2008) 457–462. DOI: 10.1080/14622200801901914

34. Gandhi, K.K., J. Foulds, M.B. Steinberg, S.E. Lu, and J.M. Williams: Lower Quit Rates Among African American and Latino Menthol Cigarette Smokers at a Tobacco Treatment Clinic; Int. J. Clin. Pract. 63 (2009) 360–367. DOI: 10.1111/j.1742-1241.2008.01969.x

35. Muscat, J.E., G. Chen, A. Knipe, S.D. Stellman, P. Lazarus, and J.P. Richie Jr: Effects of Menthol on Tobacco Smoke Exposure, Nicotine Dependence, and NNAL Glucuronidation; Cancer Epidemiol. Biomarkers Prev. 18 (2009) 35–41. DOI: 10.1158/1055-9965.EPI-08-0744

36. Fagan, P., E.T. Moolchan, A. Hart Jr, A. Rose, D. Lawrence, V.L. Shavers, and J.T. Gibson: Nicotine Dependence and Quitting Behaviors Among Menthol and Non-Menthol Smokers with Similar Consumptive Patterns; Addiction 105 (S1) (2010) 55–74. DOI: 1111/j.1360-0443.2010.03190.x

37. Ahijevych, K. and J. Ford: The Relationships between Menthol Cigarette Preference and State Tobacco Control Policies on Smoking Behaviors of Young Adult Smokers in the 2006-07 Tobacco Use Supplements to the Current Population Surveys (TUS CPS); Addiction 105 (S1) (2010) 46–54. DOI: 10.1111/j.1360-0443.2010.03201.x

38. Faseru, B., W.S. Choi, R. Krebill, M.S. Mayo, N.L. Nollen, K.S. Okuyemi, J.S. Ahluwalia, and L.S. Cox: Factors Associated with Smoking Menthol Cigarettes Among Treatment-Seeking African American Light Smokers; Addict. Behav. 36 (2011) 1321–1324. DOI: 10.1016/j.addbeh.2011.07.015

39. Reitzel, L.R., N. Nguyen, Y. Cao, J.I. Vidrine, P. Daza, P.D. Mullen, M.M. Velasquez, Y. Li, P.M. Cinciripini, L. Cofta-Woerpel, and D.W. Wetter: Race/Ethnicity Moderates the Effect of Prepartum Menthol Cigarette Use on Postpartum Smoking Abstinence; Nicotine Tob. Res. 13 (2011) 1305–1310. DOI: 10.1093/ntr/ntr095

40. D’Silva, J., R.G. Boyle, R. Lien, P. Rode, and K.S. Okuyemi: Cessation Outcomes Among Treatment-Seeking Menthol and Nonmenthol Smokers; Am. J. Prev. Med. 43 (S3) (2012) S242–S248. DOI: 10.1016/j.amepre.2012.07.033

41. Rosenbloom, J., V.W. Rees, K. Reid, J. Wong, and T. Kinnunen: A Cross-Sectional Study on Tobacco Use and Dependence Among Women: Does Menthol Matter?; Tob. Induc. Dis. 10 (2012) 19. DOI: 10.1186/1617-9625-10-19

42. Rojewski, A.M., B.A. Toll, and S.S. O’Malley: Menthol Cigarette Use Predicts Treatment Outcomes of Weight-Concerned Smokers; Nicotine Tob. Res. 16 (2014) 115–119. DOI: 10.1093/ntr/ntt137

43. Frost-Pineda, K., R. Muhammad-Kah, L. Rimmer, and Q. Liang: Predictors, Indicators, and Validated Measures of Dependence in Menthol Smokers; J. Addict. Dis. 33 (2014) 94–113. DOI: 10.1080/10550887.2014.909696

44. Curtin, G.M., S.I. Sulsky, C. Van Landingham, K.M. Marano, M.J. Graves, M.W. Ogden, and J.E. Swauger: Primary Measures of Dependence Among Menthol Compared to Non-Menthol Cigarette Smokers in the United States; Regul. Toxicol. Pharmacol. 69 (2014) 451–466. DOI: 10.1016/j.yrtph.2014.05.011

45. Muscat, J.E., J.P. Richie Jr, and S.D. Stellman: Mentholated Cigarettes and Smoking Habits in Whites and Blacks; Tob. Control 11 (2002) 368–371.

46. Pletcher, M.J., B.J. Hulley, T. Houston, C.I. Kiefe, N. Benowitz, and S. Sidney: Menthol Cigarettes, Smoking Cessation, Atherosclerosis, and Pulmonary Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study; Arch. Intern. Med. 166 (2006) 1915–1922. DOI: 10.1001/archinte.166.17.1915

47. Okuyemi, K.S., B. Faseru, L. Sanderson Cox, C.A. Bronars, and J.S. Ahluwalia: Relationship Between Menthol Cigarettes and Smoking Cessation Among African American Light Smokers; Addiction 102 (2007) 1979–1986.

48. Murray, R.P., J.E. Connett, M.A. Skeans, and D.P. Tashkin: Menthol Cigarettes and Health Risks in Lung Health Study Data; Nicotine Tob. Res. 9 (2007) 101–107.

49. Cropsey, K.L., M.F. Weaver, G.D. Eldridge, G.C. Villalobos, A.M. Best, and M.L. Stitzer: Differential Success Rates in Racial Groups: Results of a Clinical Trial of Smoking Cessation Among Female Prisoners; Nicotine Tob. Res. 11 (2009) 690–697. DOI: 10.1093/ntr/ntp051

50. Stahre, M., K.S. Okuyemi, A.M. Joseph, and S.S. Fu: Racial/Ethnic Differences in Menthol Cigarette Smoking, Population Quit Ratios and Utilization of Evidence-Based Tobacco Cessation Treatments; Addiction 105 (S1) (2010) 75–83. DOI: 10.1111/j.1360-0443.2010.03200.x

51. Rose, J.E. and F. Behm: Menthol Smokers, SES and Quit-Smoking Outcome; Society for Research on Nicotine and Tobacco Conference, Baltimore, MD, USA, February 24-27, 2010; Abstract POS5–58. Available at: (Accessed November 2016).

52. Delnevo, C.D., D.A. Gundersen, M. Hrywna, S.E. Echeverria, and M.B. Steinberg: Smoking-Cessation Prevalence Among U.S. Smokers of Menthol versus Non-Menthol Cigarettes; Am. J. Prev. Med. 41 (2011) 357–365. DOI: 10.1016/j.amepre.2011.06.039

53. Blot, W.J., S.S. Cohen, M. Aldrich, J.K. McLaughlin, M.K. Hargreaves, and L.B. Signorello: Lung Cancer Risk Among Smokers of Menthol Cigarettes; J. Natl. Cancer Inst. 103 (2011) 810–816. DOI: 10.1093/jnci/djr102

54. Reitzel, L.R., Y. Li, D.W. Stewart, Y. Cao, D.W. Wetter, A.J. Waters, and J.I. Vidrine: Race Moderates the Effect of Menthol Cigarette Use on Short-Term Smoking Abstinence; Nicotine Tob. Res. 15 (2013) 883–889. DOI: 10.1093/ntr/nts335

55. Lewis, M., Y. Wang, and C.J. Berg: Tobacco Control Environment in the United Sates and Individual Consumer Characteristics in Relation to Continued Smoking: Differential Responses Among Menthol Smokers?; Prev. Med. 65 (2014) 47–51. DOI: 10.1016/j.ypmed.2014.04.019

56. Smith, S.S., M.C. Fiore, and T.B. Baker: Smoking Cessation in Smokers who Smoke Menthol and Non-Menthol Cigarettes; Addiction 109 (2014) 2107–2117. DOI: 10.1111/add.12661

57. Lee, J.H., T.A. Herzog, C.D. Meade, M.S. Webb, and T.H. Brandon: The Use of GEE for Analyzing Longitudinal Binomial Data: A Primer Using Data from a Tobacco Intervention; Addict. Behav. 32 (2007) 187–193.

58. Lawrence, D., A. Rose, P. Fagan, E.T. Moolchan, J.T. Gibson, and C.L. Backinger: National Patterns and Correlates of Mentholated Cigarette Use in the United States; Addiction 105 (S1) (2010) 13–31. DOI: 10.1111/j.1360-0443.2010.03203.x

59. Jones, M.R., B.J. Apelberg, M. Tellez-Plaza, J.M. Samet, and A. Navas-Acien: Menthol Cigarettes, Race/Ethnicity, and Biomarkers of Tobacco Use in U.S. Adults: The 1999-2010 National Health and Nutrition Examination Survey (NHANES); Cancer Epidemiol. Biomarkers Prev. 22 (2013) 224–232. DOI: 10.1158/1055-9965.EPI-12-0912

60. Hickman, N.J. III, K.L. Delucchi, and J.J. Prochaska: Menthol Use Among Smokers with Psychological Distress: Findings from the 2008 and 2009 National Survey on Drug Use and Health; Tob. Control 23 (2014) 7–13. DOI: 10.1136/tobaccocontrol-2012-050479

61. Gundersen, D.A., C.D. Delnevo, and O. Wackowski: Exploring the Relationship between Race/Ethnicity, Menthol Smoking, and Cessation, in a Nationally Representative Sample of Adults; Prev. Med. 49 (2009) 553–557. DOI: 10.1016/j.ypmed.2009.10.003

62. Trinidad, D.R., E.J. Pérez-Stable, K. Messer, M.M. White, and J.P. Pierce: Menthol Cigarettes and Smoking Cessation Among Racial/Ethnic Groups in the United States; Addiction 105 (S1) (2010) 84–94. DOI: 10.1111/j.1360-0443.2010.03187.x

63. Levy, D.T., K. Blackman, J. Tauras, F.J. Chaloupka, A.C. Vilanti, R.S. Niaura, D.M. Vallone, and D.B. Abrams: Quit Attempts and Quit Rates Among Menthol and Nonmenthol Smokers in the United States; Am. J. Public Health 101 (2011) 1241–1247. DOI: 10.2105/AJPH.2011.300178

64. Ahluwalia, J.S., K.J. Harris, D. Catley, K.S. Okuyemi, and M.S. Mayo: Sustained-Release Bupropion for Smoking Cessation in African Americans: A Randomized Controlled Trial; JAMA 288 (2002) 468–474.

65. Ahluwalia, J.S., K. Okuyemi, N. Nollen, W.S. Choi, H. Kaur, K. Pulvers, and M.S. Mayo: The Effects of Nicotine Gum and Counselling Among African American Light Smokers: A 2 x 2 Factorial Design; Addiction 101 (2006) 883–891.

66. Partin, M.R., L.C. An, D.B. Nelson, S. Nugent, A. Snyder, S.S. Fu, M.L. Willenbring, and A.M. Joseph: Randomized Trial of an Intervention to Facilitate Recycling for Relapsed Smokers; Am. J. Prev. Med. 31 (2006) 293–299.

67. Cropsey, K., G. Eldridge, M. Weaver, G. Villalobos, M. Stitzer, and A. Best: Smoking Cessation Intervention for Female Prisoners: Addressing an Urgent Public Health Need; Am. J. Public Health 98 (2008) 1894–1901. DOI: 10.2105/AJPH.2007.128207

68. Cox, L.S., N.L. Nollen, M.S. Mayo, W.S. Choi, B. Faseru, N.L. Benowitz, R.F. Tyndale, K.S. Okuyemi, and J.S. Ahluwalia: Bupropion for Smoking Cessation in African American Light Smokers: A Randomized Controlled Trial; J. Natl. Cancer Inst. 104 (2012) 290–298. DOI: 10.1093/jnci/djr513

69. Piper, M.E., S.S. Smith, T.R. Schlam, M.C. Fiore, D.E. Jorenby, D. Fraser, and T.B. Baker: A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies; Arch. Gen. Psychiatry 66 (2009) 1253–1262. DOI: 10.1001/archgenpsychiatry.2009.142

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