Effect ofMenthol Cigarettes on Biochemical Markers ofSmoke Exposure Among BlackandWhite

Study objectives: Black smokers havebeenreported tohavehigher serum cotinine levels thando white smokers, andhavehigher ratesofmostsmoking-related diseases, despite smoking fewercig¬ arettes perday. Another striking racial difference isthepreference formentholated cigarettes amongblack smokers. Thecontribution ofmenthol tovariability inbiochemical markers ofcigarette smokeexposure (end-expiratory carbon monoxide andserum cotinine) was evaluated ina biracial sample. Descriptive cross-sectional. Setting: Auniversity smoking research laboratory. Participants: Sixty-five black and96white adult established smokers whowere paid fortheir par¬ ticipation. Information was obtained through direct observation, self-report (interview and self-administered questionnaires), measurementofbutts collected for aweek, andlaboratory anal¬ ysesofthebiochemical markers ofexposure. Results: Compared with thewhite smokers, theblack smokers hadsignificantly higher cotinine and carbon monoxide levels percigarette smokedandpermillimeter ofsmoked tobacco rod(both p<0.001). After adjusting forrace,cigarettes perday, andmean amountofeachcigarette smoked, menthol was associated withhigher cotinine levels (p=0.03) andcarbon monoxide concentrations (p=0.02). Conclusions: Theuse ofmenthol maybeassociated with increased health risks ofsmoking. Menthol use should beconsidered whenbiochemical markers ofsmokeexposure are used asquantitative measures ofsmoking intensity or asindicators ofcompliance withsmoking reduction programs. In addition, theeffect ofmenthol on total "dose" should beconsidered inanyefforts toregulate the amountofnicotine incigarettes. (CHEST 1996; 110:1194-98)