The Relationship between Menthol Cigarette Use, Smoking Cessation and Relapse: Findings from Waves 1 to 4 of the Population Assessment of Tobacco and Health Study

Introduction Some, but not all, studies suggest that menthol cigarette smokers have more difficulty quitting than non-menthol cigarette smokers. Inconsistent findings may be a result of differences in smoker characteristics (e.g. daily vs. non-daily smokers) across studies. This study examines the relationship between menthol cigarette use, cessation and relapse in a longitudinal, nationally representative study of tobacco use in the United States. Methods Data come from four waves of the Population Assessment of Tobacco and Health Study. Waves 1-4 were conducted approximately annually from September 2013 to January 2018. Generalized estimating equation models were used to prospectively examine the relationship between menthol cigarette use, cessation, and relapse in non-daily and daily adult (18+) smokers. Cessation was defined as smokers who had not used cigarettes within the past 30 days at their subsequent assessment. Relapse was defined as cessation followed by past 30-day smoking in the next assessment. Results Among daily smokers (n=13,710), 4.0% and 5.3% of menthol and non-menthol smokers quit after one year, respectively. In an adjusted model, menthol smokers were less likely to quit compared to non-menthol smokers (OR=0.76 [0.63, 0.91]). When the sample was stratified by race/ethnicity, African-American (OR=0.58 [0.34, 0.99]) and White (OR=0.58 [0.34, 0.99]) daily menthol users were less likely to have quit. Among non-daily smokers (n=3,608), there were no significant differences in quit rates. Among daily and non-daily former smokers, there were also no differences in relapse rates between menthol and non-menthol smokers. Conclusions Menthol cigarette use is associated with lower odds of cessation. Implications Findings from this study suggest that menthol cigarette use is associated with lower odds of cessation, but not relapse. Removing menthol cigarettes from the market may improve cessation rates.