Menthol cigarettes may be tougher for some to quit

NEW YORK (Reuters Health) - Menthol cigarettes may be harder to quit than the standard variety, particularly for lower-income smokers, a new study suggests.

The findings add to evidence that mentholated cigarettes may be especially addictive, but highlight a role for socioeconomics as well, researchers say.

They found that black and Hispanic smokers who favored menthol cigarettes had lower long-term quit rates than their counterparts who smoked standard cigarettes. There was no such difference among white smokers overall, but there was a pattern among unemployed whites: those who smoked menthol cigarettes had lower quit rates at one month.

Previous research has found that menthol-cigarette smokers tend to have higher blood levels of nicotine than other smokers do.

“This study suggests that people who smoke mentholated cigarettes -- particularly those with a low disposable income -- may inhale more nicotine and toxins per cigarette,” lead researcher Kunal K. Gandhi told Reuters Health.

This, in turn, may spur a stronger addiction, explained Gandhi, a researcher at University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick, New Jersey.

Income may enter the picture, Gandhi and his colleagues say, by altering the way in which people smoke. Low-income smokers may try to get more out of each smoke break by taking more puffs per cigarette or inhaling more deeply.

Menthol makes this an easier task because its cooling effect helps mask the harshness of nicotine and other tobacco toxins.

The findings, published in the International Journal of Clinical Practice, are based on 1,688 smokers who sought cessation therapy over four years. One-third of white patients smoked menthol cigarettes, compared with two-thirds of Latino patients and 81 percent of African Americans.

Among black patients, Gandhi’s team found, menthol-cigarette smokers were only one-third as likely to have quit smoking after one month as those who smoked non-menthol cigarettes. The findings were nearly identical among Latinos.

Menthol smokers were still less likely to have quit at the six-month mark as well.

People who smoke mentholated cigarettes may find themselves highly addicted even if their daily number of cigarettes is relatively low, Gandhi noted. Signs of strong addiction, he added, include waking up at night to smoke and needing a cigarette within a half-hour of getting up in the morning.

For any smoker, Gandhi said, the chances of quitting are much greater with counseling and with prescription medications for conquering nicotine addiction.

SOURCE: International Journal of Clinical Practice, February 2009.