Menthol cigs 'encourage teens to smoke more'

Behind the Headlines

Tuesday June 24 2014

Menthol cigarettes are at least as dangerous as regular cigarettes

Menthol smokers smoked twice as many cigarettes

"Menthol cigarettes ARE more addictive," the Mail Online claims, based on a survey of 5,000 teenagers. The 2010-11 Canadian school survey found that 16% of teenagers aged 14 to 18 smoke cigarettes.

The research found that teenagers who smoked menthol cigarettes were on average smoking around 60% more cigarettes than teenagers who smoked regular cigarettes (43 compared to 27).

The researchers' unproven speculation is that this difference is because menthol cigarettes are less "harsh" on the throat. But it's important to note that this type of study is not able to prove that menthol cigarettes are more addictive than normal ones.

While the media has focused on menthol smokers being almost three times more likely to intend to continue to smoke, a worryingly whopping 89% of all smokers planned to continue.

In the UK the number of teenagers who smoke is in decline, but it is estimated that 10% of 15-year-olds are smokers.

If you are a teenage smoker, read more about why you should quit and the best ways to go about it.

You can also download the free NHS Choices stop smoking iPhone app.

 

Menthol cigarettes – history of a lie

Menthol cigarettes were introduced during the 1920s. They quickly became marketed as a "healthier" and "more soothing" alternative to regular tobacco, with advertisers playing on the idea that menthol had inherent medicinal properties.

 

This is, of course, complete nonsense. Menthol cigarettes are at least as dangerous as regular cigarettes and, as this study suggests, could be even more dangerous because smokers underestimate the risks involved.

 

In June 2013 the European Union agreed in principle to ban the sale of menthol cigarettes, although legislation is not expected to be implemented for at least two years. It is also possible tobacco companies will seek to overturn the ban on legal grounds.

Where did the story come from?

The study was carried out by researchers from the University of Waterloo and Concordia University in Canada, and was funded by the Canadian Cancer Society Research Institute.

It was published in the peer-reviewed medical journal, Cancer Causes and Control.

The study was accurately summarised by the Mail Online in the main body of the reporting, although the headline was inaccurate.

The study does not prove menthol cigarettes are more addictive than normal cigarettes. It shows that teenagers who smoke menthol cigarettes smoke more than those who only smoke non-menthol cigarettes.

To prove an increased level of addiction, researchers would need groups of participants to try to quit smoking either type of cigarette and then assess how difficult each group found it on average.

 

What kind of research was this?

The researchers analysed results from the 2010-11 Canadian Youth Smoking Survey. This was a cross-sectional survey for adolescents aged 14 to 18 performed every two years across schools in Canada.

Cross-sectional studies can provide information on prevalence patterns and suggest associations, but they cannot prove cause and effect.

 

What did the research involve?

The Canadian Youth Smoking Survey was sent to all state schools in Canada. The students were asked to provide details of the number and type of cigarettes they smoked on the days they smoked, and the number of cigarettes they smoked in the previous week.

The students' intent to continue smoking was assessed by their response to the question, "At any time in the next year do you think you will smoke a cigarette?"

Other data included whether they were allowed to smoke at home and if their parent, guardian or friends smoked.

Menthol cigarette smokers were defined as those who indicated smoking at least one menthol cigarette in the last 30 days. This could therefore apparently include those who exclusively smoked menthol cigarettes as well as those who smoked non-menthol cigarettes.

The researchers then analysed the data of adolescents who smoked.

 

What were the basic results?

There were responses from 56% of the schools, with 73% of the students filling out the questionnaire. Of the 31,396 students, 5,035 were smokers. The researchers analysed the results for 4,736 of these.

Menthol cigarettes were used by 32% of current smokers in the previous 30 days. Menthol smokers smoked on average 6.86 cigarettes per day, compared with 4.59 for non-menthol smokers. When this was estimated per week, menthol smokers smoked on average 42.74 cigarettes, compared with 26.33 for non-menthol smokers.

Menthol smokers were more likely to intend to continue smoking in the next year than non-menthol smokers (odds ratio [OR] 2.95, 95% confidence interval [CI] 2.24 to 3.90). However, approximately 89% of all smokers intended to continue smoking.

Adolescents living in homes with a total ban on smoking smoked fewer cigarettes per day, with an average number of -1.64 (95% CI -2.49 to -0.79). The average number of cigarettes smoked per day was higher for:

  • males – 1.10 (95% CI 0.40 to 1.81)
  • those with a smoking parent or guardian – 2.11 (95% CI 1.30 to 2.92)
  • those with at least one friend who smokes – 2.36 95% CI 1.42 to 3.29)

 

How did the researchers interpret the results?

The researchers concluded that, "Adolescent menthol smokers smoke more cigarettes and report their intent to continue smoking in the next year more frequently than non-menthol smokers."

They go on to advise that, "The findings of this study, along with existing evidence, suggest the need for banning menthol in Canada, in part because of its significant effect on youth smoking."

 

Conclusion

This large Canadian survey has worryingly found that despite the dangers of smoking, 16% of teenagers aged between 14 and 18 are smoking, and 89% of them intend to continue. The number of cigarettes smoked was higher in teenagers who smoked menthol cigarettes.

This included those who reported at least one menthol cigarette smoked in the past 30 days, so they may not have been exclusive smokers of menthol cigarettes.

These findings reflect the widespread belief that menthol cigarettes are deemed to be a more attractive option for teenagers.

However, the survey is reliant on self-reporting and is likely to be an underestimate of the number of cigarettes smoked. It is unclear why 27% of the students did not participate in the survey, or why the researchers only included 4,736 of the 5,035 students who smoked.

Nevertheless, these results show that more targeted awareness campaigns of the health risks of cigarette smoking are required for this age group in Canada.

Recent results from the Office for National Statistics in the UK showed a trend in the right direction for youth smoking. The percentage of 15-year-olds who are regular smokers has reduced from 28% in 1994 to 10% in 2012.

Hopefully, the proposed ban of menthol cigarettes will stop UK teenagers falling for the misconception that menthol cigarettes are "lighter on the throat" and are therefore in some way healthier.

If you smoke, there is a wide range of aids and advice that can help you quit.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

Menthol cigarettes ARE more addictive: Teenagers who smoke them get through twice as much tobacco every week. Mail Online, June 23 2014

Links to the science

Azagba S, Minaker LM, Sharaf MF, et al. Smoking intensity and intent to continue smoking among menthol and non-menthol adolescent smokers in Canada. Cancer Causes and Control. Published online June 10 2014

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Media last reviewed: 18/06/2015

Next review due: 18/06/2017

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