Prevalence, determinants, and impact of menthol cigarette smoking among US adolescents
Agaku, Israel Terungwa
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BACKGROUND: Everyday, >2,500 U.S. adolescents try their first cigarette, and menthol cigarettes serve as starter products. This study measured trends in youth menthol cigarette smoking, association between menthol cigarette smoking and current e-cigarette use, public support for tobacco flavor ban (including menthol), and tobacco price inequalities by flavor variety. METHODS: Data sources included: (1) 2011-2015 National Youth Tobacco Survey, a school-based survey of U.S. 6-12th graders; (2) 2016 Summer Styles, a national survey of U.S. adults; and (3) 2011-2016 Nielsen retail scanner data, a database comprising tobacco purchase price and item data acquired from the scanner systems of retail outlets within the continental U.S. Orthogonal polynomials were used to measure menthol cigarette smoking trends during 2011-2015. Association between youth menthol cigarette smoking and current e-cigarette use was measured using a marginal structural logistic regression model. Correlates of public support for tobacco flavor ban were measured using generalized linear models. Tobacco price inequalities were analyzed within and across different products, including manufactured cigarettes, roll-your-own cigarettes, little cigars, and moist snuff. RESULTS: Among all 6-12th graders, declines occurred in menthol (6.1% to 3.1%) and nonmenthol (5.1% to 3.4%) cigarette smoking during 2011-2015 (all p-trend<0.05); no significant change however occurred in menthol use among current cigarette smokers (54.3% to 47.9%). Menthol cigarette smokers had higher odds than nonmenthol smokers of reporting current e-cigarette use (aOR=1.56, 95%CI=1.24-1.97). A pack of menthol manufactured cigarettes cost 3, 4, and 7 times more than mentholated cigarette-pack-equivalents of little cigars, moist snuff, and roll-your-own cigarettes respectively. Furthermore, mentholated varieties were cheaper than other flavors or non-flavored varieties for roll-your-own cigarettes, little cigars, and moist snuff. Support for tobacco flavor ban was 34.8%, 48.4%, and 52.0% among current, former, and never tobacco users respectively. Among both U.S. adults overall and current tobacco users, adults concerned about adolescent smoking initiation were more likely to support a tobacco flavor ban. Similarly, adult tobacco users living with children had higher support than those living with none (Adjusted prevalence ratio=1.38; 95%CI=1.05-1.82). CONCLUSION: Menthol cigarettes might be slowing progress in reducing youth smoking. Prohibiting menthol cigarettes and closing price inequalities could benefit public health.