Brief Report
Menthol Cigarette Smoking among Lesbian, Gay, Bisexual, and Transgender Adults

https://doi.org/10.1016/j.amepre.2014.07.044Get rights and content

Background

Menthol can mask the harshness and taste of tobacco, making menthol cigarettes easier to use and increasing their appeal among vulnerable populations. The tobacco industry has targeted youth, women, and racial minorities with menthol cigarettes, and these groups smoke menthol cigarettes at higher rates. The tobacco industry has also targeted the lesbian, gay, bisexual, and transgender (LGBT) communities with tobacco product marketing.

Purpose

To assess current menthol cigarette smoking by sexual orientation among a nationally representative sample of U.S. adults.

Methods

Data were obtained from the 2009–2010 National Adult Tobacco Survey, a national landline and cellular telephone survey of non-institutionalized U.S. adults aged ≥18 years, to compare current menthol cigarette smoking between LGBT (n=2,431) and heterosexual/straight (n=110,841) adults. Data were analyzed during January–April 2014 using descriptive statistics and logistic regression adjusted for sex, age, race, and educational attainment.

Results

Among all current cigarette smokers, 29.6% reported usually smoking menthol cigarettes in the past 30 days. Menthol use was significantly higher among LGBT smokers, with 36.3% reporting that the cigarettes they usually smoked were menthol compared to 29.3% of heterosexual/straight smokers (p<0.05); this difference was particularly prominent among LGBT females (42.9%) compared to heterosexual/straight women (32.4%) (p<0.05). Following adjustment, LGBT smokers had greater odds of usually smoking menthol cigarettes than heterosexual/straight smokers (OR=1.31, 95% CI=1.09, 1.57).

Conclusions

These findings suggest that efforts to reduce menthol cigarette use may have the potential to reduce tobacco use and tobacco-related disease and death among LGBT adults.

Introduction

In 2009, certain characterizing flavors in cigarettes were prohibited in the U.S.; however, menthol-flavored cigarettes can still be legally manufactured and sold.1 Menthol is a mint-flavored additive with analgesic and cooling effects that can mask the harshness and taste of tobacco, making these products easier to use and increasing their appeal among youth and other vulnerable populations.2, 3, 4 Additionally, menthol has a synergistic effect with nicotine.5

The tobacco industry has targeted youth, women, and minorities with menthol cigarettes,2, 6 and studies indicate that these groups smoke menthol cigarettes at higher rates.2, 7, 8 Little is known about whether another vulnerable group, lesbian, gay, bisexual, and transgender (LGBT) individuals, smoke menthol at higher rates than their heterosexual/straight counterparts. The LGBT community is important to consider because LGBT individuals smoke at a higher rate than the general population,9, 10 and the tobacco industry has selectively targeted the LGBT community with tobacco product marketing.11, 12 The tobacco industry’s strategy to target the LGBT community was first uncovered through the discovery of internal industry documents pertaining to “Project Subculture Urban Marketing (SCUM).”12 The tobacco industry has continued to infiltrate LGBT communities by funding AIDS and LGBT organizations, and sponsoring LGBT pride parades, street fairs, and film festivals.13

During 2009–2010, current cigarette smoking was considerably higher among U.S. LGBT adults (32.8%) than the general adult population (19.5%).9 Although one study of U.S. adults aged 18–34 years found comparable odds of menthol cigarette smoking between LGBT and heterosexual respondents,14 the extent of menthol cigarette smoking among all U.S. LGBT adults is uncertain. To address this research gap, this study assessed current menthol cigarette smoking by sexual orientation among a nationally representative sample of adults using the 2009–2010 National Adult Tobacco Survey (NATS).

Section snippets

Sample

The 2009–2010 NATS is a stratified, national landline and cellular telephone survey of non-institutionalized adults aged ≥18 years residing in the 50 U.S. states and District of Columbia.9 The sample was designed to yield nationally representative data. Respondent selection varied by phone type. For landline numbers, one adult was randomly selected from each eligible household. For cellular numbers, adults were selected if a cellular phone was the only method they could be reached by telephone

Results

Among all respondents, current menthol cigarette smoking was higher among LGBT adults (9.7%) than heterosexual/straight adults (4.2%) (Table 1, p<0.05). Among current cigarette smokers, menthol cigarette smoking was higher among LGBT smokers (36.3%) than heterosexual/straight (29.3%) smokers. This difference was particularly notable among women (LGBT=42.9%, heterosexual/straight=32.4%, p<0.05); Hispanics (LGBT=57.6%, heterosexual/straight=36.0%, p<0.05); individuals of non-Hispanic other races

Discussion

The findings from this study reveal that LGBT smokers have higher odds of using menthol cigarettes than heterosexual/straight smokers, which is consistent with previous evidence showing that the tobacco industry has selectively marketed tobacco products to LGBT individuals.11, 12 Younger people, women, and racial/ethnic minorities also have higher prevalence of menthol cigarette smoking, which is consistent with previous surveys.15 For example, during 2004–2008, 44.8% of U.S. current cigarette

Acknowledgments

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of CDC.

No financial disclosures were reported by the authors of this paper.

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