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A refreshing poison: one‐quarter of young New Zealand smokers choose menthol

A refreshing poison: one‐quarter of young New Zealand smokers choose menthol Menthol is added to cigarettes to give a cooling sensation when smoked. In the US, half of all young smokers smoke menthol. Initiation with menthol cigarettes is more likely to lead to regular smoking and young menthol smokers may be more likely to report signs of nicotine dependency. Recent New Zealand (NZ) research found no association between menthol preference and autonomy over tobacco use among young people. Nevertheless, menthol cigarettes may pose increased barriers to successful cessation, and this may be an especially important issue for young people, who already have reduced rates of success in smoking cessation. Data from the 2004 Youth Lifestyle Study and the 2006 and 2008 Youth In‐depth Survey of Year 10 students from NZ secondary schools were used to explore preferences for menthol smoking and to examine associations with dependence, cessation and enjoyment of smoking. Details of sampling have been published elsewhere. Participants who reported smoking at least once a month and who had smoked on at least one day in the past month were included in the analysis as ‘current smokers’. Participants were asked whether they usually smoked ‘regular’, ‘light/mild’ or ‘menthol’, with multiple response categories. Nicotine dependence was measured in 2004 with the Hooked on Nicotine (HONC) scale and later survey years assessed through time to first cigarette of the day. Two questions were asked on cessation: “Do you want to stop smoking now?” and “During the past year have you ever tried to stop smoking cigarettes?” In all three surveys participants were asked if they agreed with the statement “smoking is enjoyable”. Linear regression was used to model associations between dependence and use of menthol both unadjusted and adjusting for sex, age and prioritised ethnicity. Binary logistic regression was used to model both desire to smoke and making a quit attempt with menthol as a predictor both univariately and adjusted as above. All analyses took account of school cluster effects. The percentage of participants reporting current smoking was 17.5% (2004), 13.4% (2006) and 13.7% (2008); smokers being more likely to be female and more likely to be Māori. Preferences for type of cigarette are presented in Table 1 . There was no evidence of a change over time for menthol‐only smokers. However, there was evidence of a change in the menthol plus other category over time ( p =0.002) alongside a decrease in non‐menthol smokers (overall p =0.006). Across all years, females were more likely to smoke menthol than males (OR=2.5, CI 1.7–3.6, p <0.001) as were Pacific Peoples (OR=1.8, CI 1.1–3.1, p =0.028) and Asian smokers (OR=3.9, CI 1.4–10.9, p =0.009) compared to NZ/European smokers. 1 Preferred use of tobacco types, n (%) Year Frequency Menthol Menthol & Regular or Light Regular or Light 2004 (n=564) Daily Weekly Monthly Total 21 (5%) 11 (9%) 9 (16%) 41 (7%) 44 (11%) 9 (8%) 5 (9%) 58 (10%) 325 (83%) 98 (83%) 42 (75%) 465 (82%) 2006 (n=334) Daily Weekly Monthly Total 15 (7%) 11 (17%) 5 (13%) 31 (9%) 39 (17%) 6 (9%) 4 (10%) 49 (15%) 175 (76%) 48 (74%) 31 (78%) 254 (76%) 2008 (n=325) Daily Weekly Monthly Total 18 (7%) 7 (15%) 4 (11%) 29 (9%) 50 (21%) 5 (11%) 8 (22%) 63 (19%) 174 (72%) 34 (74%) 25 (68%) 233 (72%) There was no evidence of an association between use of menthol and HONC scores. However, those preferring menthol‐only had lower HONC scores than those preferring only non‐menthol (difference 2.2, CI 1.1–3.2, p <0.001) or menthol and another type (difference 2.5, CI 1.3–3.7, p <0.001). Those who smoked menthol were no more likely to report feeling like having a cigarette first thing in the morning. Using all three years’ data, no association was found between wanting to stop smoking and smoking any menthol cigarettes, or between the three types of smokers overall. Those who preferred menthol were no more likely to have made a quit attempt in the past year. However, menthol plus another type were more likely to have made a quit attempt than non‐menthol only (OR 1.5, CI 1.0–2.0, p =0.034) and menthol‐only (OR 2.0, CI 1.1–3.4, p =0.014) but with no evidence of a difference between menthol‐only and non‐menthol‐only. Overall, 76% of all participants stated they “enjoyed” smoking; menthol smokers were more likely to agree that smoking was enjoyable (OR 1.4, CI 1.0–2.0, p =0.065) than non‐menthol smokers. The number of young New Zealanders smoking menthol cigarettes in combination with regular cigarettes is increasing and needs to be monitored in NZ. More female smokers smoke menthol, confirming earlier NZ research. Given the high rates of smoking among females in NZ, particularly young Māori females, this finding is concerning and may have implications for smoking uptake. It is important that the NZ government takes a precautionary approach and examines the idea of banning menthol as an ingredient in tobacco to try and reduce smoking uptake among young people. Acknowledgements The 2004 Year 10 survey was run by the Health Sponsorship Council (HSC). The 2006 and 2008 surveys were carried out under the auspices of the NZ Youth Tobacco Monitor (NZYTM), a collaborative project with the HSC, Action on Smoking and Health, and the Ministry of Health. We acknowledge the time and effort volunteered by many NZ secondary school principals, teachers and students. TNS collected data on behalf of the HSC in 2004 and Synovate in 2006 and 2008. The authors of this research take responsibility for the outputs produced in this manuscript. Funding The Cancer Society Social and Behavioural Research Unit was supported by the Cancer Society of NZ and the University of Otago. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

A refreshing poison: one‐quarter of young New Zealand smokers choose menthol

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References (6)

Publisher
Wiley
Copyright
© 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1753-6405.2012.00926.x
pmid
23025381
Publisher site
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Abstract

Menthol is added to cigarettes to give a cooling sensation when smoked. In the US, half of all young smokers smoke menthol. Initiation with menthol cigarettes is more likely to lead to regular smoking and young menthol smokers may be more likely to report signs of nicotine dependency. Recent New Zealand (NZ) research found no association between menthol preference and autonomy over tobacco use among young people. Nevertheless, menthol cigarettes may pose increased barriers to successful cessation, and this may be an especially important issue for young people, who already have reduced rates of success in smoking cessation. Data from the 2004 Youth Lifestyle Study and the 2006 and 2008 Youth In‐depth Survey of Year 10 students from NZ secondary schools were used to explore preferences for menthol smoking and to examine associations with dependence, cessation and enjoyment of smoking. Details of sampling have been published elsewhere. Participants who reported smoking at least once a month and who had smoked on at least one day in the past month were included in the analysis as ‘current smokers’. Participants were asked whether they usually smoked ‘regular’, ‘light/mild’ or ‘menthol’, with multiple response categories. Nicotine dependence was measured in 2004 with the Hooked on Nicotine (HONC) scale and later survey years assessed through time to first cigarette of the day. Two questions were asked on cessation: “Do you want to stop smoking now?” and “During the past year have you ever tried to stop smoking cigarettes?” In all three surveys participants were asked if they agreed with the statement “smoking is enjoyable”. Linear regression was used to model associations between dependence and use of menthol both unadjusted and adjusting for sex, age and prioritised ethnicity. Binary logistic regression was used to model both desire to smoke and making a quit attempt with menthol as a predictor both univariately and adjusted as above. All analyses took account of school cluster effects. The percentage of participants reporting current smoking was 17.5% (2004), 13.4% (2006) and 13.7% (2008); smokers being more likely to be female and more likely to be Māori. Preferences for type of cigarette are presented in Table 1 . There was no evidence of a change over time for menthol‐only smokers. However, there was evidence of a change in the menthol plus other category over time ( p =0.002) alongside a decrease in non‐menthol smokers (overall p =0.006). Across all years, females were more likely to smoke menthol than males (OR=2.5, CI 1.7–3.6, p <0.001) as were Pacific Peoples (OR=1.8, CI 1.1–3.1, p =0.028) and Asian smokers (OR=3.9, CI 1.4–10.9, p =0.009) compared to NZ/European smokers. 1 Preferred use of tobacco types, n (%) Year Frequency Menthol Menthol & Regular or Light Regular or Light 2004 (n=564) Daily Weekly Monthly Total 21 (5%) 11 (9%) 9 (16%) 41 (7%) 44 (11%) 9 (8%) 5 (9%) 58 (10%) 325 (83%) 98 (83%) 42 (75%) 465 (82%) 2006 (n=334) Daily Weekly Monthly Total 15 (7%) 11 (17%) 5 (13%) 31 (9%) 39 (17%) 6 (9%) 4 (10%) 49 (15%) 175 (76%) 48 (74%) 31 (78%) 254 (76%) 2008 (n=325) Daily Weekly Monthly Total 18 (7%) 7 (15%) 4 (11%) 29 (9%) 50 (21%) 5 (11%) 8 (22%) 63 (19%) 174 (72%) 34 (74%) 25 (68%) 233 (72%) There was no evidence of an association between use of menthol and HONC scores. However, those preferring menthol‐only had lower HONC scores than those preferring only non‐menthol (difference 2.2, CI 1.1–3.2, p <0.001) or menthol and another type (difference 2.5, CI 1.3–3.7, p <0.001). Those who smoked menthol were no more likely to report feeling like having a cigarette first thing in the morning. Using all three years’ data, no association was found between wanting to stop smoking and smoking any menthol cigarettes, or between the three types of smokers overall. Those who preferred menthol were no more likely to have made a quit attempt in the past year. However, menthol plus another type were more likely to have made a quit attempt than non‐menthol only (OR 1.5, CI 1.0–2.0, p =0.034) and menthol‐only (OR 2.0, CI 1.1–3.4, p =0.014) but with no evidence of a difference between menthol‐only and non‐menthol‐only. Overall, 76% of all participants stated they “enjoyed” smoking; menthol smokers were more likely to agree that smoking was enjoyable (OR 1.4, CI 1.0–2.0, p =0.065) than non‐menthol smokers. The number of young New Zealanders smoking menthol cigarettes in combination with regular cigarettes is increasing and needs to be monitored in NZ. More female smokers smoke menthol, confirming earlier NZ research. Given the high rates of smoking among females in NZ, particularly young Māori females, this finding is concerning and may have implications for smoking uptake. It is important that the NZ government takes a precautionary approach and examines the idea of banning menthol as an ingredient in tobacco to try and reduce smoking uptake among young people. Acknowledgements The 2004 Year 10 survey was run by the Health Sponsorship Council (HSC). The 2006 and 2008 surveys were carried out under the auspices of the NZ Youth Tobacco Monitor (NZYTM), a collaborative project with the HSC, Action on Smoking and Health, and the Ministry of Health. We acknowledge the time and effort volunteered by many NZ secondary school principals, teachers and students. TNS collected data on behalf of the HSC in 2004 and Synovate in 2006 and 2008. The authors of this research take responsibility for the outputs produced in this manuscript. Funding The Cancer Society Social and Behavioural Research Unit was supported by the Cancer Society of NZ and the University of Otago.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Oct 1, 2012

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