Mentholated cigarettes and smoking habits in whites and blacks

Objective: To determine if cigarette mentholation is associated with the frequency of smoking and with quitting, and whether mentholation explains racial differences in these two smoking behaviours. Design: Cross sectional analysis of case-control data on smoking and lung cancer. Subjects: Limited to 19 545 current and former cigarette smokers. Main outcome measures: Smoking > 20 cigarettes per day (cpd) versus less than or equal to 20 cpd, and continued smoking versus quit smoking. Results: Among blacks, the prevalence odds ratio (POR) of heavy smoking (greater than or equal to 21 cpd) associated with mentholated cigarettes versus non-mentholated cigarettes was 0.7 (95% confidence interval (Cl) 0.5 to 0.9) in current smokers and 0.6 (95% Cl 0.4 to 0.9) in former smokers. Among whites, the corresponding POR were 0.9 (95% CI 0.8 to 1.0) and 0.9 (95% Cl 0.8 to 1.0). Blacks were less likely to have been heavy smokers than whites, but the difference was unrelated to cigarette mentholation. The POR of continued smoking versus quitting, associated with mentholated cigarettes was 1.1 (95% Cl 1.0 to 1.2) for both blacks and whites. Conclusion: Smoking > 20 cpd was independently associated with white race. Among blacks, smoking less than or equal to 20 cpd was independently associated with mentholated cigarettes. The risk of quitting was not associated with cigarette menthol flavour.