Overview of Current Use of Menthol
Cigarettes and Trends in Recent Years
Ralph S. Caraballo, PhD, MPH
Valerie J. Rock, MPH
Epidemiology Branch Chief
Office on Smoking and Health
CDC
2nd Conference on Menthol Cigarettes
October 19, 2009
TM
Presentation Outline
 Smoking Prevalence by Race/Ethnicity
 Who is smoking menthol cigarettes?
 Recent trends: smokers of menthol cigarettes
 Summary
 Future directions
Smoking Prevalence by Race/Ethnicity
Prevalence of Cigarette Smoking among Racial/Ethnic
Groups, United States, 2002-2005
Smoking Prevalence
Among Race
White
Hispanic
African American
23.9
27.6
27.3
Asian
American Indian/
Alaska Native
14.5
Native Hawaiian and Other Pacific Islander
Source: Caraballo RS, Yee SL, Gfroerer J, Mirza SA. Adult Tobacco Use among Racial and
Ethnic Groups Living in the United States, 2002-2005. Preventing Chronic Disease, 2008; 5(3).
http://www.cdc.gov/pcd/issues/2008/jul/07_0116htm
31.4
37.1
Percentage of Respondents Aged 18 or Older Who Smoked
Cigarettes During the 30 Days Before Being Surveyed,
by Race/Ethnicity and Sex, NSDUH, 2002-2005
Race or Ethnicity
Sex
Men
Women
Total
White
African American
American Indian or Alaska Native
Native Hawaiian and Other PI
Asian
Chinese
Filipino
Japanese
Asian Indian
Korean
Vietnamese
29.7
33.6
39.3
35.9
21.6
13.9
25.5
17.2
19.1
37.4
32.5
25.9
22.8
35.2
26.6
8.1
4.6
10.2
8.0
3.5
20.1
8.0
27.7
27.6
37.1
31.4
14.5
8.8
16.7
12.1
11.9
26.6
21.5
HISPANIC
30.1
17.5
23.9
31.0
35.6
25.3
29.3
15.7
28.0
14.7
21.5
23.8
31.5
20.2
25.2
NON-HISPANIC
Mexican
Puerto Rican
Central or South American
Cuban
Source: Caraballo RS, Yee SL, Gfroerer J, Mirza SA. Adult Tobacco Use among Racial and Ethnic Groups Living in the United States, 20022005. Preventing Chronic Disease, 2008; 5(3). http://www.cdc.gov/pcd/issues/2008/jul/07_0116htm
Who is Smoking Menthol Cigarettes?
Domestic Market Share of Menthol
Cigarettes: United States, 1963 – 2006
50
Percent
40
29%
30
20
27%
16%
20%
10
0
1965
1970
1975
1980
1985
Year
Source: Federal Trade Commission, 2009
1990
1995
2000
2005
Market Share of Menthol Cigarette Brands and Percentage of
Smokers Who Use Menthol Cigarettes—United States,
2001-2007
50
40
Percent
30.5
30
26.0
25.4
20
10
Out of 371 billion
cigarettes sold
per year
n=87,810
n=2,135
0
Market Share
2001-2006
NSDUH Menthol
Use Prevalence
2002-2007
Sources: 2009 FTC Report 2001-2006, NSDUH 2002-2007, and NHANES 2001-2006.
NHANES Menthol
Use Prevalence
2001-2006
Percentage of Smokers Who Use Menthol Cigarettes by
Race/Ethnicity—United States, NSDUH 2002-2007 and
NHANES 2001-2006
NSDUH
100
90
77.3
80
NHANES
82.2
Percent
70
60
50
n=8,563
n=461
40
30
29.7 *
23.2
19.3
20
10
12.0*
n=62,502 n=1,350
n=10,302
n=324
0
White
African American
Hispanic/Mexican
American
Sources: Self-Reports from the Population Aged 12 Years or Older from the National Surveys on Drug Use & Health, 2002-2007; and UPC (Bar Code)
Collected from the Population Aged 20 Years or Older from the Data National Health and Nutrition Examination Surveys, 2001-2006
* NSDUH captures Hispanic/Latinos; NHANES captures specifically Mexican Americans.
Percentage of Smokers Who Use Menthol Cigarettes by
Race/Ethnicity—United States, 2002-2007
100
90
80
77.3
Percent
70
60
45.7
50
35.3
40
32.0
30
29.8
25.0
23.2
20
10
0
African
American
§National
Native
Multi-racial
Hawaiian
and Other
Pacific
Islander
Surveys on Drug Use and Health, 2002-2007
Asian
Hispanic
American
Indian and
Alaska
Native
White
Number of Smokers Who Use Menthol Cigarettes
by Race/Ethnicity—United States, 2002-2007
White
10.1
African American
5.3
Hispanic
2.0
Asian
0.4
Multi-racial
0.3
American Indian/AN 0.1
Population in millions
Native Hawaiian PI <0.1
Population in millions
Source: National Surveys on Drug Use & Health, 2002-2007
Percent Distribution of Menthol Cigarette Smokers
by Race/Ethnicity—United States, 2002-2007
Hispanic
11%
Hispanic
Multi-race (1.6%)
Asian (2.4%)
11.1%
Native Hawaiian PI (0.5%)
AIAN (0.6%)
White
55.1%
African American
Source: National Survey on Drug Use & Health, 2006
28.7%
Percentage of Current Smokers Aged ≥ 12 Years Who Use
Menthol Cigarettes, by Race/Ethnicity and Sex—United States,
2002-2007
100
90
80
*
80.1
74.9
Male
Female
Percent
70
55.4
60
*
50
*
37.9
36.9
40
*
27.4 25.8
19.2
30
20
30.0
42.2
27.7
40.9
30.5
20.2
10
0
African
American
§National
White
Hispanic
Surveys on Drug Use & Health, 2002-2007
*Statistically significant
American
Indian/
Alaska
Native
Native
Hawaiian
and Pacific
Islander
Asian
Multi-racial
Percentage of Current Smokers Aged ≥ 12 Years Who Use
Menthol Cigarettes by Race/Ethnicity and Age Group—
United States, 2002-2007
100
12-17 years
18-25 years
26-64 years
65+ years
90
80
Percent
70
60
50%
50
40
30
20
10
0
§National
African
American
White
Hispanic
Surveys on Drug Use & Health, 2002-2007
American
Indian/
Alaska
Native
Native
Hawaiian
and Other
Pacific
Islander
Asian
Multi-racial
Percentage of Smokers Who Use Menthol Cigarettes by
Education among Persons Aged ≥18 Years—United States,
2002-2007
100
90
80
Percent
70
60
50
40
31.3
31.4
30.7
30
22.8
20
10
0
<HS
§National
High School
Surveys on Drug Use and Health, 2002-2007
Some College
College Grad
Percentage of Smokers Who Use Menthol Cigarettes by
Family Income among Persons Aged ≥25 Years—United
States, 2002-2007
100
90
80
Percent
70
60
50
40
34.7
30.2
30
28.5
27.6
20
10
0
<20K
§National
20-49K
Surveys on Drug Use and Health, 2002-2007
50-74K
75+K
Trends: Menthol Cigarette Use
Trends in Menthol and Non-Menthol Cigarette Use among
Current Smokers Aged ≥ 12 Years, United States, 2002-2007
100
90
Significant
80
Percent
70
Menthol
Non-Menthol
60
50
40
30
20
10
0
2002
Significant
2003
2004
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2005
2006
2007
Trends in Menthol Cigarette Use among
Current Smokers Aged ≥ 12 Years, by
Family Income, United States, 2002-2007
50
Percent
40
Significant
30
Significant
20
Significant
10
0
2002
2003
2004
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2005
2006
2007
<20K
20-49K
50-74K
75+K
Trends in Menthol Cigarette Use among
Current Smokers Aged ≥ 18 Years, by
Education, United States, 2002-2007
Significant
Source: National Surveys on Drug Use & Health, 2002-2007
Trends in Menthol Cigarette Use among Current Smokers
Aged ≥ 12 Years, by Race/Ethnicity, United States, 2002-2007
100
Significant
90
80
African American
White
Hispanic
AIAN
Asian
Multi-race
Percent
70
60
50
40
30
20
10
Significantt
0
2002
2003
2004
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2005
2006
2007
Significant
Trends in Menthol Cigarette Use among African American
Current Smokers Aged ≥12 Years, by Sex, United States,
2002-2007
100
90
Significant increase for
males and females
80
Percent
70
60
50
Male
Female
40
30
20
10
0
2002
2003
2004
2005
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2006
2007
Trends in Menthol Cigarette Use among African American
Current Smokers Aged ≥ 12 Years, by Age, United States,
2002-2007
100
90
All 3 had significant
increases
80
Percent
70
60
50
12-17
18-25
26-64
40
30
20
10
0
2002
2003
2004
2005
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2006
2007
Trends in Menthol Cigarette Use among African American
Current Smokers Aged ≥ 12 Years, by Reported Age of
Smoking Initiation, United States, 2002-2007
100
90
All 3 had significant
increases
80
Percent
70
60
Init <14 y/o
Init 15-17 y/o
Init 18+
50
40
30
20
10
0
2002
2003
2004
2005
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2006
2007
Trends in Menthol Cigarette Use among African American
Current Smokers Aged ≥ 12 Years Number of Cigarettes
Smoked Per Day, United States, 2002-2007
Percent
Significant
100
90
80
70
60
50
40
30
20
10
0
2002
Significant
2003
2004
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2005
2006
2007
<5 CPD
6-15 CPD
16-25 CPD
Quantity and Frequency of Past Month Cigarette Use among
Students Aged 12-18 Years, National Youth Tobacco Survey,
United States, 2004
Source: Caraballo RS, Novak SP, Asman K. Linking quantity and frequency profiles of cigarette smoking to the presence of nicotine
dependence symptoms among adolescent smokers: findings from the 2004 NYTS. Nicotine Tob Res 2009;11(1):49-57.
Trends in Menthol Cigarette Use among White
Current Smokers Aged ≥ 12 Years, by Age,
United States, 2002-2007
100
90
80
Percent
70
60
50
40
stat. sig.
30
20
10
0
2002
2003
2004
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2005
2006
2007
12-17
18-25
26-64
65+
Trends in Menthol Cigarette Use among Hispanic Current
Smokers Aged ≥ 12 Years, by Sex, United States, 2002-2007
100
90
80
Percent
70
Significant
60
50
Male
Female
40
30
20
Signiificant
10
0
2002
2003
2004
2005
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2006
2007
Menthol Brand Use by Race/Ethnicity
Top 10 Cigarette Brands Smoked by African American Current
Smokers Aged ≥ 12 Years, United States, 2006
100
Percent
90
80
70
60
55.4
50
40
30
2.3
2.2
1.9
1.4
1.2
B&H
Winston
GPC
Virginia
Slims
4.6
Basic
Source: National Survey on Drug Use and Health, 2006
5
Doral
8.5
Marlboro
Kool
Newport
0
11.3
Salem
20
10
Summary
 Significant overall increase of menthol cigarette
use among smokers
 Women seem to be more likely to smoke menthol
cigarettes than men
 Proportionally, African Americans more likely to
smoke menthol cigarettes than other groups
 Numerically, Whites are the majority of smokers of
menthol cigarettes
 Significant increase of cigarette menthol use
among the following African American smokers:
 Men and Women
 Ages 12 – 64 years
 All “age of initiation” groups
 Who smoke <5 cigarettes per day when they
smoke
 Who smoke 16 – 25 cigarettes per day when
they smoke
 Significant overall increase of menthol use among
smokers of all family incomes except
$50,000 – $74,999 per year
 Significant increase of cigarette menthol use
among White smokers aged 12 – 25 years
 Significant increase of cigarette menthol use
among Hispanics
 The leading menthol brand among African
American smokers is Newport, the leading brand
smoked by other Racial/Ethnic groups is Marlboro
Future Directions
 To closely monitor menthol cigarette
use among:
 African Americans
 Hispanics
 Native Hawaiians and Pacific Islanders
 Youth and Young Adults
 Triers and Experimenters
 Although out of the scope of this presentation, to
closely monitor:
 Targeted advertising and promotions to all segments of
the U.S. populations, especially
 African Americans
 Hispanics
 Native Hawaiians and Pacific Islanders
 Asians
 Youth and Young Adults
 Triers and Experimenters
 Low income
 LGBT
Acknowledgment
 Kat Asman
 Valerie Rock
 Julie Cessna
 Lynn Hughley
Overview of Current Use of Menthol
Cigarettes and Trends in Recent Years
Ralph Caraballo, PhD, MPH
Valerie Rock, MPH
Epidemiology Branch Chief
Office on Smoking and Health
E-mail: [email protected]
The findings and conclusions in this presentation are those of the authors and
do not necessarily represent the official position of the Centers for Disease Control and Prevention.
TM
Extra Slides Not Presented
Percent Population Distribution by Race/Ethnicity—
United States, July 1, 2006
Other
Ot her
0%
(0.4%)
Hispanic
14.5%
Asian (4.2%)
Multi-race (1.4%)
AIAN (0.8%)
12.2%
African American
Source:http://www.census.gov/ July 1, 2006 estimates (accessed September 29, 2009)
White
66.5%
Measurement of Menthol Use
(Cigarettes) in National Surveys
First Conference on Menthol Cigarettes’ Selected
Epidemiological (Surveillance) Needs (Giovino et al.)
 “The best way to measure menthol use
in large national surveys must be explored”
 Of all smokers who self-reported they smoked
a specific menthol or non-menthol only brand,
0.25% of them seem to have miss-reported the
information (NSDUH)
 No inaccurate reporting (0.00%) was found in
NHANES among smokers for which UPC
cigarette data were not available (NHANES)
Sources: National Cancer Institute. The First Conference on Menthol Cigarettes: Setting the Research Agenda; Executive Summary:
March 21-22, 2002. Atlanta, GA; National Surveys on Drug Use & Health, 2002-2007.
First Conference on Menthol Cigarettes’ Selected
Epidemiological (Surveillance) Needs (Giovino et al.)
 However,
 Of all smokers who self-reported they smoked
Newport, Salem, Alpine, Belair, Coronas or
Jade, 7.2% of them said they smoked a
non-menthol version of those brands (NSDUH)
 About 1.13% of Newport smokers reported
smoking a non-menthol brand (NSDUH)
Sources: National Cancer Institute. The First Conference on Menthol Cigarettes: Setting the Research Agenda; Executive Summary:
March 21-22, 2002. Atlanta, GA; National Surveys on Drug Use & Health, 2002-2007.
First Conference on Menthol Cigarettes’ Selected
Epidemiological (Surveillance) Needs (Giovino et al.)
 “The best way to measure menthol use
in large national surveys must be explored”
 Funded by CDC’s Office on Smoking
and Health, since 2001 NHANES collects
UPC bar code data on the side of the
cigarette pack
Sources: National Cancer Institute. The First Conference on Menthol Cigarettes: Setting the Research Agenda; Executive Summary:
March 21-22, 2002. Atlanta, GA; National Surveys on Drug Use & Health, 2002-2007.
First Conference on Menthol Cigarettes’ Selected
Epidemiological (Surveillance) Needs (Giovino et al.)
 “The need to monitor the use of “cross-brands” such as
Marlboro Menthol and non-menthol Newport”
 Of all Marlboro smokers (n=879), 7.6% (n=65)
provided a brand (UPC code) that was Marlboro
Menthol
 Of all Newport smokers (n=276), 0.4% (n=1)
provided a brand (UPC code) that was Newport
Non-Menthol
Sources: National Cancer Institute. The First Conference on Menthol Cigarettes: Setting the Research Agenda; Executive Summary: March
21-22, 2002. Atlanta, GA; National Health and Nutrition Examination Surveys, 2001-2006.
Trends in Menthol Cigarette Use among White Current Smokers
Aged ≥12 Years, by Sex, United States, 2002-2007
100
90
80
Male
Female
Percent
70
60
50
No 2002-2007 change
40
30
20
10
No 2002-2007 change
0
2002
2003
2004
2005
Years
Source: National Surveys on Drug Use & Health, 2002-2007
2006
2007
Trends in Menthol Cigarette Use among Current Smokers
Aged ≥ 20 Years, by Race/Ethnicity, NHANES, 2001-2006
100
No Change
90
80
Percent
70
60
50
40
Significant increase
30
African American
White
Mexican American
20
10
No change
0
2001-2002
2003-2004
Years
Source: National Health and Nutrition Examination Survey, 2001-2006
2005-2006
Trends in Menthol Cigarette Use among African American
Current Smokers Aged ≥ 20 Years, by Sex, NHANES, 20012006
Significant 2001-2002
to 2005-2006 increase
Male
100
90
80
Female
Percent
70
60
no change
50
40
30
20
10
0
2001-2002
2003-2004
Years
Source: National Health and Nutrition Examination Survey, 2001-2006
2005-2006
Trends in Menthol Cigarette Use among White Current Smokers Aged
≥ 20 Years, by Sex, NHANES, 2001-2006
100
90
80
Male
Female
Percent
70
60
50
no change
40
30
20
Significant 2001-2002 to 20052006 increase
10
0
2001-2002
2003-2004
Years
Source: National Health and Nutrition Examination Survey, 2001-2006
2005-2006
Top 10 Cigarette Brands Smoked by White Current Smokers
Aged ≥ 12 Years, United States, 2006
100
90
80
Percent
70
60
49.8
50
40
30
20
3.1
Doral
Winston
3
2.2
2.1
2
Kool
3.4
Pall Mall
5.5
USA Gold
6.5
Basic
10
Newport
10.5
0
Parliament
Camel
Marlboro
Source: National Survey on Drug Use and Health, 2006
Top 10 Cigarette Brands Smoked by American Indian/ Alaska
Native Current Smokers Aged ≥ 12 Years, United States, 2006
100
90
80
Percent
70
60
50
45.4
40
30
20
5.2
4.4
3.3
2.9
2.2
Doral
Misty
USA Gold
Kool
6.2
Benson &
Hedges
Source: National Survey on Drug Use & Health, 2006
6.5
Basic
Camel
Newport
Marlboro
0
8.1
GPC
9.4
10
Top 10 Cigarette Brands Smoked by Hispanic Current
Smokers Aged ≥ 12 Years, United States, 2006
100
90
80
Percent
70
61.8
60
50
40
30
16.1
20
1.9
1.7
1.5
1.2
1.2
1.1
1.1
Kool
Benson &
Hedges
Doral
Winston
Virginia
Slim
Salem
Pall Mall
6.4
10
0
Camel
Newport
Marlboro
Source: National Survey on Drug Use & Health, 2006
Top 10 Cigarette Brands Smoked by Asian Current Smokers
Aged ≥ 12 Years, United States, 2006
100
90
80
Percent
70
68.4
60
50
40
30
20
5.9
5.8
3.7
2.8
1.3
1.1
0.7
0.7
American
Spirit
Benson &
Hedges
Parliament
Newport
Kool
USA Gold
Kent
Capri
7.7
10
0
Camel
Marlboro
Source: National Survey on Drug Use & Health, 2006
Top 10 Cigarette Brands Smoked by Multiracial Current
Smokers Aged ≥ 12 Years, United States, 2006
100
90
80
Percent
70
60
50
40
38.2
30
17.1
20
6.2
5.4
3.6
3
2.6
1.6
Kool
Doral
USA Gold
GPC
Monarch
7.1
Misty
8.3
10
0
Camel
Basic
Newport
Marlboro
Source: National Survey on Drug Use & Health, 2006
Percent
Percentage of African American Current Smokers Who Used
Newport Cigarettes, by Sex and Age, United States, 2002-2007
100
90
80
70
60
50
40
30
20
10
0
82.5
82.9
79.4
82.6
46.4
12-17
Source: National Survey on Drug Use and Health, 2002-2007
18-25
45.1
26+
Male
Female
Percent
Percentage of White Current Smokers Who Used Newport
Cigarettes, by Sex and Age, United States, 2002-2007
100
90
80
70
60
50
40
30
20
10
0
Male
Female
17.1
20.3
11
9.7
4
3.1
12-17
Source: National Survey on Drug Use and Health, 2002-2007
18-25
26+
Percentage of Hispanic Current Smokers Who Used Newport
Cigarettes, by Sex and Age, United States, 2002-2007
100
90
80
70
Percent
60
Male
Female
50
40
30
23.7
28.4
17.5
20
10
23.5
15.5
10.1
0
12-17
Source: National Survey on Drug Use and Health, 2002-2007
18-25
26+