Smokers of menthol cigarettes may have harder time quitting

Although menthol and non-menthol cigarettes appear to be equally harmful to the lungs and cardiovascular system, menthol cigarettes may be harder to quit, according to a UCSF-led study that tracked more than 1,200 smokers over 15 years.

The study found that menthol smokers were almost twice as likely to relapse after quitting and also were less likely to stop for a substantial period of time.

Several physiological effects may underlie the difficulty in giving up menthol cigarettes, the authors report. Menthol’s cooling and local anesthetic effect may enhance smoking pleasure. But perhaps more importantly, it also increases breath-holding and decreases nicotine metabolism, thereby increasing levels of addictive nicotine in the blood.

Other studies have found that African Americans tend to smoke less than European Americans, yet have disproportionately high rates of cancer, cardiovascular disease and other smoking-related illnesses. About 70 percent of African American smokers prefer menthol cigarettes, compared to only about 30 percent of European American smokers. But the new study found that menthol cigarettes don’t appear to explain the cancer and heart disease disparities.

“The bottom line for physicians and patients is that smoking is bad for your health, no matter what kind of cigarettes you smoke,” said the study’s lead author, Mark Pletcher, MD, assistant professor of epidemiology and biostatistics at UCSF. “Per cigarette smoked, menthol cigarettes are no more or less harmful than non-menthol cigarettes.  But our findings suggest that menthol smokers may need additional encouragement and support when they try to quit.”

The study is part of the Coronary Artery Risk Development in Young Adults (CARDIA) Study and is reported in the September 25 issue of the “Archives of Internal Medicine.”

Participants were men and women age 18 to 30 at the beginning of the study, in 1985. Each underwent a medical examination and answered questions about demographics and smoking habits in 1985 and again five, seven, 10 and 15 years later. Of the original 1,535 subjects, more than 1,200 completed the study.

Those who smoked menthol cigarettes in 1985 were more likely to still smoke in subsequent years, the study found. About 69 percent of people who smoked menthol cigarettes in 1985 were still smokers in 2000, compared with about 54 percent of non-menthol smokers.

The scientists measured the association between exposure to menthol cigarettes and quitting, build-up of calcium in the arteries, and change in lung function over a 10-year period.

Co-authors are Neal Benowitz, MD, UCSF professor of medicine and psychiatry; Benjamin Hulley, UCSD School of Medicine; Thomas Houston, MD, and Catarina Kiefe, MD, University of Alabama, Birmingham; and Stephen Sidney, MD, Division of Research, Kaiser Permanente, Oakland, California.

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