New research shows that women who smoke menthol
cigarettes may be more likely to inhale deeper and potentially inhale
more nicotine than do smokers of nonmenthol cigarettes. The study
also showed that menthol cigarette smokers tend to have their first
cigarette of the day sooner than nonmenthol cigarette smokers. (The
sooner a person smokes his or her first cigarette of the day, the
more nicotine-dependent the person is thought to be.)
These results should caution smokers who believe that menthol
cigarettes are in some way healthier or less irritating than
nonmenthol brands. There is no safe cigarette, said study
author Karen Ahijevych, phd, a researcher with Ohio States
Comprehensive Cancer Center and an associate professor of nursing at
Ohio State University.
Study Results Particularly Important for African-American Women
These results are particularly important for African-American
women because the majority of African-Americans who smoke choose
menthol cigarettes, she said. Black women also have a
higher rate of smoking-related morbidity and mortality than do white women.
Studies have shown that 65% or more of African-American smokers use
mentholated cigarettes, compared to about 25% to 30% of white smokers.
The study, published in a recent issue of Addictive Behaviors,
involved 95 women smokers (average age, 35 years), 48 of whom were
black and 47 were white. Of these, 27 black women and 22 white women
smoked mentholated cigarettes. The women had smoked an average of 17
cigarettes per day for 15 years.
Dr. Ahijevych measured nicotine and carbon monoxide levels before and
after each of the women smoked a single cigarette. Other measures
included the volume of smoke inhaled (puff volume) and each
womans blood level of cotinine. Cotinine is a breakdown product
of nicotine that is frequently used as a marker for nicotine
exposure. Dr. Ahijevych also recorded each womans smoking
history, including the number of cigarettes smoked per day and how
soon after waking each woman smoked her first cigarette of the day.
The results showed that smokers of menthol cigarettes had a
significantly larger puff volume than did smokers of nonmentholated
cigarettes (45.8 vs 37.8 mL).
Menthol has been shown in animal studies to stimulate cold receptors
in the throat. Stimulating those receptors would produce a
cooling sensation, so smokers might find the smoke less irritating as
they inhale. That might lead them to inhale more deeply, said
Larger puff volumes could lead to a greater tobacco-smoke and
nicotine exposure, she said. The studys finding that
menthol smokers had significantly higher cotinine levels than did the
smokers of nonmenthol brands (239 vs 189 ng/mL) supports that supposition.
In addition, the study found that while black women in both groups
smoked fewer cigarettes per day than did white women (15 vs 19), they
had higher blood levels of cotinine (249 vs 182 ng/mL). Other studies
have also shown higher cotinine levels in black smokers compared to
white smokers, although the reason for this difference remains unknown.
Menthol and Nicotine Dependence: Is There a Link?
Smokers of menthol cigarettes also had a significantly shorter time
to first cigarette after waking (19 vs 37 minutes) than did
nonmenthol smokers. Thats useful to know because we
believe that the shorter that time period is, the more nicotine-dependent
the smoker is likely to be, said Dr. Ahijevych.
It also suggests that a link may exist between menthol and nicotine
dependence, and that clinicians should not use number of cigarettes
smoked per day as their only estimate of a patients nicotine
dependence, she said.
Asking smokers how soon after getting out of bed they have
their first cigarette of the day also has important implications for treatment.
This research was funded by a grant from the American Lung Association.