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Ralph S. Caraballo, PhD, MPH Valerie J. Rock, MPH Epidemiology Branch Chief

TM. 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. Smoking Prevalence by Race/Ethnicity

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Ralph S. Caraballo, PhD, MPH Valerie J. Rock, MPH Epidemiology Branch Chief

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  1. TM 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

  2. Smoking Prevalence by Race/Ethnicity • Who is smoking menthol cigarettes? • Recent trends: smokers of menthol cigarettes • Summary • Future directions Presentation Outline

  3. Smoking Prevalence by Race/Ethnicity

  4. Prevalence of Cigarette Smoking among Racial/Ethnic Groups, United States, 2002-2005 Smoking PrevalenceAmong Race White Hispanic African American 23.9 27.6 27.3 Asian American Indian/ Alaska Native 37.1 14.5 Native Hawaiian and Other Pacific Islander 31.4 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

  5. 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 NON-HISPANIC White 29.7 25.9 27.7 African American 33.6 22.8 27.6 American Indian or Alaska Native 39.3 35.2 37.1 Native Hawaiian and Other PI 35.9 26.6 31.4 Asian 21.6 8.1 14.5 Chinese 13.9 4.6 8.8 Filipino 25.5 10.2 16.7 Japanese 17.2 8.0 12.1 Asian Indian 19.1 3.5 11.9 Korean 37.420.1 26.6 Vietnamese 32.5 8.0 21.5 HISPANIC 30.1 17.5 23.9 Mexican 31.0 15.7 23.8 Puerto Rican 35.628.0 31.5 Central or South American 25.3 14.7 20.2 Cuban 29.3 21.5 25.2 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

  6. Who is Smoking Menthol Cigarettes?

  7. Domestic Market Share of Menthol Cigarettes: United States, 1963 – 2006 29% 27% 16% 20% Source: Federal Trade Commission, 2009

  8. Market Share of Menthol Cigarette Brands and Percentage of Smokers Who Use Menthol Cigarettes—United States, 2001-2007 Out of 371 billion cigarettes sold per year n=87,810 n=2,135 Market Share 2001-2006 NSDUH Menthol Use Prevalence 2002-2007 NHANES Menthol Use Prevalence 2001-2006 Sources: 2009 FTC Report 2001-2006, NSDUH 2002-2007, and NHANES 2001-2006.

  9. NSDUH NHANES Percentage of Smokers Who Use Menthol Cigarettes by Race/Ethnicity—United States, NSDUH 2002-2007 and NHANES 2001-2006 n=8,563 n=461 * * n=62,502 n=1,350 n=10,302 n=324 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.

  10. Percentage of Smokers Who Use Menthol Cigarettes by Race/Ethnicity—United States, 2002-2007 African American Native Hawaiian and Other Pacific Islander Multi-racial Asian Hispanic American Indian and Alaska Native White §National Surveys on Drug Use and Health, 2002-2007

  11. Number of Smokers Who Use Menthol Cigarettes by Race/Ethnicity—United States, 2002-2007 White African American Hispanic Asian Multi-racial Population in millions American Indian/AN Native Hawaiian PI Source: National Surveys on Drug Use & Health, 2002-2007

  12. Percent Distribution of Menthol Cigarette Smokers by Race/Ethnicity—United States, 2002-2007 Hispanic Multi-race (1.6%) Asian (2.4%) 11.1% Native Hawaiian PI (0.5%) AIAN (0.6%) White 55.1% 28.7% African American Source: National Survey on Drug Use & Health, 2006

  13. Percentage of Current Smokers Aged ≥ 12 Years Who Use Menthol Cigarettes, by Race/Ethnicity and Sex—United States, 2002-2007 * * * * American Indian/ Alaska Native Native Hawaiian and Pacific Islander Asian Multi-racial African American Hispanic White §National Surveys on Drug Use & Health, 2002-2007 *Statistically significant

  14. Percentage of Current Smokers Aged ≥ 12 Years Who Use Menthol Cigarettes by Race/Ethnicity and Age Group— United States, 2002-2007 50% African American Hispanic American Indian/ Alaska Native White Native Hawaiian and Other Pacific Islander Asian Multi-racial §National Surveys on Drug Use & Health, 2002-2007

  15. Percentage of Smokers Who Use Menthol Cigarettes by Education among Persons Aged ≥18 Years—United States, 2002-2007 Some College <HS High School College Grad §National Surveys on Drug Use and Health, 2002-2007

  16. Percentage of Smokers Who Use Menthol Cigarettes by Family Income among Persons Aged ≥25 Years—United States, 2002-2007 50-74K <20K 20-49K 75+K §National Surveys on Drug Use and Health, 2002-2007

  17. Trends: Menthol Cigarette Use

  18. Significant Significant Trends in Menthol and Non-Menthol Cigarette Use among Current Smokers Aged ≥ 12 Years, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  19. Significant Trends in Menthol Cigarette Use among Current Smokers Aged ≥ 12 Years, by Family Income, United States, 2002-2007 Significant Significant Source: National Surveys on Drug Use & Health, 2002-2007

  20. Significant Trends in Menthol Cigarette Use among Current Smokers Aged ≥ 18 Years, by Education, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  21. Significant Significant Trends in Menthol Cigarette Use among Current Smokers Aged ≥ 12 Years, by Race/Ethnicity, United States, 2002-2007 Significantt Source: National Surveys on Drug Use & Health, 2002-2007

  22. Significant increase for males and females Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥12 Years, by Sex, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  23. All 3 had significant increases Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥ 12 Years, by Age, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  24. All 3 had significant increases Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥ 12 Years, by Reported Age of Smoking Initiation, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  25. Significant Significant Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥ 12 Years Number of Cigarettes Smoked Per Day, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  26. 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.

  27. stat. sig. Trends in Menthol Cigarette Use among White Current Smokers Aged ≥ 12 Years, by Age, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  28. Significant Signiificant Trends in Menthol Cigarette Use among Hispanic Current Smokers Aged ≥ 12 Years, by Sex, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  29. Menthol Brand Use by Race/Ethnicity

  30. Top 10 Cigarette Brands Smoked by African American Current Smokers Aged ≥ 12 Years, United States, 2006 Virginia Slims Kool GPC B&H Salem Doral Winston Marlboro Basic Newport Source: National Survey on Drug Use and Health, 2006

  31. Summary

  32. 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

  33. 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

  34. 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

  35. Future Directions

  36. To closely monitor menthol cigarette use among: • African Americans • Hispanics • Native Hawaiians and Pacific Islanders • Youth and Young Adults • Triers and Experimenters

  37. 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

  38. Acknowledgment • Kat Asman • Valerie Rock • Julie Cessna • Lynn Hughley

  39. TM 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: rfc8@cdc.gov 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.

  40. Extra Slides Not Presented

  41. Percent Population Distribution by Race/Ethnicity— United States, July 1, 2006 Other (0.4%) Hispanic 14.5% Asian (4.2%) Multi-race (1.4%) AIAN (0.8%) White 12.2% 66.5% African American Source:http://www.census.gov/ July 1, 2006 estimates (accessed September 29, 2009)

  42. Measurement of Menthol Use (Cigarettes) in National Surveys

  43. 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.

  44. 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.

  45. 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.

  46. 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.

  47. No 2002-2007 change No 2002-2007 change Trends in Menthol Cigarette Use among White Current Smokers Aged ≥12 Years, by Sex, United States, 2002-2007 Source: National Surveys on Drug Use & Health, 2002-2007

  48. No Change Significant increase No change Trends in Menthol Cigarette Use among Current Smokers Aged ≥ 20 Years, by Race/Ethnicity, NHANES, 2001-2006 Source: National Health and Nutrition Examination Survey, 2001-2006

  49. Significant 2001-2002 to 2005-2006 increase no change Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥ 20 Years, by Sex, NHANES, 2001-2006 Male Female Source: National Health and Nutrition Examination Survey, 2001-2006

  50. no change Significant 2001-2002 to 2005-2006 increase Trends in Menthol Cigarette Use among White Current Smokers Aged ≥ 20 Years, by Sex, NHANES, 2001-2006 Source: National Health and Nutrition Examination Survey, 2001-2006

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