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

Ralph S. Caraballo, PhD, MPHValerie J. Rock, MPHEpidemiology Branch ChiefOffice on Smoking and HealthCDC

TM

2nd Conference on Menthol Cigarettes

October 19, 2009

Overview of Current Use of Menthol Cigarettes and Trends in Recent Years

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

WhiteAfrican American

American Indian/Alaska Native

Asian

Hispanic

Smoking PrevalenceAmong Race

27.327.623.

9

14.5 37.1Native 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

Race or Ethnicity SexMen Women Total

NON-HISPANICWhite 29.7 25.9 27.7African American 33.6 22.8 27.6 American Indian or Alaska Native 39.3 35.2 37.1Native Hawaiian and Other PI 35.9 26.6 31.4Asian 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 37.4 20.1 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 35.6 28.0 31.5 Central or South American 25.3 14.7 20.2 Cuban 29.3 21.5 25.2

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

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

Who is Smoking Menthol Cigarettes?

Domestic Market Share of Menthol Cigarettes: United States, 1963 – 2006

0

10

20

30

40

50

1965 1970 1975 1980 1985 1990 1995 2000 2005

Year

Perc

ent

Source: Federal Trade Commission, 2009

20%

27%29%

16%

26.030.5

25.4

0

10

20

30

40

50

Perc

ent

Market Share of Menthol Cigarette Brands and Percentage of Smokers Who Use Menthol Cigarettes—United States, 2001-2007

Sources: 2009 FTC Report 2001-2006, NSDUH 2002-2007, and NHANES 2001-2006.

Market Share

2001-2006

NSDUH Menthol Use Prevalence

2002-2007

NHANES Menthol Use Prevalence

2001-2006

n=87,810 n=2,135Out of 371 billion cigarettes sold

per year

Percentage of Smokers Who Use Menthol Cigarettes by Race/Ethnicity—United States, NSDUH 2002-2007 and NHANES 2001-2006

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.

23.2

77.3

29.7

19.3

82.2

12.0

0

10

20

30

40

50

60

70

80

90

100

White African American Hispanic/MexicanAmerican

Perc

ent

NSDUH NHANES

*

n=461

n=1,350 n=324

n=62,502

n=8,563

n=10,302

*

Percentage of Smokers Who Use Menthol Cigarettes by Race/Ethnicity—United States, 2002-2007

§National Surveys on Drug Use and Health, 2002-2007

77.3

35.329.8

23.2

45.7

32.025.0

0

1020

304050

60708090

100

Perc

ent

African American

Native Hawaiian and Other

Pacific Islander

Multi-racial Asian Hispanic American Indian and

Alaska Native

White

0.1

0.3

0.4

2.0

5.3

<0.1

10.1

Population in millions

White

Multi-racial

American Indian/AN

Native Hawaiian PI

Asian

Hispanic

African American

Population in millions

Source: National Surveys on Drug Use & Health, 2002-2007

Number of Smokers Who Use Menthol Cigarettes by Race/Ethnicity—United States, 2002-2007

Hispanic11%

African American

Source: National Survey on Drug Use & Health, 2006

White

Hispanic

Asian (2.4%)

55.1%

11.1%

28.7%

Multi-race (1.6%)

Native Hawaiian PI (0.5%)

AIAN (0.6%)

Percent Distribution of Menthol Cigarette Smokers by Race/Ethnicity—United States, 2002-2007

74.9

19.225.8

20.2

37.9

27.7 30.5

80.1

27.436.9

30.0

55.4

42.2 40.9

0

10

20

30

40

50

60

70

80

90

100

Perc

ent

MaleFemale

Percentage of Current Smokers Aged ≥ 12 Years Who Use Menthol Cigarettes, by Race/Ethnicity and Sex—United States, 2002-2007

§National Surveys on Drug Use & Health, 2002-2007*Statistically significant

African American White Hispanic American

Indian/ Alaska Native

Native Hawaiian

and Pacific Islander

Asian

*

*

*

Multi-racial

*

0102030405060708090

100

Perc

ent

12-17 years18-25 years26-64 years65+ years

Percentage of Current Smokers Aged ≥ 12 Years Who Use Menthol Cigarettes by Race/Ethnicity and Age Group— United States, 2002-2007

§National Surveys on Drug Use & Health, 2002-2007

African American White Hispanic American

Indian/ Alaska Native

Native Hawaiian and Other

Pacific Islander

Asian Multi-racial

50%

Percentage of Smokers Who Use Menthol Cigarettes by Education among Persons Aged ≥18 Years—United States, 2002-2007


31.3 30.731.422.8

0

1020

304050

60708090

100

Perc

ent

<HS High School Some College College Grad

Percentage of Smokers Who Use Menthol Cigarettes by Family Income among Persons Aged ≥25 Years—United States, 2002-2007


34.728.530.2 27.6

0

1020

304050

60708090

100

Perc

ent

<20K 20-49K 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


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent Menthol

Non-Menthol

Significant

Significant

Trends in Menthol Cigarette Use among Current Smokers Aged ≥ 12 Years, by Family Income, United States, 2002-2007


0

10

20

30

40

50

2002 2003 2004 2005 2006 2007Years

Perc

ent

<20K20-49K50-74K75+K

Significant

Significant

Significant

Trends in Menthol Cigarette Use among Current Smokers Aged ≥ 18 Years, by Education, United States, 2002-2007


Significant

Trends in Menthol Cigarette Use among Current Smokers Aged ≥ 12 Years, by Race/Ethnicity, United States, 2002-2007


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent

African AmericanWhiteHispanicAIANAsianMulti-race

Significant

Significant Significantt

Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥12 Years, by Sex, United States, 2002-2007


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent

MaleFemale

Significant increase for males and females

Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥ 12 Years, by Age, United States, 2002-2007


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent

12-1718-2526-64

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


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent

Init <14 y/oInit 15-17 y/oInit 18+

All 3 had significant increases

Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥ 12 Years Number of Cigarettes Smoked Per Day, United States, 2002-2007


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent <5 CPD

6-15 CPD16-25 CPD

Significant

Significant

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


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent

12-1718-2526-6465+

stat. sig.

Trends in Menthol Cigarette Use among Hispanic Current Smokers Aged ≥ 12 Years, by Sex, United States, 2002-2007


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent

MaleFemale

Significant

Signiificant

Menthol Brand Use by Race/Ethnicity

Top 10 Cigarette Brands Smoked by African American Current Smokers Aged ≥ 12 Years, United States, 2006

Source: National Survey on Drug Use and Health, 2006

55.4

11.3 8.5 5 4.6 2.3 2.2 1.9 1.4 1.20

102030405060708090

100

Perc

ent

New

port

Kool

Marlboro

Salem

Doral

Basic

B&

H

Winston

GPC

Virginia Slim

s

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

Ralph Caraballo, PhD, MPHValerie Rock, MPH Epidemiology Branch ChiefOffice on Smoking and Health

TM

Overview of Current Use of Menthol Cigarettes and Trends in Recent Years

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.

Extra Slides Not Presented

Other0%

African American

Source:http://www.census.gov/ July 1, 2006 estimates (accessed September 29, 2009)

White

Hispanic

Asian (4.2%)

Percent Population Distribution by Race/Ethnicity— United States, July 1, 2006

66.5%

14.5%

12.2%

Multi-race (1.4%)

Other (0.4%)

AIAN (0.8%)

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.


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)



“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


“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


0102030405060708090

100

2002 2003 2004 2005 2006 2007Years

Perc

ent

MaleFemale

No 2002-2007 change

No 2002-2007 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

0102030405060708090

100

2001-2002 2003-2004 2005-2006Years

Perc

ent

African AmericanWhiteMexican American

No Change

Significant increase

No change

Trends in Menthol Cigarette Use among African American Current Smokers Aged ≥ 20 Years, by Sex, NHANES, 2001-2006


0102030405060708090

100

2001-2002 2003-2004 2005-2006Years

Perc

ent

Male

Female

Significant 2001-2002 to 2005-2006 increase

no change

Trends in Menthol Cigarette Use among White Current Smokers Aged ≥ 20 Years, by Sex, NHANES, 2001-2006


0102030405060708090

100

2001-2002 2003-2004 2005-2006Years

Perc

ent

MaleFemale

Significant 2001-2002 to 2005-2006 increase

no change

Top 10 Cigarette Brands Smoked by White Current Smokers Aged ≥ 12 Years, United States, 2006

Source: National Survey on Drug Use and Health, 2006

49.8

10.5 6.5 5.5 3.4 3.1 3 2.2 2.1 20

102030405060708090

100

Perc

ent

M

arlboro

Cam

el

New

port

Basic

Doral

Winston

Parliament

USA

Gold

Pall Mall

Kool

Top 10 Cigarette Brands Smoked by American Indian/ Alaska Native Current Smokers Aged ≥ 12 Years, United States, 2006


45.4

9.4 8.1 6.5 6.2 5.2 4.4 3.3 2.9 2.20

1020304050

60708090

100

Perc

ent

Marlboro

New

port

Cam

el

Basic

Benson &

H

edges

GPC

Doral

Misty

USA

Gold

Kool

61.8

16.16.4

1.9 1.7 1.5 1.2 1.2 1.1 1.10

102030405060708090

100

Perc

ent

Top 10 Cigarette Brands Smoked by Hispanic Current Smokers Aged ≥ 12 Years, United States, 2006


Marlboro

New

port

Cam

el

Kool

Benson &

H

edges

Doral

Winston

Virginia Slim

Salem

Pall Mall

68.4

7.7 5.9 5.8 3.7 2.8 1.3 1.1 0.7 0.70

10203040

5060708090

100

Perc

ent

Top 10 Cigarette Brands Smoked by Asian Current Smokers Aged ≥ 12 Years, United States, 2006

Source: National Survey on Drug Use & Health, 2006 C

amel

Am

erican Spirit

Parliament

Benson &

H

edges

New

port

Kool

Capri

USA

Gold

Kent

Marlboro

38.2

17.18.3 7.1 6.2 5.4 3.6 3 2.6 1.6

0102030405060708090

100

Perc

ent

Top 10 Cigarette Brands Smoked by Multiracial Current Smokers Aged ≥ 12 Years, United States, 2006


Marlboro

New

port

Basic

Cam

el

GPC

Doral

Misty

USA

Gold

Kool

Monarch

Percentage of African American Current Smokers Who Used Newport Cigarettes, by Sex and Age, United States, 2002-2007

Source: National Survey on Drug Use and Health, 2002-2007

82.5 79.4

46.4

82.9 82.6

45.1

0102030405060708090

100

12-17 18-25 26+

Perc

ent

MaleFemale

Percentage of White Current Smokers Who Used Newport Cigarettes, by Sex and Age, United States, 2002-2007


17.19.7

3.1

20.311

40

102030405060708090

100

12-17 18-25 26+

Perc

ent

MaleFemale

Percentage of Hispanic Current Smokers Who Used Newport Cigarettes, by Sex and Age, United States, 2002-2007


23.717.5

10.1

28.423.5

15.5

0102030405060708090

100

12-17 18-25 26+

Perc

ent

MaleFemale

Documents

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