Menthol cigarettes, smoking cessation, atherosclerosis, and pulmonary function: the Coronary Artery Risk Development in Young Adults (CARDIA) Study.
BACKGROUND
African American smokers are more likely to experience tobacco-related morbidity and mortality than European American smokers, and higher rates of menthol cigarette smoking may contribute to these disparities.


METHODS
We prospectively measured cumulative exposure to menthol and nonmenthol cigarettes and smoking cessation behavior (1985-2000), coronary calcification (2000), and 10-year change in pulmonary function (1985-1995) in African American and European American smokers recruited in 1985 for the Coronary Artery Risk Development in Young Adults Study.


RESULTS
We identified 1535 smokers in 1985 (972 menthol and 563 nonmenthol); 89% of African Americans preferred menthol vs 29% of European Americans (P<.001). After adjustment for ethnicity, demographics, and social factors, we found nonsignificant trends in menthol smokers toward lower cessation (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.49-1.02; P = .06) and recent quit attempt (OR, 0.77; 95% CI, 0.56-1.06; P = .11) rates and a significant increase in the risk of relapse (OR, 1.89; 95% CI, 1.17-3.05; P = .009). Per pack-year of exposure, however, we found no differences from menthol in tobacco-related coronary calcification (adjusted OR, 1.27; 95% CI, 1.01-1.60 for menthol cigarettes and 1.33; 95% CI, 1.06-1.68 for nonmenthol cigarettes per 10-pack-year increase; P = .75 for comparison) or 10-year pulmonary function decline (adjusted excess decline in forced expiratory volume in 1 second, 84 mL; 95% CI, 32-137 for menthol cigarettes and 80 mL; 95% CI, 30-129 for nonmenthol cigarettes, per 10-pack-year increase; P = .88 for comparison).


CONCLUSIONS
Menthol and nonmenthol cigarettes seem to be equally harmful per cigarette smoked in terms of atherosclerosis and pulmonary function decline, but menthol cigarettes may be harder to quit smoking.
Pletcher
Mark J
MJ
Departments of Epidemiology and Biostatistics and Medicine, University of California, San Francisco, 185 Berry St, Lobby 4, Suite 5700, San Francisco, CA 94143-0560, USA. mpletcher@epi.ucsf.edu
Hulley
Benjamin J
BJ
Houston
Thomas
T
Kiefe
Catarina I
CI
Benowitz
Neal
N
Sidney
Stephen
S
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D050197:Atherosclerosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008610:Menthol / Q000009:adverse effects*; D011446:Prospective Studies; D012123:Pulmonary Ventilation / Q000187:drug effects*; D012907:Smoking / Q000009:adverse effects* / Q000208:ethnology; D016540:Smoking Cessation / Q000208:ethnology*; D044465:White People
D008610:Menthol