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Table 7 Summary of Evidence Related to Rate of Abstinence/Quitting

From: Assessing the evidence on the differential impact of menthol versus non-menthol cigarette use on smoking cessation in the U.S. population: a systematic review and meta-analysis

Study Sampling / Recruitment Strategya, Data Collection Period Study Findings Study Quality
Decreased Rate of Abstinence/Quitting with Menthol Cigarette Use
 Thihalolipavan et al., 2014 [68] New York City Nicotine Patch and Gum Program;
2012
Smoking menthol cigarettes was associated with a 10% lower prevalence of quitting (PR = 0.90, 95% CI: 0.83 to 0.97) after 3 to 6 weeks. Poor
 Lewis et al., 2014 [47] Nielsen Homescan Panel;
January 2004–December 2009
Menthol smokers had a significantly lower likelihood of quitting compared with non-menthol smokers (HR = 0.79, 95% CI: 0.64 to 0.99). Fair
 Rojewski et al., 2014 [61] A trial of 166 weight-concerned smokers who smoked at least 10 CPD for at least a year and had at least one prior quit attempt;
2005–2009
Menthol smokers were significantly less likely to be abstinent; specifically, non-menthol smokers were 2.4 times more likely to report 7-day PPA Weeks 14 and 26 (Week 14: AOR = 2.40, 95% CI: 1.04 to 5.55; Week 26 AOR = 2.47, 95% CI: 1.40 to 5.90; p = 0.04). Good
 Faseru et al., 2013 [34] KIS-III trial;
community-based clinic sample serving a predominantly Black population;
2007–2010
Menthol cigarette use was associated with significantly lower odds of cotinine-verified 7-day PPA at the end of 7 weeks of treatment compared to non-menthol cigarette use; specifically, non-menthol, compared to menthol, smokers had 84% greater odds of 7-day PPA at week 7 (AOR = 1.84, 95% CI: 1.01 to 3.36; p < 0.05). Good
No Difference in Rate of Abstinence/Quitting with Menthol Cigarette Use
 Keeler et al., 2018 [45] Probability sample of U.S. households;
personal and telephone interviews;
May/August 2006 to January 2007, and May/August 2010 to January 2011
No difference between Black menthol and non-menthol smokers in the rate of successful cessation (≥3 months (AOR = 1.01, 95% CI: 0.70 to 1.45; p = NS). Similarly, no difference was found for the rate of successful cessation (≥3 months) between White menthol and non-menthol smokers (AOR = 0.94, 95% CI: 0.84 to 1.07). Fair
 Keeler et al., 2017 [44] Probability sample of U.S. households; personal and telephone interviews;
2006 to 2007 and 2010 to 2011
No difference between menthol and non-menthol smokers in the odds of cessation (≥3 months (AOR = 0.92 95% CI: 0.83 to 1.03; p = 0.1470). Similarly, no difference for the odds of cessation in subgroup analyses of: Black menthol and non-menthol smokers (AOR = 1.03, 95% CI: 0.73 to 1.44; p = 0.8630); White menthol and non-menthol smokers (AOR = 0.94, 95% CI: 0.84 to 1.06; p = 0.3190); Asian menthol and non-menthol smokers (AOR = 0.98, 95% CI: 0.44 to 2.19; p = 0.9540); and Hispanic menthol and non-menthol smokers (AOR = 0.88, 95% CI: 0.60 to 1.28; p = 0.4980. Fair
 Winhusen et al., 2013 [71] Randomized trial of U.S. substance use outpatient treatment program participants receiving smoking cessation treatment; Feb 2010-July 2012 No difference in effect for smoking cessation (as measured by 7-day PPA at week 10) between menthol and non-menthol cigarette type among either the cocaine-dependent (p = 0.81) or methamphetamine-dependent (p = 0.9) participants. Fair
 D’Silva et al., 2012 [30] ClearWay Minnesota phone line;
September 2009 – July 2011, 7-month post-registration follow-up survey March 2010–February 2011
No difference between menthol and non-menthol smokers in the odds of quitting (as assessed by 30-day PPA (AOR = 1.29, 95% CI: 0.77 to 2.15). Fair
 Nonnemaker et al., 2012 [50] ALLTURS;
U.S. school-based survey of middle and high school youth; 2000–2002
No difference between those who initiated smoking with menthol and non-menthol in quit rates (AOR = 1.18, 95% CI: 0.78 to 1.80; ref. = NM). Good
 Reitzel, 2011a [56] Project BREAK FREE; Houston metro area; 2005–2007 No difference between menthol and non-menthol cigarette use in predicting prolonged abstinence from smoking among Black smokers in adjusted analyses (β = .33, SE = .32; χ2 = 1.06; p = .30; n = 457). Fair
 Reitzel, 2011b [57] Project CARE;
Texas;
2005–2007
No difference between menthol and non-menthol cigarette use in predicting prolonged abstinence from smoking in adjusted analyses (β = 0.05, SE = 0.25; χ2 = 0.04; p = 0.84). Fair
 Steinberg et al., 2011 [66] Cessation study that enrolled 723 smokers age 16–78 No difference between menthol and non-menthol smokers in the odds of abstinence (7-day PPA) at 6 months after target quit date (AOR = 1.02, 95% CI: 0.66 to 1.58). Good
 Hyland et al., 2002 [40]; Hyland & Rivard, 2010 [41] COMMIT cessation trial; modified random-digit-dial method of approximately 5400 HHs with focus on communities with the highest prevalence of non-Whites;
1988–2001
No differences in quit rates between menthol and non-menthol smokers who were smoking from 1988 to 2001 and had not attempted to quit (AOR = 0.84, 95% CI: 0.61 to 1.15), who had attempted to quit (AOR = 1.03, 95% CI: 0.71 to 1.48), or among the corresponding White sub-samples (no quit attempts: AOR = 0.79, 95% CI: 0.56 to 1.11; quit attempts: AOR = 0.96, 95% CI: 0.65 to 1.41).
Also, no difference in quitting between menthol and non-menthol cigarette use in 1988 among: smokers in 1993 (AOR = 1.00, 95% CI: 0.90 to 1.11); White smokers (AOR = 0.94, 95% CI: 0.83 to 1.05); Black smokers (AOR = 1.04, 95% CI: 0.73 to 1.47); and Hispanic smokers (AOR = 1.22, 95% CI: 0.80 to 1.87).
Good
 Cropsey et al., 2009 [28] Female prison sample;
June 2004–June 2006
No differences between menthol and non-menthol smokers in smoking cessation (as evaluated by 7-day PPA (Wald chi-square = 1.2; p = 0.272; and with interaction of race X menthol: Wald chi-square = 0.1; p = 0.27). Fair
 Fu et al., 2008 [36] VA medical center sample;
February–October 2002
No difference between menthol and non-menthol smokers in smoking abstinence (as assessed by self-reported 7-day PPA (AOR = 1.31, 95% CI: 0.95 to 1.82). Good
 Okuyemi et al., 2007 [52] KIS trial; cessation program of an inner-city health center mostly serving a low-income Black population;
March 2003–June 2004
No difference was found for 7-day PPA at week 26 (p = 0.93) between categorized age (<  50 versus ≥50 years) and menthol status. Further, among the < 50 years of age group, no difference between menthol and non-menthol smokers in cessation rates (AOR = 2.077, 95% CI: 0.944 to 4.569; p = 0.069). Likewise, among those ≥50 years, no difference between menthol and non-menthol cigarette use in abstinence (AOR = 1.676; 95% C1: 0.760 to 3.698; p = 0.221). Good
 Foulds et al., 2006 [35] Convenience sample of patients attempting to quit at a specialist tobacco dependence treatment outpatient clinic; 2001–2006 At the four-week follow up, was no difference between menthol and non-menthol smokers in 7-day PPA (AOR = 1.36, 95% CI: 1.0 to 1.86). Good
 Pletcher et al., 2006 [54] CARDIA;
men and women in the U.S. age 18–30 at baseline with follow-up data through year 19; 1985–2000
No different between menthol and non-menthol smokers in quit rate (i.e., not currently smoking at any examination (AOR = 0.90, 95% CI: 0.68 to 1.19). There was also no difference in quitting between menthol and non-menthol smokers who tried to quit (AOR = 1.00, 95% CI: 0.71 to 1.42). In longitudinal analyses, no difference between menthol and non-menthol smokers in sustained smoking cessation (AOR = 0.71, 95% CI: 0.49 to 1.02; p = 0.06). Good
 Muscat et al., 2002 [49] Newly diagnosed, non-surgical cancer patients; 1981–1999 In adjusted analyses, no difference was found between menthol and non-menthol cigarette use in continued smoking among Black participants (POR = 1.1, 95% CI: 0.8 to 1.4) and White participants (POR = 1.1, 95% CI: 1.0 to 1.3). Fair
 Schneller et al., 2020 [63]; Schneller, 2020 [64] PATH;
12 September 2013 to 14 December 2014 (Wave 1), 23 October 2014 to 30 October 2015 (Wave 2)
No significant difference in the adjusted odds of menthol users reporting successful cessation at Wave 2 compared to non-menthol users, when adjusting for gender, age, race/ethnicity, education, and HSI (AOR = 1.09, 95% CI: 0.88–1.37, p = NS). In a similar model—replacing HSI (above) with CPD—the results were almost identically non-significant (RRR = 1.09, 95% CI: 0.87–1.35, p = NS) Fair
Results of Mixed Significance in Rate of Abstinence/Quitting
 Sulsky et al., 2014 [67] NHIS;
2005,2010;
TUS-CPS;
2010/2011
Decrease with Menthol Cigarette Use
According to the TUS-CPS data, menthol cigarette use among Black regular and daily smokers was significantly lower for the adjusted odds of abstinence for 1–3 years (regular smokers: AOR = 0.87, 95% CI: 0.80 to 0.95; daily smokers: AOR = 0.89, 95% CI: 0.81 to 0.98).
No Difference
According to the NHIS data, among White participants, there was no difference between menthol regular and daily smokers in the adjusted odds of past-year abstinence (regular smokers: AOR = 1.06, 95% CI: 0.95 to 1.18; daily smokers: AOR = 1.04, 95% CI: 0.82 to 1.33).
No difference between White menthol and non-menthol regular and daily smokers in the adjusted odds of abstinence for 1–3 years (regular smokers: AOR = 0.97, 95% CI: 0.94 to 1.00; daily smokers: AOR = 0.98, 95% CI: 0.95 to 1.01).
For participants whose race/ethnicity was other than White or Black, no difference for abstinence for 1–3 years between menthol and non-menthol smokers (regular smokers: AOR = 0.99, 95% CI: 0.91 to 1.08; daily smokers: AOR = 1.00, 95% CI: 0.92 to 1.09).
Good
 Reitzel et al., 2013 [60] Texas;
lung cancer case-control study;
February 1996–July 2001
Decrease with Menthol Cigarette Use
Menthol cigarette use was significantly associated with a lower probability of short-term continuous smoking abstinence among White participants (β = − 1.56, SE = 0.79; χ2 = 3.96; p = 0.05). Racially stratified analyses also found a significant association of menthol cigarette use with 7-day PPA smoking abstinence through post-quit Week 3 among White participants (β = − 1.90, SE = 0.82; p = 0.02).
No difference
No significant effect of menthol cigarette use status on continuous short-term smoking abstinence (β = − 0.31, SE = 0.40; χ2 = 0.60; p = 0.44).
Moreover, no difference between Black menthol, versus non-menthol, smokers for short-term continuous smoking abstinence (β = 0.54, SE = 0.55; χ2 = 0.95; p = 0.33); even after racially stratifying analyses, no difference between Black menthol and non-menthol smokers according to 7-day PPA (β = 1.00, SE = 0.67; p = 0.11).
Fair
 Blot et al., 2011 [27] 40–79 year olds living in southern U.S. states;
March 2002 – September 2009
Increase with Menthol Cigarette Use
Adjusting for age and other covariates, White menthol, versus non-menthol, cigarette smokers were more likely to have quit smoking prior to study enrollment (AOR = 1.55, 95% CI: 1.41 to 1.70).
No difference
No difference between Black menthol and non-menthol cigarette smokers in the likelihood of quitting smoking prior to study enrollment (AOR = 1.03, 95% CI: 0.96 to 1.11).
Fair
 Delnevo et al., 2010;
Delnevo et al., 2011
[31, 32]
TUS-CPS, 2003,2006/2007 Adjusted odds of being a former smoker (menthol versus non-menthol) was measured across five sample restrictions: cigarette smokers and former smokers who quit in the past 5 years (restriction 1); cigarette smokers and former smokers who quit in the past 5 years who do not currently use other tobacco products (restriction 2); cigarette smokers and former smokers who quit in the past 5 years who have made a quit attempt (restriction 3); cigarette smokers and former smokers who quit in the past 5 years who have made a quit attempt and do not currently use other tobacco products (restriction 4); and past-year smokers (restriction 5, also adjusting for past-year cigarette tax increase).
Decrease with Menthol Cigarette Use
The odds of being a former smoker were significantly lower among menthol, versus non-menthol, smokers in the overall sample with the least restrictions (restriction 1; AOR = 0.91, 95% CI: 0.87 to 0.96). The same significant difference was consistently found across restrictions 2, 3, and 4 with AORs ranging from 0.90 to 0.92.
Black menthol smokers were significantly less likely to be former smokers with restriction 1 (AOR = 0.81, 95% CI: 0.67, 0.98) and across all four additional sample restrictions with the range of AORs from 0.68 to 0.81.
White menthol smokers had significantly lower odds of being a former smoker (AOR = 0.93, 95% CI: 0.88, 0.98) across three of the five sample restrictions (1, 2 and 3).
Puerto Rican menthol smokers were consistently and significantly less likely to be former smokers across all five sample restrictions, with AORs ranging from 0.42 to 0.63.
Increase with Menthol Cigarette Use
Two of the five sample restrictions (2 and 4) reported significantly higher odds of being a former smoker among Mexican menthol, versus non-menthol, smokers with AORs of 1.34 and 1.35, respectively.
No difference
No difference between menthol and non-menthol smokers was found in the adjusted odds of being a former smoker for the overall sample (AOR =0.922, 95% CI: 0.847 to 1.004).
Also, no difference between White menthol and non-menthol smokers in the odds of being a former smoker (restrictions 4 and 5); likewise, no difference between Hispanic menthol and non-menthol smokers (restrictions 1 to 4); and, no difference between Mexican menthol and non-menthol smokers (restrictions 1, 3, and 5).
Good
 Reitzel, 2011c;
Reitzel et al., 2011
[58, 59]
Project MOM;
2005–2007
Decrease with Menthol Cigarette Use
Adjusting for age, partner status, income, and educational achievement, time, treatment group, CPD, and time to the first cigarette of the day, White female menthol, versus non-menthol, cigarette smokers were significantly less likely to maintain continuous abstinence (β = − 1.62, SE = 0.76; χ2 = 4.49; p = 0.03; AOR = 0.19, 95% CI: 0.04 to 0.89).
No Difference
Across the entire sample, no difference between menthol and non-menthol use in continuous abstinence from smoking through 26 weeks postpartum (β = − 0.32, SE = 0.30; p = 0.29; n = 297).
No difference between Black female menthol and non-menthol smokers in continuous abstinence (β = − 1.12, SE = .64; c2 = 3.06; p = .08; n = 96); likewise, no difference between Latina female menthol and non-menthol smokers in continuous abstinence (β = .46, SE = .50; c2 = .86; p = .35; n = 93).
Good
 Trinidad et al., 2010 [69] TUS-CPS;
2003, 2006–2007
Descrease with Menthol Cigarette Use
The odds of successful quiting for ≥6 months among former smokers was significantly less likely in menthol, versus non-menthol, smokers, across all race/ethnicity subgroups evaluated: White smokers (AOR = 0.28, 95% CI: 0.25 to 0.33); Black smokers (AOR = 0.23, 95% CI: 0.17 to 0.31); Asian-American/Pacific Islander smokers (AOR = 0.22, 95% CI: 0.11 to 0.45); and Hispanic/Latino smokers (AOR = 0.48, 95% CI: 0.34 to 0.69).
No Difference
No difference between Native American/Alaskan Native former menthol and non-menthol smokers in the odds of successful quiting for ≥6 months (AOR = 0.49, 95% CI: 0.14 to 1.71).
Good
 Gandhi et al., 2009 [37] Outpatient tobacco treatment clinic patients;
January 2001–June 2005
Decrease with Menthol Cigarette Use
The odds of Black menthol, versus non-menthol, smokers’ abstinence were significantly lower at 4 weeks (measured by 7-day PPA (AOR = 0.32, 95% CI: 0.16 to 0.62) and at 6 months post-quit (AOR = 0.48, 95% CI: 0.25 to 0.90).
Hispanic menthol, versus non-menthol, smokers’ odds of abstinence at 4 weeks post-quit were also significantly lower (AOR = 0.43, 95% CI: 0.1 to 0.9).
No Difference
No difference between White menthol and non-menthol smokers in the likelihood of abstinence at 4 weeks (AOR = 0.96, 95% CI: 0.72 to 1.20) or 6 months post-quit (AOR = 1.0, 95% CI: 0.8 to 1.4). Also, no difference between Hispanic menthol and non-menthol smokers in the odds of abstinence at 6 months (AOR = 0.64, 95% CI: 0.2 to 1.80).
Fair
 Gundersen et al., 2009 [39] NHIS-CCS; 2005 Decrease with Menthol Cigarette Use
Subgroup analysis found that Hispanic menthol, versus non-menthol, smokers were significantly less likely to have quit smoking (AOR = 0.61, 95% CI: 0.39 to 0.97; p = 0.04).
When Black and Hispanic smokers were combined (defining a “non-White” subsample), non-White menthol, versus non-menthol, smokers were significantly less likely to have quit smoking (AOR = 0.55, 95% CI: 0.43 to 0.71; p < 0.01).
Increase with Menthol
Subgroup analysis found that White menthol, versus non-menthol, smokers were significantly more likely to have quit smoking (AOR = 1.17, 95% CI: 1.00 to 1.36; p < 0.05).
No difference
Without stratifying for race/ethnicity, no difference between menthol and non-menthol smokers in smoking cessation (AOR = 1.05, 95% CI: 0.92 to 1.21).
Subgroup analysis: no difference between Black menthol and non-menthol smokers in the odds of smoking cessation (AOR = 0.78, 95% CI: 0.56 to 1.09).
Good
 Okuyemi et al., 2003 [51] KIS trial; August 2000–November 2000. Decrease with Menthol Cigarette Use
Although biochemically verified 7-day PPA abstinence was measured at both 6 weeks and 6 months, authors only modeled for 6 weeks “because univariate analysis did not reveal significant differences in abstinence rates between menthol and non-menthol smokers at 6 months.” In addition, overall modeled results were not presented.
Among adults < 50 years of age, non-menthol, versus menthol, smokers had significantly higher odds of quitting (AOR = 2.02, 95% CI: 1.03 to 3.95).
No Difference
No difference between menthol and non-menthol smokers > 50 years of age in abstinence rates (p = 0.57).
Good
  1. a Details of sampling and recruitment strategies for the data sources can be found in Table 3: Study, Data Set, and Sample Characteristics