Harm Perceptions of Menthol and Nonmenthol Cigarettes Differ by Brand, Race/Ethnicity, and Gender in US Adult Smokers: Results from PATH Wave 1

Harm Perceptions of Menthol and Nonmenthol Cigarettes Differ by Brand, Race/Ethnicity, and Gender... Abstract Introduction Harm perceptions of menthol cigarettes may contribute to their appeal and use. African-Americans, women, and younger smokers disproportionately use menthol cigarettes, and may misperceive harm of menthol cigarettes. Methods Data were from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses of current adult smokers (18 and older) were used to estimate the correlates of menthol smoking among all cigarette brands and separately for the top three cigarette brands (Newport, Camel, and Marlboro). Adjusted models examined the main effect of menthol smoking on harm perceptions of one’s own brand of cigarette and interactions with race/ethnicity, age, and gender. Results Menthol cigarettes were used by nearly 40% of current smokers, although the prevalence of menthol smoking differed across the top three brands (94% Newport, 46% Camel, and 18% Marlboro). Among menthol smokers, 80% perceived their cigarette as equally harmful, 14% perceived their brand as more harmful, and 7% perceived their brand as less harmful. In adjusted models, menthol smokers were more likely than nonmenthol smokers to misperceive their own brand as more harmful than other brands (compared to no difference in harm). Race and gender emerged as moderators of the association between menthol brand preference and harm perceptions. Conclusions In adjusted analyses, menthol smokers were more likely than nonmenthol smokers to perceive their brand as more harmful than other brands, with differences by sub-groups who disproportionately use menthol. Implications Menthol cigarettes have been historically marketed with messages conveying lower harm than other cigarettes. Little is known about how contemporary adult menthol smokers perceive the harm of their usual brand, and potential differences by race, gender, and young adult versus older adult age group. After adjusting for other factors, menthol smokers were more likely than nonmenthol smokers to perceive their cigarette brand as more harmful than other brands. Further, the association between menthol smoking and harm perceptions differed by race and gender, but not by age group (young adult vs. older adult). This type of large-scale study identifies critical links between menthol smoking and harm perceptions among vulnerable smokers that will inform regulatory actions designed to decrease smoking-related harm. Introduction The Family Smoking Prevention and Tobacco Control Act banned characterizing flavors in cigarettes in the United States in 2009, but did not ban menthol. Its minty and cooling sensation has been hypothesized to mask the harshness of inhaled smoke, contributing to the perception that menthol cigarettes are less harmful and less addictive than nonmenthol cigarettes. Menthol smokers have higher nicotine dependence and greater difficulty quitting, even though they smoke fewer cigarettes per day1–11 and show greater relapse rates.10,11 Perceptions that menthol cigarettes are less harmful than nonmenthol cigarettes may be one reason behind their appeal and use.12 Menthol cigarettes have been historically marketed in such a way to lead consumers to perceive that they are “healthier” than nonmenthol cigarettes,13 through messages promoting “medicinal” and throat soothing properties and health-enhancing effects.13,14 These messages have been primarily targeted toward African-American and Hispanic audiences,15–18 females,19 and young users, all groups who disproportionately use menthol.7,8,18,20–26 The link between harm perceptions and menthol smoking is concerning, given that perception of tobacco-related risk is an important correlate and predictor of tobacco use behavior,12 particularly among younger users.27–29 Published research does not consistently show that menthol cigarettes are perceived as less harmful than nonmenthol cigarettes,30–32 and some studies suggest that harm perceptions of menthol cigarette may vary by age as well as race/ethnicity. In a paper from the International Tobacco Control (ITC) US Survey published in 2011, there was no significant effect of menthol brand on cigarette harm perceptions,33 and findings from a 2012 study also published from the ITC survey similarly showed that menthol smoking was unrelated to smokers’ perceptions of their own brand’s “smoothness,”34 a proposed mechanism linking menthol smoking to lower harm perceptions. In a study of young adult smokers, Richter35 found that African-Americans believed menthol cigarettes were either equally or more harmful than nonmenthol cigarettes, but did not perceive them to be less harmful than nonmenthol cigarettes. Two recently published studies by Wackowski and colleagues of young adult tobacco users and nonusers in the National Young Adult Health Survey and in adults from the New Jersey Adult Tobacco Survey also show that menthol smoking is perceived as more risky than nonmenthol smoking and that few menthol smokers perceive menthol cigarettes to be less risky compared to nonmenthol cigarettes.31,32 In contrast, Allen and colleagues found that age and race may play a role in perceptions of menthol’s harm. They found that older African-American smokers (aged 40 or older) were more likely than younger African-American smokers to perceive menthol cigarettes as less harmful than nonmenthol cigarettes and to hold positive health expectancies of menthol cigarettes (eg, “Menthols help loosen a stuffed up nose better than non-menthols”).36 Furthermore, a recent focus group study with young adult menthol smokers, also conducted by Wackowski and colleagues, showed that most smokers in their study perceived menthol to be less harmful than nonmenthol cigarettes upon smoking initiation, but perceived menthol as more harmful once their smoking progressed.30 Beyond harm perception, cigarette brand may also have an impact on smokers’ use of menthol cigarettes.12,19 Recent changes in menthol cigarette market share show a significant increase in Camel menthol market share, from 5.8% in 2002 to 32.7% in 2013, as well as smaller but significant increases in Marlboro menthol market shares from 10% to 14.5%.37 In an analysis of menthol cigarette advertisements that included mail, print, online, and email over a 9-month period, Richardson and colleagues found that 90% of all types of advertisements promoted Camel, Marlboro, or Newport menthol cigarettes.19 Many of the print advertisements were in magazines with a primarily African-American or female readership. Differences in correlates of menthol use and menthol harm perceptions across cigarette brands may signal marketing and advertising strategies specific to each brand that focus on vulnerable groups, and which could be targeted by regulatory authorities. Although harm perceptions of menthol cigarette smoking have been investigated,7–9,38,39 a paucity of work has examined whether harm perceptions of menthol versus nonmenthol cigarette smoking vary by cigarette brand in adult menthol smokers, and whether harm perceptions differ among sub-groups of adult smokers who disproportionately use menthol cigarettes, namely younger, female, or African-American and Hispanic smokers. Using a population-based sample of current adult smokers in the United States, the first aim of this study was to examine the prevalence and correlates of menthol cigarette smoking among all cigarette brands and again separately across the top three cigarette brands to determine if menthol smokers are a homogeneous group or if there are brand-specific differences among users. Because menthol is disproportionately used by Black, young adult, and female smokers, the second aim was to examine whether the association between menthol smoking and harm perceptions of one’s own brand (if significant), would be moderated by age, race, and gender. That is, are there differences in the strength or direction of association between menthol brand preferences and harm perceptions of smoking by these different groups of menthol smokers? Methods Sample Data are from the Adult Wave 1 Public Use File of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of adults and youth in the United States, ages 12 years and older conducted from September 12, 2013 to December 15, 2014. This analysis draws from the 32320 adults (≥18 years old) interviews. Recruitment involved address-based, area-probability sampling, using an in-person household screener to select participants. Adult tobacco users, young adults ages 18 to 24, and African-Americans were oversampled. Weighting procedures adjusted for oversampling and nonresponse; combined with the use of a probability sample, the weighted data yield representative estimates of the noninstitutionalized, civilian US population in 2012–2013. The weighted response rate for the household screener was 54.0%. Among households that were screened, the overall weighted response rate was 74.0% for the adult interview. Further details regarding the design and methods are available elsewhere.40 Respondents included in the current study were current adult smokers, defined as those who consumed at least 100 cigarettes in their lifetime and who reported currently smoking “some days” or “every day.” For all study variables, responses of “don’t know” and “refused” were treated as missing. Measures Menthol Brand Preference: Respondents who reported having a regular brand of cigarettes were asked to report what brand and sub-brand of cigarettes they usually smoke by selecting from images of cigarette brand logos or “some other brand;” those without a regular brand were asked what brand they last smoked. Based on the brand selected, smokers were then asked what specific sub-brand they smoked (eg, Marlboro Gold nonmenthol 100s). Sub-brands were classified into either menthol or nonmenthol products. Capsule cigarette products, like Camel Crush, that can be both menthol or nonmenthol were classified as “menthol” products. Sub-brand names include the term menthol or nonmenthol. Harm perceptions: Participants were asked about the harm of their usual brand of cigarette compared to other brands: “Do you think the brand of cigarettes you usually smoke might be less harmful, no different, or more harmful compared to other cigarette brands?” Tobacco Use: Participants who reported smoking “everyday” were asked on average, how many cigarettes they smoked each day, and those who reported smoking “some days” were asked on average, how many cigarettes they smoked on the days that they smoked. Number of quit attempts in the past year, and nicotine dependence, as measured by time-to-first cigarette upon waking (<5 min, 5–29 min, >30 min) were also assessed. Those who had not tried to quit in the last year were classified as making zero quit attempts. Demographics: Demographic variables used in analyses included gender, age (18–24; 25–34, 35–44, 45+), race (nonHispanic White, nonHispanic African-American, nonHispanic Other, Hispanic), income (<$10000; $10000–$24999; $25000–$49999; ≥$50000), and education (<high school, high school/GED, some college, college, or higher). Statistical Analyses Prevalence estimates of demographics, tobacco use variables, and harm perception ratings were assessed across menthol and nonmenthol smokers via weighted cross-tabulations, conducted among all cigarette brands and separately across the three most popular brands of cigarettes assessed in the Wave 1 survey. Crude and adjusted odds ratios were then computed via bivariate weighted logistic regressions to examine demographic, tobacco use, and harm perception correlates of menthol smoking status among all cigarette brands and separately across the top three brands. Finally, multinomial logistic regression models were conducted to examine the association of menthol smoking status (independent variable) on harm perceptions of one’s own brand of cigarettes (more harmful vs. no difference and less harmful vs. no difference), among all cigarette brands, and separately across the top three cigarette brands, controlling for demographic and tobacco use correlates. Multinomial regression models used the relative risk ratios because meaningful prevalence estimates were available.41 Because evidence is equivocal regarding the direction of association between menthol smoking and harm perceptions, we examined the extent to which menthol smokers perceived their brand as more harmful (vs. no difference) and less harmful (vs. no difference) compared to other cigarette brands. Interactions of menthol smoking with race, age, and gender were also examined across all brands only. Interactions were not examined separately across three most popular cigarette brands due to insufficient sample sizes in some cells. Analyses were conducted using SVY procedures in Stata/MP version 14.1 to account for the complex survey design. Results Prevalence and Correlates of Menthol Cigarette Smoking Among All Brands and Separately Across the Three Most Popular Cigarette Brands Table 1 shows the prevalence of menthol and nonmenthol smoking among current smokers by all brands and across the three most popular cigarette brands (Newport, Camel, and Marlboro). Overall, 40% of the sample identified that their usual brand of cigarette was a menthol variety. Across all brands, a greater percentage of menthol smokers compared to nonmenthol smokers were younger, female, African-American or Hispanic, reported lower income, and were less likely to have a bachelor’s degree or higher. Overall, menthol smokers reported lower cigarettes per day (CPD), had attempted to quit smoking more times in the past year than nonmenthol smokers, and were more nicotine dependent (ie, smoking within 5 min of waking). Table 1. Demographic and Tobacco Use Characteristics of Menthol Smokers Across the Top Three Cigarette Brands (Newport, Marlboro, and Camel) and Among All Cigarette Brands Total   Newport (1738)  Marlboro (4227)  Camel (1201)  All brands (10238)  Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   94.2% (1640)   5.8% (98)   17.7% (803)   82.3% (3424)   45.5% (592)   54.5% (609)   38.8% (4190)   61.2% (6048)   Age   18–24  19.1% (488)  14.8% (25)  25.8% (289)  15.1% (779)  36.1%% (284)  19.2% (166)  19.1% (1208)  12.6% (1168)   25–34  32.8% (478)  39.8% (33)  38.8% (262)  23.8% (760)  39.7% (198)  35.2% (193)  30.6% (1159)  22.2% (1264)   35–44  30.0% (304)  18.1% (16)  15.5% (116)  23.4% (752)  16.5% (68)  19.6% (105)  17.5% (655)  20.7% (1191)   45+  27.2% (370)  27.3% (24)  20.0% (136)  37.7% (1133)  7.7% (42)  26.1% (145)  32.8% (1168)  44.6% (2424)  Gender   Female  45.7% (808)  35.2% (40)  47.7% (426)  40.2% (1456)  47.1% (297)  33.7% (222)  48.8% (2187)  42.5% (2702)   Male  54.3% (832)  64.8% (58)  50.3% (377)  59.8% (1968)  52.9% (295)  66.3% (387)  51.2% (2003)  57.6% (3346)  Race/Ethnicity   NH White  25.3% (392)  78.4% (72)  76.9% (595)  77.4% (2549)  66.1% (372)  84.5% (498)  49.4% (1982)  80.8% (4710)   NH Black  53.5% (856)  9.3% (9)  4.4% (35)  2.0% (63)  3.6% (20)  2.3% (14)  31.1% (1260)  2.9% (166)   NH other  4.6% (114)  6.6% (11)  6.3% (61)  7.5% (273)  8.7% (56)  5.2% (43)  5.6% (304)  6.3% (448)   Hispanic  16.7% (278)  5.7% (6)  12.4% (112)  13.1% (539)  21.5% (144)  8.0% 54)  14.0% (644)  10.0% (724)  Income   <$10000  32.3% (536)  24.3% (26)  16.7% (138)  17.4% (609)  20.4% (120)  15.2% (105)  25.0% (1006)  17.6% (1074)   $10000–$24999  30.8% (468)  29.8% (27)  24.1% (196)  23.3% (762)  26.2% (160)  24.8% (147)  29.1% (1160)  25.6% (1460)   $25000–$49999  20.9% (304)  36.2% (32)  26.7% (189)  25.7% (796)  29.9% (146)  26.9% (159)  24.4% (916)  26.9% (1442)   $50000+  16.0% (213)  9.7% (8)  32.5% (214)  33.7% (967)  23.6% (120)  33.1% (176)  21.6% (756)  29.9% (1532)  Education   <High School  19.1% (329)  18.5% (22)  10.2% (90)  14.7% (539)  9.4% (62)  11.7% (76)  15.4% (679)  15.2% (964)   HS/GED  43.2% (658)  48.0% (40)  35.5% (280)  39.4% (1276)  30.6% (192)  30.2% (166)  40.1% (1591)  38.5% 2157)   Some college  32.8% (569)  28.2% (30)  43.4% (345)  32.9% (1174)  44.7% (259)  40.3% (265)  35.8% (1544)  33.2% (2127)   Bachelor’s degree or higher  4.9% (74)  5.4% (5)  11.0% (83)  13.0% (406)  15.3% (78)  17.8% (98)  8.7% (347)  13.2% (746)  Cigarettes per day   weighted mean  (standard error)  8.7 (0.2)  11.8 (0.9)  9.6 (0.3)  10.4 (0.2)  8.0 (0.4)  8.6 (0.3)  9.3 (0.2)  10.6 (0.1)  Nicotine dependence   High (<5 min)  57.9% (936)  56.7% (55)  53.5% (433)  52.0% (1793)  54.0% (325)  48.5% (302)  54.9% (2294)  50.7% (3102)   Moderate (5–29 min)  27.5% (464)  30.2% (30)  30.1% (239)  30.9% (1058)  32.1% (189)  35.1% (211)  29.0% (1236)  32.3% (1935)   Low (>30 min)  14.7% (240)  13.2% (13)  16.4% (131)  17.1% (573)  14.0% (78)  16.4% (96)  16.1% (660)  17.0% (1011)  Number of times tried to quit in the past year   weighted mean  (standard error)  2.2 (0.3)  1.2 (0.2)  1.9 (0.3)  2.2 (0.5)  1.5 (0.1)  1.7 (0.8)  4.4 (1.6)  1.9 (0.3)  Harm perceptions of your brand compared to other brands   No difference  74.7% (1218)  90.4% (89)  86.0% (686)  85.8% (2927)  85.1% (501)  88.0% (534)  79.8% (3330)  83.9% (5056)   Less harmful  3.6% (60)  3.3% (3)  5.2% (39)  8.2% (269)  3.8% (20)  6.5% (38)  6.6% (256)  11.2% (652)   More harmful  21.6% (356)  6.3% (6)  8.8% (77)  6.0% (211)  11.1% (69)  5.5% (33)  13.6% (585)  4.9% (306)  Total   Newport (1738)  Marlboro (4227)  Camel (1201)  All brands (10238)  Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   94.2% (1640)   5.8% (98)   17.7% (803)   82.3% (3424)   45.5% (592)   54.5% (609)   38.8% (4190)   61.2% (6048)   Age   18–24  19.1% (488)  14.8% (25)  25.8% (289)  15.1% (779)  36.1%% (284)  19.2% (166)  19.1% (1208)  12.6% (1168)   25–34  32.8% (478)  39.8% (33)  38.8% (262)  23.8% (760)  39.7% (198)  35.2% (193)  30.6% (1159)  22.2% (1264)   35–44  30.0% (304)  18.1% (16)  15.5% (116)  23.4% (752)  16.5% (68)  19.6% (105)  17.5% (655)  20.7% (1191)   45+  27.2% (370)  27.3% (24)  20.0% (136)  37.7% (1133)  7.7% (42)  26.1% (145)  32.8% (1168)  44.6% (2424)  Gender   Female  45.7% (808)  35.2% (40)  47.7% (426)  40.2% (1456)  47.1% (297)  33.7% (222)  48.8% (2187)  42.5% (2702)   Male  54.3% (832)  64.8% (58)  50.3% (377)  59.8% (1968)  52.9% (295)  66.3% (387)  51.2% (2003)  57.6% (3346)  Race/Ethnicity   NH White  25.3% (392)  78.4% (72)  76.9% (595)  77.4% (2549)  66.1% (372)  84.5% (498)  49.4% (1982)  80.8% (4710)   NH Black  53.5% (856)  9.3% (9)  4.4% (35)  2.0% (63)  3.6% (20)  2.3% (14)  31.1% (1260)  2.9% (166)   NH other  4.6% (114)  6.6% (11)  6.3% (61)  7.5% (273)  8.7% (56)  5.2% (43)  5.6% (304)  6.3% (448)   Hispanic  16.7% (278)  5.7% (6)  12.4% (112)  13.1% (539)  21.5% (144)  8.0% 54)  14.0% (644)  10.0% (724)  Income   <$10000  32.3% (536)  24.3% (26)  16.7% (138)  17.4% (609)  20.4% (120)  15.2% (105)  25.0% (1006)  17.6% (1074)   $10000–$24999  30.8% (468)  29.8% (27)  24.1% (196)  23.3% (762)  26.2% (160)  24.8% (147)  29.1% (1160)  25.6% (1460)   $25000–$49999  20.9% (304)  36.2% (32)  26.7% (189)  25.7% (796)  29.9% (146)  26.9% (159)  24.4% (916)  26.9% (1442)   $50000+  16.0% (213)  9.7% (8)  32.5% (214)  33.7% (967)  23.6% (120)  33.1% (176)  21.6% (756)  29.9% (1532)  Education   <High School  19.1% (329)  18.5% (22)  10.2% (90)  14.7% (539)  9.4% (62)  11.7% (76)  15.4% (679)  15.2% (964)   HS/GED  43.2% (658)  48.0% (40)  35.5% (280)  39.4% (1276)  30.6% (192)  30.2% (166)  40.1% (1591)  38.5% 2157)   Some college  32.8% (569)  28.2% (30)  43.4% (345)  32.9% (1174)  44.7% (259)  40.3% (265)  35.8% (1544)  33.2% (2127)   Bachelor’s degree or higher  4.9% (74)  5.4% (5)  11.0% (83)  13.0% (406)  15.3% (78)  17.8% (98)  8.7% (347)  13.2% (746)  Cigarettes per day   weighted mean  (standard error)  8.7 (0.2)  11.8 (0.9)  9.6 (0.3)  10.4 (0.2)  8.0 (0.4)  8.6 (0.3)  9.3 (0.2)  10.6 (0.1)  Nicotine dependence   High (<5 min)  57.9% (936)  56.7% (55)  53.5% (433)  52.0% (1793)  54.0% (325)  48.5% (302)  54.9% (2294)  50.7% (3102)   Moderate (5–29 min)  27.5% (464)  30.2% (30)  30.1% (239)  30.9% (1058)  32.1% (189)  35.1% (211)  29.0% (1236)  32.3% (1935)   Low (>30 min)  14.7% (240)  13.2% (13)  16.4% (131)  17.1% (573)  14.0% (78)  16.4% (96)  16.1% (660)  17.0% (1011)  Number of times tried to quit in the past year   weighted mean  (standard error)  2.2 (0.3)  1.2 (0.2)  1.9 (0.3)  2.2 (0.5)  1.5 (0.1)  1.7 (0.8)  4.4 (1.6)  1.9 (0.3)  Harm perceptions of your brand compared to other brands   No difference  74.7% (1218)  90.4% (89)  86.0% (686)  85.8% (2927)  85.1% (501)  88.0% (534)  79.8% (3330)  83.9% (5056)   Less harmful  3.6% (60)  3.3% (3)  5.2% (39)  8.2% (269)  3.8% (20)  6.5% (38)  6.6% (256)  11.2% (652)   More harmful  21.6% (356)  6.3% (6)  8.8% (77)  6.0% (211)  11.1% (69)  5.5% (33)  13.6% (585)  4.9% (306)  PATH Wave 1 Data (weighted column %; unweighted n). Current smokers defined as those who consumed at least 100 cigarettes in their lifetime and who currently smoked “somedays” or “every day.” Camel Crush cigarettes coded as menthol. “Don’t know” and “refused” responses coded as missing. View Large Table 1. Demographic and Tobacco Use Characteristics of Menthol Smokers Across the Top Three Cigarette Brands (Newport, Marlboro, and Camel) and Among All Cigarette Brands Total   Newport (1738)  Marlboro (4227)  Camel (1201)  All brands (10238)  Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   94.2% (1640)   5.8% (98)   17.7% (803)   82.3% (3424)   45.5% (592)   54.5% (609)   38.8% (4190)   61.2% (6048)   Age   18–24  19.1% (488)  14.8% (25)  25.8% (289)  15.1% (779)  36.1%% (284)  19.2% (166)  19.1% (1208)  12.6% (1168)   25–34  32.8% (478)  39.8% (33)  38.8% (262)  23.8% (760)  39.7% (198)  35.2% (193)  30.6% (1159)  22.2% (1264)   35–44  30.0% (304)  18.1% (16)  15.5% (116)  23.4% (752)  16.5% (68)  19.6% (105)  17.5% (655)  20.7% (1191)   45+  27.2% (370)  27.3% (24)  20.0% (136)  37.7% (1133)  7.7% (42)  26.1% (145)  32.8% (1168)  44.6% (2424)  Gender   Female  45.7% (808)  35.2% (40)  47.7% (426)  40.2% (1456)  47.1% (297)  33.7% (222)  48.8% (2187)  42.5% (2702)   Male  54.3% (832)  64.8% (58)  50.3% (377)  59.8% (1968)  52.9% (295)  66.3% (387)  51.2% (2003)  57.6% (3346)  Race/Ethnicity   NH White  25.3% (392)  78.4% (72)  76.9% (595)  77.4% (2549)  66.1% (372)  84.5% (498)  49.4% (1982)  80.8% (4710)   NH Black  53.5% (856)  9.3% (9)  4.4% (35)  2.0% (63)  3.6% (20)  2.3% (14)  31.1% (1260)  2.9% (166)   NH other  4.6% (114)  6.6% (11)  6.3% (61)  7.5% (273)  8.7% (56)  5.2% (43)  5.6% (304)  6.3% (448)   Hispanic  16.7% (278)  5.7% (6)  12.4% (112)  13.1% (539)  21.5% (144)  8.0% 54)  14.0% (644)  10.0% (724)  Income   <$10000  32.3% (536)  24.3% (26)  16.7% (138)  17.4% (609)  20.4% (120)  15.2% (105)  25.0% (1006)  17.6% (1074)   $10000–$24999  30.8% (468)  29.8% (27)  24.1% (196)  23.3% (762)  26.2% (160)  24.8% (147)  29.1% (1160)  25.6% (1460)   $25000–$49999  20.9% (304)  36.2% (32)  26.7% (189)  25.7% (796)  29.9% (146)  26.9% (159)  24.4% (916)  26.9% (1442)   $50000+  16.0% (213)  9.7% (8)  32.5% (214)  33.7% (967)  23.6% (120)  33.1% (176)  21.6% (756)  29.9% (1532)  Education   <High School  19.1% (329)  18.5% (22)  10.2% (90)  14.7% (539)  9.4% (62)  11.7% (76)  15.4% (679)  15.2% (964)   HS/GED  43.2% (658)  48.0% (40)  35.5% (280)  39.4% (1276)  30.6% (192)  30.2% (166)  40.1% (1591)  38.5% 2157)   Some college  32.8% (569)  28.2% (30)  43.4% (345)  32.9% (1174)  44.7% (259)  40.3% (265)  35.8% (1544)  33.2% (2127)   Bachelor’s degree or higher  4.9% (74)  5.4% (5)  11.0% (83)  13.0% (406)  15.3% (78)  17.8% (98)  8.7% (347)  13.2% (746)  Cigarettes per day   weighted mean  (standard error)  8.7 (0.2)  11.8 (0.9)  9.6 (0.3)  10.4 (0.2)  8.0 (0.4)  8.6 (0.3)  9.3 (0.2)  10.6 (0.1)  Nicotine dependence   High (<5 min)  57.9% (936)  56.7% (55)  53.5% (433)  52.0% (1793)  54.0% (325)  48.5% (302)  54.9% (2294)  50.7% (3102)   Moderate (5–29 min)  27.5% (464)  30.2% (30)  30.1% (239)  30.9% (1058)  32.1% (189)  35.1% (211)  29.0% (1236)  32.3% (1935)   Low (>30 min)  14.7% (240)  13.2% (13)  16.4% (131)  17.1% (573)  14.0% (78)  16.4% (96)  16.1% (660)  17.0% (1011)  Number of times tried to quit in the past year   weighted mean  (standard error)  2.2 (0.3)  1.2 (0.2)  1.9 (0.3)  2.2 (0.5)  1.5 (0.1)  1.7 (0.8)  4.4 (1.6)  1.9 (0.3)  Harm perceptions of your brand compared to other brands   No difference  74.7% (1218)  90.4% (89)  86.0% (686)  85.8% (2927)  85.1% (501)  88.0% (534)  79.8% (3330)  83.9% (5056)   Less harmful  3.6% (60)  3.3% (3)  5.2% (39)  8.2% (269)  3.8% (20)  6.5% (38)  6.6% (256)  11.2% (652)   More harmful  21.6% (356)  6.3% (6)  8.8% (77)  6.0% (211)  11.1% (69)  5.5% (33)  13.6% (585)  4.9% (306)  Total   Newport (1738)  Marlboro (4227)  Camel (1201)  All brands (10238)  Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   94.2% (1640)   5.8% (98)   17.7% (803)   82.3% (3424)   45.5% (592)   54.5% (609)   38.8% (4190)   61.2% (6048)   Age   18–24  19.1% (488)  14.8% (25)  25.8% (289)  15.1% (779)  36.1%% (284)  19.2% (166)  19.1% (1208)  12.6% (1168)   25–34  32.8% (478)  39.8% (33)  38.8% (262)  23.8% (760)  39.7% (198)  35.2% (193)  30.6% (1159)  22.2% (1264)   35–44  30.0% (304)  18.1% (16)  15.5% (116)  23.4% (752)  16.5% (68)  19.6% (105)  17.5% (655)  20.7% (1191)   45+  27.2% (370)  27.3% (24)  20.0% (136)  37.7% (1133)  7.7% (42)  26.1% (145)  32.8% (1168)  44.6% (2424)  Gender   Female  45.7% (808)  35.2% (40)  47.7% (426)  40.2% (1456)  47.1% (297)  33.7% (222)  48.8% (2187)  42.5% (2702)   Male  54.3% (832)  64.8% (58)  50.3% (377)  59.8% (1968)  52.9% (295)  66.3% (387)  51.2% (2003)  57.6% (3346)  Race/Ethnicity   NH White  25.3% (392)  78.4% (72)  76.9% (595)  77.4% (2549)  66.1% (372)  84.5% (498)  49.4% (1982)  80.8% (4710)   NH Black  53.5% (856)  9.3% (9)  4.4% (35)  2.0% (63)  3.6% (20)  2.3% (14)  31.1% (1260)  2.9% (166)   NH other  4.6% (114)  6.6% (11)  6.3% (61)  7.5% (273)  8.7% (56)  5.2% (43)  5.6% (304)  6.3% (448)   Hispanic  16.7% (278)  5.7% (6)  12.4% (112)  13.1% (539)  21.5% (144)  8.0% 54)  14.0% (644)  10.0% (724)  Income   <$10000  32.3% (536)  24.3% (26)  16.7% (138)  17.4% (609)  20.4% (120)  15.2% (105)  25.0% (1006)  17.6% (1074)   $10000–$24999  30.8% (468)  29.8% (27)  24.1% (196)  23.3% (762)  26.2% (160)  24.8% (147)  29.1% (1160)  25.6% (1460)   $25000–$49999  20.9% (304)  36.2% (32)  26.7% (189)  25.7% (796)  29.9% (146)  26.9% (159)  24.4% (916)  26.9% (1442)   $50000+  16.0% (213)  9.7% (8)  32.5% (214)  33.7% (967)  23.6% (120)  33.1% (176)  21.6% (756)  29.9% (1532)  Education   <High School  19.1% (329)  18.5% (22)  10.2% (90)  14.7% (539)  9.4% (62)  11.7% (76)  15.4% (679)  15.2% (964)   HS/GED  43.2% (658)  48.0% (40)  35.5% (280)  39.4% (1276)  30.6% (192)  30.2% (166)  40.1% (1591)  38.5% 2157)   Some college  32.8% (569)  28.2% (30)  43.4% (345)  32.9% (1174)  44.7% (259)  40.3% (265)  35.8% (1544)  33.2% (2127)   Bachelor’s degree or higher  4.9% (74)  5.4% (5)  11.0% (83)  13.0% (406)  15.3% (78)  17.8% (98)  8.7% (347)  13.2% (746)  Cigarettes per day   weighted mean  (standard error)  8.7 (0.2)  11.8 (0.9)  9.6 (0.3)  10.4 (0.2)  8.0 (0.4)  8.6 (0.3)  9.3 (0.2)  10.6 (0.1)  Nicotine dependence   High (<5 min)  57.9% (936)  56.7% (55)  53.5% (433)  52.0% (1793)  54.0% (325)  48.5% (302)  54.9% (2294)  50.7% (3102)   Moderate (5–29 min)  27.5% (464)  30.2% (30)  30.1% (239)  30.9% (1058)  32.1% (189)  35.1% (211)  29.0% (1236)  32.3% (1935)   Low (>30 min)  14.7% (240)  13.2% (13)  16.4% (131)  17.1% (573)  14.0% (78)  16.4% (96)  16.1% (660)  17.0% (1011)  Number of times tried to quit in the past year   weighted mean  (standard error)  2.2 (0.3)  1.2 (0.2)  1.9 (0.3)  2.2 (0.5)  1.5 (0.1)  1.7 (0.8)  4.4 (1.6)  1.9 (0.3)  Harm perceptions of your brand compared to other brands   No difference  74.7% (1218)  90.4% (89)  86.0% (686)  85.8% (2927)  85.1% (501)  88.0% (534)  79.8% (3330)  83.9% (5056)   Less harmful  3.6% (60)  3.3% (3)  5.2% (39)  8.2% (269)  3.8% (20)  6.5% (38)  6.6% (256)  11.2% (652)   More harmful  21.6% (356)  6.3% (6)  8.8% (77)  6.0% (211)  11.1% (69)  5.5% (33)  13.6% (585)  4.9% (306)  PATH Wave 1 Data (weighted column %; unweighted n). Current smokers defined as those who consumed at least 100 cigarettes in their lifetime and who currently smoked “somedays” or “every day.” Camel Crush cigarettes coded as menthol. “Don’t know” and “refused” responses coded as missing. View Large Differences in the prevalence of menthol versus nonmenthol cigarette smoking emerged across the top three brands. The majority of Newport smokers identified a menthol variety as their usual cigarette type (94%), compared with 46% of Camel smokers who identified menthol as their usual variety, and 18% of Marlboro smokers. Camel smokers who used a menthol variety had a higher prevalence of users who were young adults (aged 18–24) compared to smokers of other brands who used a menthol variety (36% for Camel, 26% for Marlboro, and 19% for Newport). Newport smokers of a menthol variety were primarily African-American (53.5%), while Marlboro and Camel smokers of a menthol variety were primarily white (76.9% for Marlboro and 66.1% for Camel). Prevalence estimates of harm perceptions are also reported in Table 1. Across all brands, most menthol smokers (80%) perceived their brand to be equally as harmful as other brands (ie, no difference in harm), 14% of menthol smokers perceived their brand to be more harmful than other brands, and 7% of menthol smokers perceived their brand to be less harmful. Among nonmenthol smokers, 84% perceived their brand to be equally harmful as other brands, 5% perceived their brand to be more harmful, and 11% perceived their brand to be less harmful. Table 2 shows crude and adjusted odds ratios of correlates of menthol cigarette smoking across the top three brands and all cigarette brands from logistic regression models. Across all cigarette brands, menthol smoking was associated with younger age, female gender, nonWhite race/ethnicity, and lower education. Across the top three brands, female gender was the only correlate consistently associated with menthol cigarette smoking in adjusted models for Newport, Marlboro, and Camel. There were age variations in menthol cigarette smoking across the three brands as well. Specifically, for both Marlboro and Camel smokers, all age groups were more likely than the oldest age group (45+) to use menthol (vs. nonmenthol) versions of these brands; whereas for Newport cigarettes, only young adults (ages 18–24) were more likely than the oldest adults (45+) to use menthol cigarette versions of this brand. Table 2. Crude and Adjusted Odds Ratios or Correlates of Menthol Smoking Across the Top Three Cigarette Brands and All Cigarette Brands; n = 11402 Current Adult Cigarette Smokers, PATH Wave 1   Newport menthol (vs. Newport nonmenthol)   Marlboro menthol (vs. Marlboro nonmenthol)   Camel menthol (vs. Camel nonmenthol)   All brands (menthol vs. nonmenthol)   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Age, n = 10237   18–24  1.29[0.60, 2.79]  2.87 [1.30, 6.30]  3.21 [2.48, 4.17]  3.72 [2.82, 4.90]  6.33 [4.32, 9.53]  6.20 [3.84, 10.01]  2.07 [1.79, 2.38]  2.79 [2.38, 3.26]   25–34  0.83 [0.43, 1.58]  1.54 [0.70, 3.37]  3.06 [2.36, 3.98]  3.49 [2.66, 4.57]  3.81 [2.51, 5.77]  3.91 [2.53, 6.03]  1.88 [1.66, 2.13]  2.53 [2.22, 2.87]   35–44  1.16 [0.57, 2.37]  1.67 [0.75, 3.75]  1.24 [0.94, 1.64]  1.31 [0.98, 1.77]  2.84 [1.75, 4.61]  2.90 [1.70, 4.93]  1.13 [1.00, 1.33]  1.39 [1.18, 1.64]   45+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.54 [1.02, 2.34]  2.18 [1.31, 3.64]  1.47 [1.21, 1.78]  1.65 [1.34, 2.01]  1.75 [1.37, 2.24]  1.92 [1.41, 2.60]  1.29 [1.18,1.40]  1.61 [1.45, 1.78]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238   NH White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   NH Black  17.79 [7.83, 40.45]  24.07 [8.78, 65.97]  2.26 [1.29, 3.93]  3.42 [1.91, 6.12]  1.97[0.89,4.33]  2.45 [0.94, 6.36]  17.64 [14.43, 21.57]  22.22 [17.94, 27.52]   NH Other  2.16 [1.23, 3.80]  2.08 [1.13, 3.81]  0.85 [0.54, 1.33]  0.83 [0.51, 1.37]  2.14[1.12,4.10]  2.00 [0.95, 4.21]  1.46 [1.12, 1.91]  1.41 [1.01, 1.88]   Hispanic  9.13 [3.32, 15.09]  15.34 [5.22, 45.06]  0.95 [0.73, 1.23]  1.12 [0.86, 1.46]  3.45[2.17,5.51]  3.16 [1.88, 5.30]  2.28 [1.97, 2.65]  2.29 [1.95, 2.68]  Income, n = 9401   Less than $10000  0.81 [0.26, 2.49]  0.27 [0.07, 1.04]  0.99 [0.75, 1.31]  0.82 [0.59, 1.13]  1.89 [1.21, 2.94]  1.42 [0.88, 2.32]  1.97 [1.70, 2.29]  1.07 [0.91, 1.25]   $10000–$24999  0.63 [0.23, 1.72]  0.33 [0.11, 1.01]  1.07 [0.83, 1.39]  0.89 [0.67, 1.16]  1.48 [1.05, 2.08]  1.21 [0.83, 1.77]  1.57 [1.40, 1.78]  1.08 [0.96, 1.22]   $25000–$49999  0.35 [0.13, 0.95]  0.22 [0.07, 0.68]  1.08 [0.84, 1.39]  0.95 [0.71, 1.26]  1.56 [1.08, 2.25]  1.49 [0.99, 2.22]  1.26 [1.10, 1.43]  0.99 [0.85, 1.14]   $50000+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Education, n = 10,165   <High school  1.13 [0.34, 3.83]  1.16 [0.28, 4.79]  0.82 [0.55, 1.22]  0.83 [0.54, 1.26]  0.93[0.56, 1.55]  0.77 [0.43, 1.38]  1.52 [1.28, 1.80]  0.99 [0.80, 1.24]   HS/GED  0.98 [0.32, 3.05]  1.26 [0.37, 4.35]  1.07 [0.75, 1.53]  1.07 [0.76, 1.52]  1.18 [0.76, 1.82]  1.12 [0.69, 1.84]  1.57 [1.31, 1.87]  1.26 [1.04, 1.53]   Some college  1.27 [0.40, 4.07]  1.51 [0.44, 5.13]  1.57 [1.12, 2.19]  1.50 [1.07, 2.10]  1.29 [0.87, 1.90]  1.08 [0.71, 1.66]  1.62 [1.40, 1.89]  1.31 [1.09, 1.57]   Bachelor’s or higher  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Cigarettes per day, n = 10238   Cigarettes per day  0.95 [0.92, 0.98]  0.97 [0.94, 1.01]  0.99 [0.98, 1.00]  1.00 [0.99, 1.01]  0.99[0.97,1.01]  1.01 [0.99, 1.03]  0.98 [0.98, 0.99]  1.00 [0.99, 1.01]  Nicotine Dependence n = 10238   High (<5 min)  0.92 [0.47, 1.80]  0.79 [0.36, 1.72]  1.08 [0.85, 1.37]  1.04 [0.81, 1.34]  1.31 [0.91, 1.90]]  1.08 [0.71, 1.64]  1.14 [1.02, 1.27]  0.93 [0.80, 1.09]   Moderate (5–29 min)  0.82 [0.41, 1.63]  0.94 [0.40, 2.19]  1.02 [0.80, 1.31]  1.00 [0.74, 1.37]  1.08 [0.75, 1.54]  1.02 [0.67, 1.55]  0.94 [0.84, 1.06]  0.96 [0.85, 1.09]   Low (>30 min)  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Number of quit attempts in past year, n = 10186   Times tried to quit  1.06 [0.98, 1.15]  1.03 [0.96, 1.10]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  1.00 [0.98, 1.02]  1.00 [0.99, 1.01]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  Harm Perceptions of your own brand compared to other cigarette brands n = 10185  No difference  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   Less harmful  1.3 [0.25, 7.09]  0.96 [0.14, 6.47]  0.63 [0.44, 0.91]  0.68 [0.43, 1.08]  0.60 [0.34, 1.07]  0.77 [0.41, 1.52]  0.62 [0.53, 0.72]  0.60 [0.49, 0.74]   More harmful  4.16 [1.59, 10.88]  11.54 [3.12, 42.71]  1.47 [1.13, 1.92]  1.39 [1.01, 1.91]  2.10 [1.31, 3.38]  2.96 [1.77, 4.98]  2.94 [2.52, 3.43]  2.80 [2.31, 3.40]    Newport menthol (vs. Newport nonmenthol)   Marlboro menthol (vs. Marlboro nonmenthol)   Camel menthol (vs. Camel nonmenthol)   All brands (menthol vs. nonmenthol)   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Age, n = 10237   18–24  1.29[0.60, 2.79]  2.87 [1.30, 6.30]  3.21 [2.48, 4.17]  3.72 [2.82, 4.90]  6.33 [4.32, 9.53]  6.20 [3.84, 10.01]  2.07 [1.79, 2.38]  2.79 [2.38, 3.26]   25–34  0.83 [0.43, 1.58]  1.54 [0.70, 3.37]  3.06 [2.36, 3.98]  3.49 [2.66, 4.57]  3.81 [2.51, 5.77]  3.91 [2.53, 6.03]  1.88 [1.66, 2.13]  2.53 [2.22, 2.87]   35–44  1.16 [0.57, 2.37]  1.67 [0.75, 3.75]  1.24 [0.94, 1.64]  1.31 [0.98, 1.77]  2.84 [1.75, 4.61]  2.90 [1.70, 4.93]  1.13 [1.00, 1.33]  1.39 [1.18, 1.64]   45+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.54 [1.02, 2.34]  2.18 [1.31, 3.64]  1.47 [1.21, 1.78]  1.65 [1.34, 2.01]  1.75 [1.37, 2.24]  1.92 [1.41, 2.60]  1.29 [1.18,1.40]  1.61 [1.45, 1.78]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238   NH White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   NH Black  17.79 [7.83, 40.45]  24.07 [8.78, 65.97]  2.26 [1.29, 3.93]  3.42 [1.91, 6.12]  1.97[0.89,4.33]  2.45 [0.94, 6.36]  17.64 [14.43, 21.57]  22.22 [17.94, 27.52]   NH Other  2.16 [1.23, 3.80]  2.08 [1.13, 3.81]  0.85 [0.54, 1.33]  0.83 [0.51, 1.37]  2.14[1.12,4.10]  2.00 [0.95, 4.21]  1.46 [1.12, 1.91]  1.41 [1.01, 1.88]   Hispanic  9.13 [3.32, 15.09]  15.34 [5.22, 45.06]  0.95 [0.73, 1.23]  1.12 [0.86, 1.46]  3.45[2.17,5.51]  3.16 [1.88, 5.30]  2.28 [1.97, 2.65]  2.29 [1.95, 2.68]  Income, n = 9401   Less than $10000  0.81 [0.26, 2.49]  0.27 [0.07, 1.04]  0.99 [0.75, 1.31]  0.82 [0.59, 1.13]  1.89 [1.21, 2.94]  1.42 [0.88, 2.32]  1.97 [1.70, 2.29]  1.07 [0.91, 1.25]   $10000–$24999  0.63 [0.23, 1.72]  0.33 [0.11, 1.01]  1.07 [0.83, 1.39]  0.89 [0.67, 1.16]  1.48 [1.05, 2.08]  1.21 [0.83, 1.77]  1.57 [1.40, 1.78]  1.08 [0.96, 1.22]   $25000–$49999  0.35 [0.13, 0.95]  0.22 [0.07, 0.68]  1.08 [0.84, 1.39]  0.95 [0.71, 1.26]  1.56 [1.08, 2.25]  1.49 [0.99, 2.22]  1.26 [1.10, 1.43]  0.99 [0.85, 1.14]   $50000+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Education, n = 10,165   <High school  1.13 [0.34, 3.83]  1.16 [0.28, 4.79]  0.82 [0.55, 1.22]  0.83 [0.54, 1.26]  0.93[0.56, 1.55]  0.77 [0.43, 1.38]  1.52 [1.28, 1.80]  0.99 [0.80, 1.24]   HS/GED  0.98 [0.32, 3.05]  1.26 [0.37, 4.35]  1.07 [0.75, 1.53]  1.07 [0.76, 1.52]  1.18 [0.76, 1.82]  1.12 [0.69, 1.84]  1.57 [1.31, 1.87]  1.26 [1.04, 1.53]   Some college  1.27 [0.40, 4.07]  1.51 [0.44, 5.13]  1.57 [1.12, 2.19]  1.50 [1.07, 2.10]  1.29 [0.87, 1.90]  1.08 [0.71, 1.66]  1.62 [1.40, 1.89]  1.31 [1.09, 1.57]   Bachelor’s or higher  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Cigarettes per day, n = 10238   Cigarettes per day  0.95 [0.92, 0.98]  0.97 [0.94, 1.01]  0.99 [0.98, 1.00]  1.00 [0.99, 1.01]  0.99[0.97,1.01]  1.01 [0.99, 1.03]  0.98 [0.98, 0.99]  1.00 [0.99, 1.01]  Nicotine Dependence n = 10238   High (<5 min)  0.92 [0.47, 1.80]  0.79 [0.36, 1.72]  1.08 [0.85, 1.37]  1.04 [0.81, 1.34]  1.31 [0.91, 1.90]]  1.08 [0.71, 1.64]  1.14 [1.02, 1.27]  0.93 [0.80, 1.09]   Moderate (5–29 min)  0.82 [0.41, 1.63]  0.94 [0.40, 2.19]  1.02 [0.80, 1.31]  1.00 [0.74, 1.37]  1.08 [0.75, 1.54]  1.02 [0.67, 1.55]  0.94 [0.84, 1.06]  0.96 [0.85, 1.09]   Low (>30 min)  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Number of quit attempts in past year, n = 10186   Times tried to quit  1.06 [0.98, 1.15]  1.03 [0.96, 1.10]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  1.00 [0.98, 1.02]  1.00 [0.99, 1.01]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  Harm Perceptions of your own brand compared to other cigarette brands n = 10185  No difference  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   Less harmful  1.3 [0.25, 7.09]  0.96 [0.14, 6.47]  0.63 [0.44, 0.91]  0.68 [0.43, 1.08]  0.60 [0.34, 1.07]  0.77 [0.41, 1.52]  0.62 [0.53, 0.72]  0.60 [0.49, 0.74]   More harmful  4.16 [1.59, 10.88]  11.54 [3.12, 42.71]  1.47 [1.13, 1.92]  1.39 [1.01, 1.91]  2.10 [1.31, 3.38]  2.96 [1.77, 4.98]  2.94 [2.52, 3.43]  2.80 [2.31, 3.40]  Bold = significant at p < .05 level or lower. View Large Table 2. Crude and Adjusted Odds Ratios or Correlates of Menthol Smoking Across the Top Three Cigarette Brands and All Cigarette Brands; n = 11402 Current Adult Cigarette Smokers, PATH Wave 1   Newport menthol (vs. Newport nonmenthol)   Marlboro menthol (vs. Marlboro nonmenthol)   Camel menthol (vs. Camel nonmenthol)   All brands (menthol vs. nonmenthol)   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Age, n = 10237   18–24  1.29[0.60, 2.79]  2.87 [1.30, 6.30]  3.21 [2.48, 4.17]  3.72 [2.82, 4.90]  6.33 [4.32, 9.53]  6.20 [3.84, 10.01]  2.07 [1.79, 2.38]  2.79 [2.38, 3.26]   25–34  0.83 [0.43, 1.58]  1.54 [0.70, 3.37]  3.06 [2.36, 3.98]  3.49 [2.66, 4.57]  3.81 [2.51, 5.77]  3.91 [2.53, 6.03]  1.88 [1.66, 2.13]  2.53 [2.22, 2.87]   35–44  1.16 [0.57, 2.37]  1.67 [0.75, 3.75]  1.24 [0.94, 1.64]  1.31 [0.98, 1.77]  2.84 [1.75, 4.61]  2.90 [1.70, 4.93]  1.13 [1.00, 1.33]  1.39 [1.18, 1.64]   45+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.54 [1.02, 2.34]  2.18 [1.31, 3.64]  1.47 [1.21, 1.78]  1.65 [1.34, 2.01]  1.75 [1.37, 2.24]  1.92 [1.41, 2.60]  1.29 [1.18,1.40]  1.61 [1.45, 1.78]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238   NH White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   NH Black  17.79 [7.83, 40.45]  24.07 [8.78, 65.97]  2.26 [1.29, 3.93]  3.42 [1.91, 6.12]  1.97[0.89,4.33]  2.45 [0.94, 6.36]  17.64 [14.43, 21.57]  22.22 [17.94, 27.52]   NH Other  2.16 [1.23, 3.80]  2.08 [1.13, 3.81]  0.85 [0.54, 1.33]  0.83 [0.51, 1.37]  2.14[1.12,4.10]  2.00 [0.95, 4.21]  1.46 [1.12, 1.91]  1.41 [1.01, 1.88]   Hispanic  9.13 [3.32, 15.09]  15.34 [5.22, 45.06]  0.95 [0.73, 1.23]  1.12 [0.86, 1.46]  3.45[2.17,5.51]  3.16 [1.88, 5.30]  2.28 [1.97, 2.65]  2.29 [1.95, 2.68]  Income, n = 9401   Less than $10000  0.81 [0.26, 2.49]  0.27 [0.07, 1.04]  0.99 [0.75, 1.31]  0.82 [0.59, 1.13]  1.89 [1.21, 2.94]  1.42 [0.88, 2.32]  1.97 [1.70, 2.29]  1.07 [0.91, 1.25]   $10000–$24999  0.63 [0.23, 1.72]  0.33 [0.11, 1.01]  1.07 [0.83, 1.39]  0.89 [0.67, 1.16]  1.48 [1.05, 2.08]  1.21 [0.83, 1.77]  1.57 [1.40, 1.78]  1.08 [0.96, 1.22]   $25000–$49999  0.35 [0.13, 0.95]  0.22 [0.07, 0.68]  1.08 [0.84, 1.39]  0.95 [0.71, 1.26]  1.56 [1.08, 2.25]  1.49 [0.99, 2.22]  1.26 [1.10, 1.43]  0.99 [0.85, 1.14]   $50000+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Education, n = 10,165   <High school  1.13 [0.34, 3.83]  1.16 [0.28, 4.79]  0.82 [0.55, 1.22]  0.83 [0.54, 1.26]  0.93[0.56, 1.55]  0.77 [0.43, 1.38]  1.52 [1.28, 1.80]  0.99 [0.80, 1.24]   HS/GED  0.98 [0.32, 3.05]  1.26 [0.37, 4.35]  1.07 [0.75, 1.53]  1.07 [0.76, 1.52]  1.18 [0.76, 1.82]  1.12 [0.69, 1.84]  1.57 [1.31, 1.87]  1.26 [1.04, 1.53]   Some college  1.27 [0.40, 4.07]  1.51 [0.44, 5.13]  1.57 [1.12, 2.19]  1.50 [1.07, 2.10]  1.29 [0.87, 1.90]  1.08 [0.71, 1.66]  1.62 [1.40, 1.89]  1.31 [1.09, 1.57]   Bachelor’s or higher  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Cigarettes per day, n = 10238   Cigarettes per day  0.95 [0.92, 0.98]  0.97 [0.94, 1.01]  0.99 [0.98, 1.00]  1.00 [0.99, 1.01]  0.99[0.97,1.01]  1.01 [0.99, 1.03]  0.98 [0.98, 0.99]  1.00 [0.99, 1.01]  Nicotine Dependence n = 10238   High (<5 min)  0.92 [0.47, 1.80]  0.79 [0.36, 1.72]  1.08 [0.85, 1.37]  1.04 [0.81, 1.34]  1.31 [0.91, 1.90]]  1.08 [0.71, 1.64]  1.14 [1.02, 1.27]  0.93 [0.80, 1.09]   Moderate (5–29 min)  0.82 [0.41, 1.63]  0.94 [0.40, 2.19]  1.02 [0.80, 1.31]  1.00 [0.74, 1.37]  1.08 [0.75, 1.54]  1.02 [0.67, 1.55]  0.94 [0.84, 1.06]  0.96 [0.85, 1.09]   Low (>30 min)  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Number of quit attempts in past year, n = 10186   Times tried to quit  1.06 [0.98, 1.15]  1.03 [0.96, 1.10]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  1.00 [0.98, 1.02]  1.00 [0.99, 1.01]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  Harm Perceptions of your own brand compared to other cigarette brands n = 10185  No difference  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   Less harmful  1.3 [0.25, 7.09]  0.96 [0.14, 6.47]  0.63 [0.44, 0.91]  0.68 [0.43, 1.08]  0.60 [0.34, 1.07]  0.77 [0.41, 1.52]  0.62 [0.53, 0.72]  0.60 [0.49, 0.74]   More harmful  4.16 [1.59, 10.88]  11.54 [3.12, 42.71]  1.47 [1.13, 1.92]  1.39 [1.01, 1.91]  2.10 [1.31, 3.38]  2.96 [1.77, 4.98]  2.94 [2.52, 3.43]  2.80 [2.31, 3.40]    Newport menthol (vs. Newport nonmenthol)   Marlboro menthol (vs. Marlboro nonmenthol)   Camel menthol (vs. Camel nonmenthol)   All brands (menthol vs. nonmenthol)   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Age, n = 10237   18–24  1.29[0.60, 2.79]  2.87 [1.30, 6.30]  3.21 [2.48, 4.17]  3.72 [2.82, 4.90]  6.33 [4.32, 9.53]  6.20 [3.84, 10.01]  2.07 [1.79, 2.38]  2.79 [2.38, 3.26]   25–34  0.83 [0.43, 1.58]  1.54 [0.70, 3.37]  3.06 [2.36, 3.98]  3.49 [2.66, 4.57]  3.81 [2.51, 5.77]  3.91 [2.53, 6.03]  1.88 [1.66, 2.13]  2.53 [2.22, 2.87]   35–44  1.16 [0.57, 2.37]  1.67 [0.75, 3.75]  1.24 [0.94, 1.64]  1.31 [0.98, 1.77]  2.84 [1.75, 4.61]  2.90 [1.70, 4.93]  1.13 [1.00, 1.33]  1.39 [1.18, 1.64]   45+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.54 [1.02, 2.34]  2.18 [1.31, 3.64]  1.47 [1.21, 1.78]  1.65 [1.34, 2.01]  1.75 [1.37, 2.24]  1.92 [1.41, 2.60]  1.29 [1.18,1.40]  1.61 [1.45, 1.78]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238   NH White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   NH Black  17.79 [7.83, 40.45]  24.07 [8.78, 65.97]  2.26 [1.29, 3.93]  3.42 [1.91, 6.12]  1.97[0.89,4.33]  2.45 [0.94, 6.36]  17.64 [14.43, 21.57]  22.22 [17.94, 27.52]   NH Other  2.16 [1.23, 3.80]  2.08 [1.13, 3.81]  0.85 [0.54, 1.33]  0.83 [0.51, 1.37]  2.14[1.12,4.10]  2.00 [0.95, 4.21]  1.46 [1.12, 1.91]  1.41 [1.01, 1.88]   Hispanic  9.13 [3.32, 15.09]  15.34 [5.22, 45.06]  0.95 [0.73, 1.23]  1.12 [0.86, 1.46]  3.45[2.17,5.51]  3.16 [1.88, 5.30]  2.28 [1.97, 2.65]  2.29 [1.95, 2.68]  Income, n = 9401   Less than $10000  0.81 [0.26, 2.49]  0.27 [0.07, 1.04]  0.99 [0.75, 1.31]  0.82 [0.59, 1.13]  1.89 [1.21, 2.94]  1.42 [0.88, 2.32]  1.97 [1.70, 2.29]  1.07 [0.91, 1.25]   $10000–$24999  0.63 [0.23, 1.72]  0.33 [0.11, 1.01]  1.07 [0.83, 1.39]  0.89 [0.67, 1.16]  1.48 [1.05, 2.08]  1.21 [0.83, 1.77]  1.57 [1.40, 1.78]  1.08 [0.96, 1.22]   $25000–$49999  0.35 [0.13, 0.95]  0.22 [0.07, 0.68]  1.08 [0.84, 1.39]  0.95 [0.71, 1.26]  1.56 [1.08, 2.25]  1.49 [0.99, 2.22]  1.26 [1.10, 1.43]  0.99 [0.85, 1.14]   $50000+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Education, n = 10,165   <High school  1.13 [0.34, 3.83]  1.16 [0.28, 4.79]  0.82 [0.55, 1.22]  0.83 [0.54, 1.26]  0.93[0.56, 1.55]  0.77 [0.43, 1.38]  1.52 [1.28, 1.80]  0.99 [0.80, 1.24]   HS/GED  0.98 [0.32, 3.05]  1.26 [0.37, 4.35]  1.07 [0.75, 1.53]  1.07 [0.76, 1.52]  1.18 [0.76, 1.82]  1.12 [0.69, 1.84]  1.57 [1.31, 1.87]  1.26 [1.04, 1.53]   Some college  1.27 [0.40, 4.07]  1.51 [0.44, 5.13]  1.57 [1.12, 2.19]  1.50 [1.07, 2.10]  1.29 [0.87, 1.90]  1.08 [0.71, 1.66]  1.62 [1.40, 1.89]  1.31 [1.09, 1.57]   Bachelor’s or higher  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Cigarettes per day, n = 10238   Cigarettes per day  0.95 [0.92, 0.98]  0.97 [0.94, 1.01]  0.99 [0.98, 1.00]  1.00 [0.99, 1.01]  0.99[0.97,1.01]  1.01 [0.99, 1.03]  0.98 [0.98, 0.99]  1.00 [0.99, 1.01]  Nicotine Dependence n = 10238   High (<5 min)  0.92 [0.47, 1.80]  0.79 [0.36, 1.72]  1.08 [0.85, 1.37]  1.04 [0.81, 1.34]  1.31 [0.91, 1.90]]  1.08 [0.71, 1.64]  1.14 [1.02, 1.27]  0.93 [0.80, 1.09]   Moderate (5–29 min)  0.82 [0.41, 1.63]  0.94 [0.40, 2.19]  1.02 [0.80, 1.31]  1.00 [0.74, 1.37]  1.08 [0.75, 1.54]  1.02 [0.67, 1.55]  0.94 [0.84, 1.06]  0.96 [0.85, 1.09]   Low (>30 min)  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Number of quit attempts in past year, n = 10186   Times tried to quit  1.06 [0.98, 1.15]  1.03 [0.96, 1.10]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  1.00 [0.98, 1.02]  1.00 [0.99, 1.01]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  Harm Perceptions of your own brand compared to other cigarette brands n = 10185  No difference  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   Less harmful  1.3 [0.25, 7.09]  0.96 [0.14, 6.47]  0.63 [0.44, 0.91]  0.68 [0.43, 1.08]  0.60 [0.34, 1.07]  0.77 [0.41, 1.52]  0.62 [0.53, 0.72]  0.60 [0.49, 0.74]   More harmful  4.16 [1.59, 10.88]  11.54 [3.12, 42.71]  1.47 [1.13, 1.92]  1.39 [1.01, 1.91]  2.10 [1.31, 3.38]  2.96 [1.77, 4.98]  2.94 [2.52, 3.43]  2.80 [2.31, 3.40]  Bold = significant at p < .05 level or lower. View Large Adjusted logistic regression models also showed several correlates of menthol smoking that were unique to each of the top three brands. Among Newport smokers, those with income between $25000–$49999 compared to those with the highest income ($50000+) were less likely to smoke menthol cigarettes as their usual variety; however, income was not a significant correlate of menthol smoking for the two other brands or across all cigarette brands. Compared to White smokers, Newport smokers who were either African-American, Hispanic, or of Other race/ethnicity were more likely to use menthol than nonmenthol cigarettes; African-American Marlboro smokers were more likely to use menthol than nonmenthol cigarettes (aOR = 3.42; 95% CI = 1.91–6.12), and Hispanic smokers using Camel were more likely to use menthol than nonmenthol cigarettes (aOR = 3.16; 95% CI = 1.88–5.30). Smokers with some college education compared to those with a bachelor degree or higher were more likely to be use Marlboro menthol than nonmenthol cigarettes (aOR = 1.57; 95% CI = 1.12–2.19); however, education was unrelated to menthol use for both Newport and Camel smokers. CPD, nicotine dependence, and number of past-year quit attempts were unrelated to menthol use across the top three brands and all brands in adjusted models. Association between Menthol Smoking and Harm Perceptions of One’s Own Brand Table 3 shows adjusted risk ratios (aRR) from multinomial logistic regression models of the main effects of menthol status on harm perceptions of one’s own brand of cigarettes (less harm or more harm vs. no difference), and interactions with age, race, and gender. Across all brands, main effects showed that menthol smokers were more likely than nonmenthol smokers to perceive their brand as more harmful (vs. no different in harm) compared to other cigarette brands. Across the top three brands, this same association was found for Newport cigarette brand (aRR = 11.51; 95% CI = 3.34–39.70), Marlboro (aRR = 1.39; 95% CI = 1.01, 1.91), and Camel cigarette brand (aRR = 2.54; 95% CI = 1.52–4.25). Table 3. Adjusted Multinomial Logistic Regression Models of the Main and Interactive Effects of Menthol Smoking Status, Age, Gender, and Race on Harm Perceptions of One’s Own Cigarette Brand Compared with Other Cigarette Brands   Newport   Marlboro   Camel   All brands   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   3.71% less harm   20.74% more harm   7.62% less harm   6.83% more harm   4.77% less harm   8.55% more harm   9.16% less harm   8.55% more harm   Main effects  Menthol smoking status, n = 10185   Menthol  0.72 [0.12, 4.38]  11.51 [3.34, 39.7]  0.62 [0.39, 0.97]  1.39 [1.01, 1.91]  0.63 [0.33, 1.19]  2.54 [1.52, 4.25]  0.54 [0.44, 0.66]  2.87 [2.36, 3.48]   Nonmenthol  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Age, n = 10237   18–24  0.83 [0.34, 2.06]  1.23 [0.93, 1.64]  0.57 [0.39, 0.84]  1.45 [1.11, 1.91]  0.55[0.27, 1.15]  1.34 [0.85, 2.14]  0.67 [0.54, 0.84]  1.38 [1.16, 1.65]   25+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.21 [0.64, 2.27]  0.95 [0.69, 1.31]  1.10 [0.85, 1.42]  0.69 [0.52, 0.93]  0.68 [0.34, 1.32]  0.64 [0.39, 1.04]  1.15 [0.97, 1.37]  0.72 [0.60, 0.87]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238  White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   African- American  2.80 [0.79, 9.86]  0.33 [0.24, 0.44]  2.85 [1.30, 6.26]  2.06 [0.74, 5.76]  1.92 [0.35, 10.45]  1.28 [0.27, 6.08]  1.51 [1.13, 2.02]  0.93 [0.75, 1.16]   Other  6.80 [1.43, 32.35]  0.99 [0.56, 1.75]  1.16 [0.65, 2.05]  1.13 [0.64, 1.99]  0.80 [0.23, 2.77]  0.25 [0.07, 0.87]  1.17 [0.77, 1.76]  1.16 [0.81, 1.67]   Hispanic  3.20 [0.81, 12.64]  0.55 [0.37, 0.83]  1.08 [0.68, 1.73]  1.12 [0.72, 1.74]  1.25 [0.43, 3.59]  0.81 [0.36, 1.83]  1.08 [0.84, 1.39]  1.10 [0.84, 1.44]  Interaction Model 1: Menthol × Age  Menthol × Age (overall)  Adjusted Wald Test, F(2,98) = 0.61, p = .54   Menthol × 18–24  —  —  —  —  —  —  0.75 [0.44, 1.29]  0.94 [0.68, 1.30]  Interaction Model 2: Menthol × Gender  Menthol × Gender (overall)  Adjusted Wald Test, F(2,98) = 4.73, p = 0.01   Menthol × female  —  —  —  —  —  —  0.78 [0.54, 1.12]  1.66 [1.13, 2.45]  Interaction Model 3: Menthol × Race  Menthol × Race (overall)  Adjusted Wald Test, F(6,94) = 3.17, p = 0.01   Menthol × Black  —  —  —  —  —  --  0.53 [0.28, 0.98]  0.27 [0.13, 0.59]   Menthol × Other  —  —  —  —  —  —  1.11 [0.55, 2.23]  0.66 [0.37, 1.20]   Menthol × Hispanic  —  —  —  —  —  —  1.27 [0.69, 2.34]  0.79 [0.49, 1.30]    Newport   Marlboro   Camel   All brands   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   3.71% less harm   20.74% more harm   7.62% less harm   6.83% more harm   4.77% less harm   8.55% more harm   9.16% less harm   8.55% more harm   Main effects  Menthol smoking status, n = 10185   Menthol  0.72 [0.12, 4.38]  11.51 [3.34, 39.7]  0.62 [0.39, 0.97]  1.39 [1.01, 1.91]  0.63 [0.33, 1.19]  2.54 [1.52, 4.25]  0.54 [0.44, 0.66]  2.87 [2.36, 3.48]   Nonmenthol  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Age, n = 10237   18–24  0.83 [0.34, 2.06]  1.23 [0.93, 1.64]  0.57 [0.39, 0.84]  1.45 [1.11, 1.91]  0.55[0.27, 1.15]  1.34 [0.85, 2.14]  0.67 [0.54, 0.84]  1.38 [1.16, 1.65]   25+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.21 [0.64, 2.27]  0.95 [0.69, 1.31]  1.10 [0.85, 1.42]  0.69 [0.52, 0.93]  0.68 [0.34, 1.32]  0.64 [0.39, 1.04]  1.15 [0.97, 1.37]  0.72 [0.60, 0.87]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238  White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   African- American  2.80 [0.79, 9.86]  0.33 [0.24, 0.44]  2.85 [1.30, 6.26]  2.06 [0.74, 5.76]  1.92 [0.35, 10.45]  1.28 [0.27, 6.08]  1.51 [1.13, 2.02]  0.93 [0.75, 1.16]   Other  6.80 [1.43, 32.35]  0.99 [0.56, 1.75]  1.16 [0.65, 2.05]  1.13 [0.64, 1.99]  0.80 [0.23, 2.77]  0.25 [0.07, 0.87]  1.17 [0.77, 1.76]  1.16 [0.81, 1.67]   Hispanic  3.20 [0.81, 12.64]  0.55 [0.37, 0.83]  1.08 [0.68, 1.73]  1.12 [0.72, 1.74]  1.25 [0.43, 3.59]  0.81 [0.36, 1.83]  1.08 [0.84, 1.39]  1.10 [0.84, 1.44]  Interaction Model 1: Menthol × Age  Menthol × Age (overall)  Adjusted Wald Test, F(2,98) = 0.61, p = .54   Menthol × 18–24  —  —  —  —  —  —  0.75 [0.44, 1.29]  0.94 [0.68, 1.30]  Interaction Model 2: Menthol × Gender  Menthol × Gender (overall)  Adjusted Wald Test, F(2,98) = 4.73, p = 0.01   Menthol × female  —  —  —  —  —  —  0.78 [0.54, 1.12]  1.66 [1.13, 2.45]  Interaction Model 3: Menthol × Race  Menthol × Race (overall)  Adjusted Wald Test, F(6,94) = 3.17, p = 0.01   Menthol × Black  —  —  —  —  —  --  0.53 [0.28, 0.98]  0.27 [0.13, 0.59]   Menthol × Other  —  —  —  —  —  —  1.11 [0.55, 2.23]  0.66 [0.37, 1.20]   Menthol × Hispanic  —  —  —  —  —  —  1.27 [0.69, 2.34]  0.79 [0.49, 1.30]  Bold = significant at p < .05 level. Interactions examined in separate models. Other covariates not shown in the table included income, education, cigarettes per day, nicotine dependence, number of quit attempts in the past year. aRR = adjusted risk ratio. View Large Table 3. Adjusted Multinomial Logistic Regression Models of the Main and Interactive Effects of Menthol Smoking Status, Age, Gender, and Race on Harm Perceptions of One’s Own Cigarette Brand Compared with Other Cigarette Brands   Newport   Marlboro   Camel   All brands   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   3.71% less harm   20.74% more harm   7.62% less harm   6.83% more harm   4.77% less harm   8.55% more harm   9.16% less harm   8.55% more harm   Main effects  Menthol smoking status, n = 10185   Menthol  0.72 [0.12, 4.38]  11.51 [3.34, 39.7]  0.62 [0.39, 0.97]  1.39 [1.01, 1.91]  0.63 [0.33, 1.19]  2.54 [1.52, 4.25]  0.54 [0.44, 0.66]  2.87 [2.36, 3.48]   Nonmenthol  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Age, n = 10237   18–24  0.83 [0.34, 2.06]  1.23 [0.93, 1.64]  0.57 [0.39, 0.84]  1.45 [1.11, 1.91]  0.55[0.27, 1.15]  1.34 [0.85, 2.14]  0.67 [0.54, 0.84]  1.38 [1.16, 1.65]   25+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.21 [0.64, 2.27]  0.95 [0.69, 1.31]  1.10 [0.85, 1.42]  0.69 [0.52, 0.93]  0.68 [0.34, 1.32]  0.64 [0.39, 1.04]  1.15 [0.97, 1.37]  0.72 [0.60, 0.87]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238  White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   African- American  2.80 [0.79, 9.86]  0.33 [0.24, 0.44]  2.85 [1.30, 6.26]  2.06 [0.74, 5.76]  1.92 [0.35, 10.45]  1.28 [0.27, 6.08]  1.51 [1.13, 2.02]  0.93 [0.75, 1.16]   Other  6.80 [1.43, 32.35]  0.99 [0.56, 1.75]  1.16 [0.65, 2.05]  1.13 [0.64, 1.99]  0.80 [0.23, 2.77]  0.25 [0.07, 0.87]  1.17 [0.77, 1.76]  1.16 [0.81, 1.67]   Hispanic  3.20 [0.81, 12.64]  0.55 [0.37, 0.83]  1.08 [0.68, 1.73]  1.12 [0.72, 1.74]  1.25 [0.43, 3.59]  0.81 [0.36, 1.83]  1.08 [0.84, 1.39]  1.10 [0.84, 1.44]  Interaction Model 1: Menthol × Age  Menthol × Age (overall)  Adjusted Wald Test, F(2,98) = 0.61, p = .54   Menthol × 18–24  —  —  —  —  —  —  0.75 [0.44, 1.29]  0.94 [0.68, 1.30]  Interaction Model 2: Menthol × Gender  Menthol × Gender (overall)  Adjusted Wald Test, F(2,98) = 4.73, p = 0.01   Menthol × female  —  —  —  —  —  —  0.78 [0.54, 1.12]  1.66 [1.13, 2.45]  Interaction Model 3: Menthol × Race  Menthol × Race (overall)  Adjusted Wald Test, F(6,94) = 3.17, p = 0.01   Menthol × Black  —  —  —  —  —  --  0.53 [0.28, 0.98]  0.27 [0.13, 0.59]   Menthol × Other  —  —  —  —  —  —  1.11 [0.55, 2.23]  0.66 [0.37, 1.20]   Menthol × Hispanic  —  —  —  —  —  —  1.27 [0.69, 2.34]  0.79 [0.49, 1.30]    Newport   Marlboro   Camel   All brands   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   3.71% less harm   20.74% more harm   7.62% less harm   6.83% more harm   4.77% less harm   8.55% more harm   9.16% less harm   8.55% more harm   Main effects  Menthol smoking status, n = 10185   Menthol  0.72 [0.12, 4.38]  11.51 [3.34, 39.7]  0.62 [0.39, 0.97]  1.39 [1.01, 1.91]  0.63 [0.33, 1.19]  2.54 [1.52, 4.25]  0.54 [0.44, 0.66]  2.87 [2.36, 3.48]   Nonmenthol  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Age, n = 10237   18–24  0.83 [0.34, 2.06]  1.23 [0.93, 1.64]  0.57 [0.39, 0.84]  1.45 [1.11, 1.91]  0.55[0.27, 1.15]  1.34 [0.85, 2.14]  0.67 [0.54, 0.84]  1.38 [1.16, 1.65]   25+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.21 [0.64, 2.27]  0.95 [0.69, 1.31]  1.10 [0.85, 1.42]  0.69 [0.52, 0.93]  0.68 [0.34, 1.32]  0.64 [0.39, 1.04]  1.15 [0.97, 1.37]  0.72 [0.60, 0.87]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238  White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   African- American  2.80 [0.79, 9.86]  0.33 [0.24, 0.44]  2.85 [1.30, 6.26]  2.06 [0.74, 5.76]  1.92 [0.35, 10.45]  1.28 [0.27, 6.08]  1.51 [1.13, 2.02]  0.93 [0.75, 1.16]   Other  6.80 [1.43, 32.35]  0.99 [0.56, 1.75]  1.16 [0.65, 2.05]  1.13 [0.64, 1.99]  0.80 [0.23, 2.77]  0.25 [0.07, 0.87]  1.17 [0.77, 1.76]  1.16 [0.81, 1.67]   Hispanic  3.20 [0.81, 12.64]  0.55 [0.37, 0.83]  1.08 [0.68, 1.73]  1.12 [0.72, 1.74]  1.25 [0.43, 3.59]  0.81 [0.36, 1.83]  1.08 [0.84, 1.39]  1.10 [0.84, 1.44]  Interaction Model 1: Menthol × Age  Menthol × Age (overall)  Adjusted Wald Test, F(2,98) = 0.61, p = .54   Menthol × 18–24  —  —  —  —  —  —  0.75 [0.44, 1.29]  0.94 [0.68, 1.30]  Interaction Model 2: Menthol × Gender  Menthol × Gender (overall)  Adjusted Wald Test, F(2,98) = 4.73, p = 0.01   Menthol × female  —  —  —  —  —  —  0.78 [0.54, 1.12]  1.66 [1.13, 2.45]  Interaction Model 3: Menthol × Race  Menthol × Race (overall)  Adjusted Wald Test, F(6,94) = 3.17, p = 0.01   Menthol × Black  —  —  —  —  —  --  0.53 [0.28, 0.98]  0.27 [0.13, 0.59]   Menthol × Other  —  —  —  —  —  —  1.11 [0.55, 2.23]  0.66 [0.37, 1.20]   Menthol × Hispanic  —  —  —  —  —  —  1.27 [0.69, 2.34]  0.79 [0.49, 1.30]  Bold = significant at p < .05 level. Interactions examined in separate models. Other covariates not shown in the table included income, education, cigarettes per day, nicotine dependence, number of quit attempts in the past year. aRR = adjusted risk ratio. View Large Age, Race/Ethnicity, and Gender as Moderators of the Association between Menthol Smoking and Harm Perceptions Significant interactions of menthol status with gender and race emerged. Age did not emerge as a moderator. Explicating the menthol status by gender interaction (Figure 1) showed that, among both men and women, a greater proportion of nonmenthol versus menthol smokers perceived their cigarette as less harmful than other brands and a lower proportion perceived their brand as more harmful. However, the difference between menthol and nonmenthol smokers’ harm perceptions was not as large for men as it was for women. Among men, slightly twice as many menthol (15.8%) compared to nonmenthol smokers (6.8%) perceived their cigarette brand as more harmful; whereas for women, four times as many menthol (12.6%) versus nonmenthol (3.2%) smokers perceived their brand as more harmful. Figure 1. View largeDownload slide Gender differences in the proportion of menthol and nonmenthol smokers (across all cigarette brands) reporting their cigarette brand as less harmful or more harmful than other brands. Figure 1. View largeDownload slide Gender differences in the proportion of menthol and nonmenthol smokers (across all cigarette brands) reporting their cigarette brand as less harmful or more harmful than other brands. Further, female nonmenthol smokers were the most likely to perceive their cigarette brand as less harmful than all other menthol × gender groups (13%), whereas male menthol smokers were the most likely to perceive their cigarette brand as more harmful (15%), compared to all other menthol x gender groups. Among menthol smokers, relatively few males and females perceived their brand as less harmful than other brands (6.5% for both sexes). Explicating the menthol status by race interaction (Figure 2) showed that, across all racial/ethnic groups, perceptions that one’s usual brand of cigarettes was less harmful or more harmful was roughly equivalent across menthol smokers, with a greater percentage of menthol smokers perceiving their cigarette brand as more harmful than less harmful. Among nonmenthol smokers, a greater percentage of African-American nonmenthol smokers perceived their cigarette as less harmful than other brands compared to smokers of all other race/ethnicities (25% vs. 12.9% Other, 11.7% Hispanic, and 11.1% White). Finally, within menthol smokers, perceptions that one’s usual brand of cigarettes was less harmful or more harmful was roughly equivalent across all racial/ethnic groups. Figure 2. View largeDownload slide Racial/ethnic differences in the proportion of menthol and nonmenthol smokers (across all brands) reporting their cigarette brand as less harmful or more harmful than other brands. Figure 2. View largeDownload slide Racial/ethnic differences in the proportion of menthol and nonmenthol smokers (across all brands) reporting their cigarette brand as less harmful or more harmful than other brands. Discussion In the current study, menthol smokers comprised nearly 40% of current adult smokers reporting a regular brand. Menthol smokers overwhelmingly used Newport as their preferred brand of cigarettes. Bivariate prevalence estimates showed that most menthol and nonmenthol smokers perceive their cigarette as equally harmful as other brands. However, in adjusted multinomial models, across all cigarette brands and within Newport and Camel brands, the risk of perceiving one’s cigarette brand as more harmful than other brands (compared with no difference) was greater among menthol smokers versus nonmenthol smokers. Harm perceptions of one’s own cigarette brand did not differ across menthol smoking status among Marlboro smokers. Findings are consistent with several other large-scale surveys, which found that, in young adult and adult samples, menthol cigarettes were more likely to be perceived as more, rather than less risky, compared with nonmenthol cigarettes, controlling for other covariates.30–32 Interactions also revealed that the association between menthol smoking and perceptions of harm of one’s own brand varies by race and gender. Specifically, male menthol smokers were most likely to perceive their brand as “more harmful” than other brands, while female nonmenthol smokers were most likely to perceive their cigarette as less harmful than other brands. With respect to menthol’s interaction with race, African-American nonmenthol smokers were most likely to perceive their cigarettes as less harmful than other brands relative to any other menthol by race/ethnicity group of smokers. Both female menthol smokers and African-American menthol smokers were more likely than nonmenthol smokers of these same groups to perceive their brand as more harmful than other brands. This corresponds to several population-based studies showing higher menthol use among these groups.42–44 Based on tobacco documents showing that menthol cigarettes were marketed as less harmful than nonmenthol cigarettes, and these messages targeted African-American and female consumers, we would have expected these sub-groups of menthol smokers to be more likely to report that their usual brand as less harmful than other brands. Surprisingly, the association between menthol status and harm perceptions did not differ by older or young adults in the current study. We would have thought that young adult menthol smokers compared to older groups of menthol smokers would be more likely to perceive menthol cigarettes as less harmful than other brands because of targeted tobacco marketing to younger users and because menthol is associated with cigarette initiation. Analyses of correlates across the top three brands suggests that not all menthol smokers are the same. As documented in other national samples,21,23,42,45 adjusted models of correlates of menthol use, aggregating across all cigarette brands showed that younger age, female gender, nonWhite race/ethnicities, and lower educational attainment were significant correlates of menthol cigarette smoking aggregated across all three brands. CPD, nicotine dependence severity, and quit attempts were not correlated with menthol use, across all brands or within the top three brands. Adjusted models also revealed correlates of menthol smoking that were unique to smokers of each of the top three brands. Correlates of Newport menthol smoking included nonWhite race, lower/middle income, and younger age, suggesting that marketing strategies differ across brands and may target different sub-groups.44 It is worth noting that, across all three brands, female gender was consistently associated with menthol cigarette smoking and the association between menthol cigarette smoking and cigarette harm perceptions differed by gender. Prior research regarding harm perceptions by gender are inconsistent. Tobacco industry documents indicate that female smokers are more health conscious than male smokers and thus may be more attracted to cigarettes they believe are less harmful.46 As noted in a study by Richardson and colleagues,19 menthol advertisements were frequently found in publications with a primarily female readership. Additionally, in a prior national study, female smokers were more likely than male smokers to not know whether menthol cigarettes were more or less harmful than nonmenthol cigarettes.47 Given these prior findings, the reasons why women and men differentially misperceive the harms of menthol versus nonmenthol cigarettes should be examined in future studies. That menthol smokers were more likely to perceive their usual brand as more harmful than other brands is a misperception worth noting, as there is no evidence that menthol cigarettes are more or less harmful than other cigarettes,48,49 though they may facilitate smoking initiation and be harder to quit.39,50 Moreover, consistent with other prior work,31,32 menthol smokers were more likely than nonmenthol smokers to misperceive their cigarette brand as more harmful than other brands (compared to no difference in harm). There could be several explanations for these findings. First, counter-marketing campaigns like the “Tips From Former Smokers” campaign, may have raised awareness of the harms of smoking overall.51,52 Increased awareness of smoking-related harms may come as a greater “surprise” for menthol smokers, who have historically been exposed to messages about menthol’s medicinal and health-enhancing effects,53 and who may have initiated cigarette smoking with the misperception that menthol was less harmful to their health than nonmenthol cigarettes, a hypothesis consistent with recent focus group work among young adults.30 Second, perceptions of harm may be influenced by individual differences in the interpretation and understanding of what constitutes harm, although this conjecture goes beyond the data. We cannot determine whether menthol smokers interpret smoking-related harm as greater addiction to cigarette smoking (ie, finding it harder to quit smoking) or if harm is perceived as negative health consequences associated with smoking. Perhaps perceiving one’s own cigarette as more harmful, ie, more difficult to quit smoking, negatively affects a smoker’s belief in his/her ability to quit. Future work should examine the association between harm perceptions of one’s usual brand with cessation attempts as a function of menthol smoking status. Finally, some younger menthol smokers might perceive their cigarette brand as more harmful because they view menthol as a chemical additive that increases the “harshness” of the throat hit from inhalation,30 as well as hold myths that menthol contains fiber glass that harms the lungs.54 While menthol smokers may be more likely to perceive their cigarette brand as more harmful to their health, it is important to note that these harm perceptions have not necessarily helped reduced their smoking at rates greater than nonmenthol smokers. Evidence-based interventions for smoking cessation continue to be underutilized among racial/ethnic minority smokers, many of whom use menthol, and this may be one reason why menthol smokers continue to smoke despite knowledge of the negative consequences of their own smoking.55 Messaging campaigns targeting menthol smokers should enhance motivation to quit by building upon existing negative health perceptions of cigarette smoking and target beliefs that smokers may have about their self-efficacy to quit smoking.56 It is possible that menthol smokers who already perceive their brand as more harmful than other brands may show increased motivation and interest in quitting smoking if menthol cigarettes were banned and thus unavailable to them. Previous research shows that menthol smokers are open to this, with many saying they would quit smoking if menthol cigarettes were banned.57,58 This study had several limitations. First, we did not measure the impact of exposure to marketing, or counter-marketing, which may affect harm perceptions in different populations. Measures of tobacco marketing in the PATH Wave 1 survey did not specifically assess menthol marketing. Second, data are cross-sectional and causal interpretations cannot be made. We are unclear whether harm perceptions affect cigarette consumption and brand choice, or whether brand choice affects perceptions of harm of one’s own brand. Third, aside from menthol use, we were not able to assess other sub-brand factors that could be related to lower harm perceptions, found in prior studies,33 such as the use of “light” cigarettes like in Marlboro or Camel Gold or Silver. Because the use of the term “light” was banned by the tobacco control act, there are now a variety of ways in which “light” is designated, including color, the look of the pack or the product, or other descriptors. These indicators are idiosyncratic and vary within and across brands, making it difficult to reliably identify all light versus full flavored cigarettes. Fourth, this study focused solely on adult established smokers, thus findings cannot generalize to understanding how perceptions of menthol versus nonmenthol cigarettes differ among youth. In conclusion, results highlight brand-specific correlates of menthol cigarette smoking, suggesting that population-level interventions should not take a “one size fits all” approach. The findings also paint a concerning picture for menthol cigarette smokers: even though they perceive their own brand as more harmful than other brands, they are not more likely than nonmenthol smokers to quit smoking, all other factors being held equal. Even small reductions in smoking prevalence linked to menthol use, either through a ban on menthol or through improved cessation interventions targeting menthol smokers, would have important population-level effects on smoking-related morbidity and mortality. Funding This study was funded by a grant from the DC Metro Tobacco Research and Instruction Consortium (MeTRIC) to the first author. Declaration of Interests All authors declare no competing interests. Ethical Approval The study was determined to be exempt as nonhuman research as it constitutes secondary analysis of de-identified data. Acknowledgments AC and SR conceived the manuscript topic and lead the analysis team. AC wrote the first draft of the paper. VI, LC, and TG conducted the analyses. AC, SR, VI, TG, LC, ACV, DM, EL, KT, CD, AM, and LP contributed to the analysis plan, interpretation of results, and manuscript writing and revisions. References 1. Collins CC, Moolchan ET. Shorter time to first cigarette of the day in menthol adolescent cigarette smokers. Addict Behav . 2006; 31( 8): 1460– 1464. Google Scholar CrossRef Search ADS PubMed  2. Muscat JE, Stellman SD, Caraballo RS, Richie JPJr. Time to first cigarette after waking predicts cotinine levels. Cancer Epidemiol Biomarkers Prev . 2009; 18( 12): 3415– 3420. Google Scholar CrossRef Search ADS PubMed  3. Okuyemi KS, Ahluwalia JS, Ebersole-Robinson M, Catley D, Mayo MS, Resnicow K. Does menthol attenuate the effect of bupropion among African American smokers? Addiction . 2003; 98( 10): 1387– 1393. Google Scholar CrossRef Search ADS PubMed  4. Muscat JE, Liu HP, Stellman SD, Richie JPJr. Menthol smoking in relation to time to first cigarette and cotinine: results from a community-based study. Regul Toxicol Pharmacol . 2012; 63( 1): 166– 170. Google Scholar CrossRef Search ADS PubMed  5. Bover MT, Foulds J, Steinberg MB, Richardson D, Marcella SW. 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Risk perceptions of menthol cigarettes compared with nonmenthol cigarettes among New Jersey adults. Nicotine Tob Res . 2010; 12( 7): 786– 790. Google Scholar CrossRef Search ADS PubMed  33. Mutti S, Hammond D, Borland R, Cummings MK, O’Connor RJ, Fong GT. Beyond light and mild: cigarette brand descriptors and perceptions of risk in the International Tobacco Control (ITC) Four Country Survey. Addiction . 2011; 106( 6): 1166– 1175. Google Scholar CrossRef Search ADS PubMed  34. O’Connor RJ, Caruso RV, Borland Ret al.   Relationship of cigarette-related perceptions to cigarette design features: findings from the 2009 ITC U.S. Survey. Nicotine Tob Res . 2013; 15( 11): 1943– 1947. Google Scholar CrossRef Search ADS PubMed  35. Richter PA, Pederson LL, O’Hegarty MM. Young adult smoker risk perceptions of traditional cigarettes and nontraditional tobacco products. Am J Health Behav . 2006; 30( 3): 302– 312. Google Scholar CrossRef Search ADS PubMed  36. 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Harm Perceptions of Menthol and Nonmenthol Cigarettes Differ by Brand, Race/Ethnicity, and Gender in US Adult Smokers: Results from PATH Wave 1

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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10.1093/ntr/ntx277
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Abstract

Abstract Introduction Harm perceptions of menthol cigarettes may contribute to their appeal and use. African-Americans, women, and younger smokers disproportionately use menthol cigarettes, and may misperceive harm of menthol cigarettes. Methods Data were from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses of current adult smokers (18 and older) were used to estimate the correlates of menthol smoking among all cigarette brands and separately for the top three cigarette brands (Newport, Camel, and Marlboro). Adjusted models examined the main effect of menthol smoking on harm perceptions of one’s own brand of cigarette and interactions with race/ethnicity, age, and gender. Results Menthol cigarettes were used by nearly 40% of current smokers, although the prevalence of menthol smoking differed across the top three brands (94% Newport, 46% Camel, and 18% Marlboro). Among menthol smokers, 80% perceived their cigarette as equally harmful, 14% perceived their brand as more harmful, and 7% perceived their brand as less harmful. In adjusted models, menthol smokers were more likely than nonmenthol smokers to misperceive their own brand as more harmful than other brands (compared to no difference in harm). Race and gender emerged as moderators of the association between menthol brand preference and harm perceptions. Conclusions In adjusted analyses, menthol smokers were more likely than nonmenthol smokers to perceive their brand as more harmful than other brands, with differences by sub-groups who disproportionately use menthol. Implications Menthol cigarettes have been historically marketed with messages conveying lower harm than other cigarettes. Little is known about how contemporary adult menthol smokers perceive the harm of their usual brand, and potential differences by race, gender, and young adult versus older adult age group. After adjusting for other factors, menthol smokers were more likely than nonmenthol smokers to perceive their cigarette brand as more harmful than other brands. Further, the association between menthol smoking and harm perceptions differed by race and gender, but not by age group (young adult vs. older adult). This type of large-scale study identifies critical links between menthol smoking and harm perceptions among vulnerable smokers that will inform regulatory actions designed to decrease smoking-related harm. Introduction The Family Smoking Prevention and Tobacco Control Act banned characterizing flavors in cigarettes in the United States in 2009, but did not ban menthol. Its minty and cooling sensation has been hypothesized to mask the harshness of inhaled smoke, contributing to the perception that menthol cigarettes are less harmful and less addictive than nonmenthol cigarettes. Menthol smokers have higher nicotine dependence and greater difficulty quitting, even though they smoke fewer cigarettes per day1–11 and show greater relapse rates.10,11 Perceptions that menthol cigarettes are less harmful than nonmenthol cigarettes may be one reason behind their appeal and use.12 Menthol cigarettes have been historically marketed in such a way to lead consumers to perceive that they are “healthier” than nonmenthol cigarettes,13 through messages promoting “medicinal” and throat soothing properties and health-enhancing effects.13,14 These messages have been primarily targeted toward African-American and Hispanic audiences,15–18 females,19 and young users, all groups who disproportionately use menthol.7,8,18,20–26 The link between harm perceptions and menthol smoking is concerning, given that perception of tobacco-related risk is an important correlate and predictor of tobacco use behavior,12 particularly among younger users.27–29 Published research does not consistently show that menthol cigarettes are perceived as less harmful than nonmenthol cigarettes,30–32 and some studies suggest that harm perceptions of menthol cigarette may vary by age as well as race/ethnicity. In a paper from the International Tobacco Control (ITC) US Survey published in 2011, there was no significant effect of menthol brand on cigarette harm perceptions,33 and findings from a 2012 study also published from the ITC survey similarly showed that menthol smoking was unrelated to smokers’ perceptions of their own brand’s “smoothness,”34 a proposed mechanism linking menthol smoking to lower harm perceptions. In a study of young adult smokers, Richter35 found that African-Americans believed menthol cigarettes were either equally or more harmful than nonmenthol cigarettes, but did not perceive them to be less harmful than nonmenthol cigarettes. Two recently published studies by Wackowski and colleagues of young adult tobacco users and nonusers in the National Young Adult Health Survey and in adults from the New Jersey Adult Tobacco Survey also show that menthol smoking is perceived as more risky than nonmenthol smoking and that few menthol smokers perceive menthol cigarettes to be less risky compared to nonmenthol cigarettes.31,32 In contrast, Allen and colleagues found that age and race may play a role in perceptions of menthol’s harm. They found that older African-American smokers (aged 40 or older) were more likely than younger African-American smokers to perceive menthol cigarettes as less harmful than nonmenthol cigarettes and to hold positive health expectancies of menthol cigarettes (eg, “Menthols help loosen a stuffed up nose better than non-menthols”).36 Furthermore, a recent focus group study with young adult menthol smokers, also conducted by Wackowski and colleagues, showed that most smokers in their study perceived menthol to be less harmful than nonmenthol cigarettes upon smoking initiation, but perceived menthol as more harmful once their smoking progressed.30 Beyond harm perception, cigarette brand may also have an impact on smokers’ use of menthol cigarettes.12,19 Recent changes in menthol cigarette market share show a significant increase in Camel menthol market share, from 5.8% in 2002 to 32.7% in 2013, as well as smaller but significant increases in Marlboro menthol market shares from 10% to 14.5%.37 In an analysis of menthol cigarette advertisements that included mail, print, online, and email over a 9-month period, Richardson and colleagues found that 90% of all types of advertisements promoted Camel, Marlboro, or Newport menthol cigarettes.19 Many of the print advertisements were in magazines with a primarily African-American or female readership. Differences in correlates of menthol use and menthol harm perceptions across cigarette brands may signal marketing and advertising strategies specific to each brand that focus on vulnerable groups, and which could be targeted by regulatory authorities. Although harm perceptions of menthol cigarette smoking have been investigated,7–9,38,39 a paucity of work has examined whether harm perceptions of menthol versus nonmenthol cigarette smoking vary by cigarette brand in adult menthol smokers, and whether harm perceptions differ among sub-groups of adult smokers who disproportionately use menthol cigarettes, namely younger, female, or African-American and Hispanic smokers. Using a population-based sample of current adult smokers in the United States, the first aim of this study was to examine the prevalence and correlates of menthol cigarette smoking among all cigarette brands and again separately across the top three cigarette brands to determine if menthol smokers are a homogeneous group or if there are brand-specific differences among users. Because menthol is disproportionately used by Black, young adult, and female smokers, the second aim was to examine whether the association between menthol smoking and harm perceptions of one’s own brand (if significant), would be moderated by age, race, and gender. That is, are there differences in the strength or direction of association between menthol brand preferences and harm perceptions of smoking by these different groups of menthol smokers? Methods Sample Data are from the Adult Wave 1 Public Use File of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of adults and youth in the United States, ages 12 years and older conducted from September 12, 2013 to December 15, 2014. This analysis draws from the 32320 adults (≥18 years old) interviews. Recruitment involved address-based, area-probability sampling, using an in-person household screener to select participants. Adult tobacco users, young adults ages 18 to 24, and African-Americans were oversampled. Weighting procedures adjusted for oversampling and nonresponse; combined with the use of a probability sample, the weighted data yield representative estimates of the noninstitutionalized, civilian US population in 2012–2013. The weighted response rate for the household screener was 54.0%. Among households that were screened, the overall weighted response rate was 74.0% for the adult interview. Further details regarding the design and methods are available elsewhere.40 Respondents included in the current study were current adult smokers, defined as those who consumed at least 100 cigarettes in their lifetime and who reported currently smoking “some days” or “every day.” For all study variables, responses of “don’t know” and “refused” were treated as missing. Measures Menthol Brand Preference: Respondents who reported having a regular brand of cigarettes were asked to report what brand and sub-brand of cigarettes they usually smoke by selecting from images of cigarette brand logos or “some other brand;” those without a regular brand were asked what brand they last smoked. Based on the brand selected, smokers were then asked what specific sub-brand they smoked (eg, Marlboro Gold nonmenthol 100s). Sub-brands were classified into either menthol or nonmenthol products. Capsule cigarette products, like Camel Crush, that can be both menthol or nonmenthol were classified as “menthol” products. Sub-brand names include the term menthol or nonmenthol. Harm perceptions: Participants were asked about the harm of their usual brand of cigarette compared to other brands: “Do you think the brand of cigarettes you usually smoke might be less harmful, no different, or more harmful compared to other cigarette brands?” Tobacco Use: Participants who reported smoking “everyday” were asked on average, how many cigarettes they smoked each day, and those who reported smoking “some days” were asked on average, how many cigarettes they smoked on the days that they smoked. Number of quit attempts in the past year, and nicotine dependence, as measured by time-to-first cigarette upon waking (<5 min, 5–29 min, >30 min) were also assessed. Those who had not tried to quit in the last year were classified as making zero quit attempts. Demographics: Demographic variables used in analyses included gender, age (18–24; 25–34, 35–44, 45+), race (nonHispanic White, nonHispanic African-American, nonHispanic Other, Hispanic), income (<$10000; $10000–$24999; $25000–$49999; ≥$50000), and education (<high school, high school/GED, some college, college, or higher). Statistical Analyses Prevalence estimates of demographics, tobacco use variables, and harm perception ratings were assessed across menthol and nonmenthol smokers via weighted cross-tabulations, conducted among all cigarette brands and separately across the three most popular brands of cigarettes assessed in the Wave 1 survey. Crude and adjusted odds ratios were then computed via bivariate weighted logistic regressions to examine demographic, tobacco use, and harm perception correlates of menthol smoking status among all cigarette brands and separately across the top three brands. Finally, multinomial logistic regression models were conducted to examine the association of menthol smoking status (independent variable) on harm perceptions of one’s own brand of cigarettes (more harmful vs. no difference and less harmful vs. no difference), among all cigarette brands, and separately across the top three cigarette brands, controlling for demographic and tobacco use correlates. Multinomial regression models used the relative risk ratios because meaningful prevalence estimates were available.41 Because evidence is equivocal regarding the direction of association between menthol smoking and harm perceptions, we examined the extent to which menthol smokers perceived their brand as more harmful (vs. no difference) and less harmful (vs. no difference) compared to other cigarette brands. Interactions of menthol smoking with race, age, and gender were also examined across all brands only. Interactions were not examined separately across three most popular cigarette brands due to insufficient sample sizes in some cells. Analyses were conducted using SVY procedures in Stata/MP version 14.1 to account for the complex survey design. Results Prevalence and Correlates of Menthol Cigarette Smoking Among All Brands and Separately Across the Three Most Popular Cigarette Brands Table 1 shows the prevalence of menthol and nonmenthol smoking among current smokers by all brands and across the three most popular cigarette brands (Newport, Camel, and Marlboro). Overall, 40% of the sample identified that their usual brand of cigarette was a menthol variety. Across all brands, a greater percentage of menthol smokers compared to nonmenthol smokers were younger, female, African-American or Hispanic, reported lower income, and were less likely to have a bachelor’s degree or higher. Overall, menthol smokers reported lower cigarettes per day (CPD), had attempted to quit smoking more times in the past year than nonmenthol smokers, and were more nicotine dependent (ie, smoking within 5 min of waking). Table 1. Demographic and Tobacco Use Characteristics of Menthol Smokers Across the Top Three Cigarette Brands (Newport, Marlboro, and Camel) and Among All Cigarette Brands Total   Newport (1738)  Marlboro (4227)  Camel (1201)  All brands (10238)  Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   94.2% (1640)   5.8% (98)   17.7% (803)   82.3% (3424)   45.5% (592)   54.5% (609)   38.8% (4190)   61.2% (6048)   Age   18–24  19.1% (488)  14.8% (25)  25.8% (289)  15.1% (779)  36.1%% (284)  19.2% (166)  19.1% (1208)  12.6% (1168)   25–34  32.8% (478)  39.8% (33)  38.8% (262)  23.8% (760)  39.7% (198)  35.2% (193)  30.6% (1159)  22.2% (1264)   35–44  30.0% (304)  18.1% (16)  15.5% (116)  23.4% (752)  16.5% (68)  19.6% (105)  17.5% (655)  20.7% (1191)   45+  27.2% (370)  27.3% (24)  20.0% (136)  37.7% (1133)  7.7% (42)  26.1% (145)  32.8% (1168)  44.6% (2424)  Gender   Female  45.7% (808)  35.2% (40)  47.7% (426)  40.2% (1456)  47.1% (297)  33.7% (222)  48.8% (2187)  42.5% (2702)   Male  54.3% (832)  64.8% (58)  50.3% (377)  59.8% (1968)  52.9% (295)  66.3% (387)  51.2% (2003)  57.6% (3346)  Race/Ethnicity   NH White  25.3% (392)  78.4% (72)  76.9% (595)  77.4% (2549)  66.1% (372)  84.5% (498)  49.4% (1982)  80.8% (4710)   NH Black  53.5% (856)  9.3% (9)  4.4% (35)  2.0% (63)  3.6% (20)  2.3% (14)  31.1% (1260)  2.9% (166)   NH other  4.6% (114)  6.6% (11)  6.3% (61)  7.5% (273)  8.7% (56)  5.2% (43)  5.6% (304)  6.3% (448)   Hispanic  16.7% (278)  5.7% (6)  12.4% (112)  13.1% (539)  21.5% (144)  8.0% 54)  14.0% (644)  10.0% (724)  Income   <$10000  32.3% (536)  24.3% (26)  16.7% (138)  17.4% (609)  20.4% (120)  15.2% (105)  25.0% (1006)  17.6% (1074)   $10000–$24999  30.8% (468)  29.8% (27)  24.1% (196)  23.3% (762)  26.2% (160)  24.8% (147)  29.1% (1160)  25.6% (1460)   $25000–$49999  20.9% (304)  36.2% (32)  26.7% (189)  25.7% (796)  29.9% (146)  26.9% (159)  24.4% (916)  26.9% (1442)   $50000+  16.0% (213)  9.7% (8)  32.5% (214)  33.7% (967)  23.6% (120)  33.1% (176)  21.6% (756)  29.9% (1532)  Education   <High School  19.1% (329)  18.5% (22)  10.2% (90)  14.7% (539)  9.4% (62)  11.7% (76)  15.4% (679)  15.2% (964)   HS/GED  43.2% (658)  48.0% (40)  35.5% (280)  39.4% (1276)  30.6% (192)  30.2% (166)  40.1% (1591)  38.5% 2157)   Some college  32.8% (569)  28.2% (30)  43.4% (345)  32.9% (1174)  44.7% (259)  40.3% (265)  35.8% (1544)  33.2% (2127)   Bachelor’s degree or higher  4.9% (74)  5.4% (5)  11.0% (83)  13.0% (406)  15.3% (78)  17.8% (98)  8.7% (347)  13.2% (746)  Cigarettes per day   weighted mean  (standard error)  8.7 (0.2)  11.8 (0.9)  9.6 (0.3)  10.4 (0.2)  8.0 (0.4)  8.6 (0.3)  9.3 (0.2)  10.6 (0.1)  Nicotine dependence   High (<5 min)  57.9% (936)  56.7% (55)  53.5% (433)  52.0% (1793)  54.0% (325)  48.5% (302)  54.9% (2294)  50.7% (3102)   Moderate (5–29 min)  27.5% (464)  30.2% (30)  30.1% (239)  30.9% (1058)  32.1% (189)  35.1% (211)  29.0% (1236)  32.3% (1935)   Low (>30 min)  14.7% (240)  13.2% (13)  16.4% (131)  17.1% (573)  14.0% (78)  16.4% (96)  16.1% (660)  17.0% (1011)  Number of times tried to quit in the past year   weighted mean  (standard error)  2.2 (0.3)  1.2 (0.2)  1.9 (0.3)  2.2 (0.5)  1.5 (0.1)  1.7 (0.8)  4.4 (1.6)  1.9 (0.3)  Harm perceptions of your brand compared to other brands   No difference  74.7% (1218)  90.4% (89)  86.0% (686)  85.8% (2927)  85.1% (501)  88.0% (534)  79.8% (3330)  83.9% (5056)   Less harmful  3.6% (60)  3.3% (3)  5.2% (39)  8.2% (269)  3.8% (20)  6.5% (38)  6.6% (256)  11.2% (652)   More harmful  21.6% (356)  6.3% (6)  8.8% (77)  6.0% (211)  11.1% (69)  5.5% (33)  13.6% (585)  4.9% (306)  Total   Newport (1738)  Marlboro (4227)  Camel (1201)  All brands (10238)  Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   94.2% (1640)   5.8% (98)   17.7% (803)   82.3% (3424)   45.5% (592)   54.5% (609)   38.8% (4190)   61.2% (6048)   Age   18–24  19.1% (488)  14.8% (25)  25.8% (289)  15.1% (779)  36.1%% (284)  19.2% (166)  19.1% (1208)  12.6% (1168)   25–34  32.8% (478)  39.8% (33)  38.8% (262)  23.8% (760)  39.7% (198)  35.2% (193)  30.6% (1159)  22.2% (1264)   35–44  30.0% (304)  18.1% (16)  15.5% (116)  23.4% (752)  16.5% (68)  19.6% (105)  17.5% (655)  20.7% (1191)   45+  27.2% (370)  27.3% (24)  20.0% (136)  37.7% (1133)  7.7% (42)  26.1% (145)  32.8% (1168)  44.6% (2424)  Gender   Female  45.7% (808)  35.2% (40)  47.7% (426)  40.2% (1456)  47.1% (297)  33.7% (222)  48.8% (2187)  42.5% (2702)   Male  54.3% (832)  64.8% (58)  50.3% (377)  59.8% (1968)  52.9% (295)  66.3% (387)  51.2% (2003)  57.6% (3346)  Race/Ethnicity   NH White  25.3% (392)  78.4% (72)  76.9% (595)  77.4% (2549)  66.1% (372)  84.5% (498)  49.4% (1982)  80.8% (4710)   NH Black  53.5% (856)  9.3% (9)  4.4% (35)  2.0% (63)  3.6% (20)  2.3% (14)  31.1% (1260)  2.9% (166)   NH other  4.6% (114)  6.6% (11)  6.3% (61)  7.5% (273)  8.7% (56)  5.2% (43)  5.6% (304)  6.3% (448)   Hispanic  16.7% (278)  5.7% (6)  12.4% (112)  13.1% (539)  21.5% (144)  8.0% 54)  14.0% (644)  10.0% (724)  Income   <$10000  32.3% (536)  24.3% (26)  16.7% (138)  17.4% (609)  20.4% (120)  15.2% (105)  25.0% (1006)  17.6% (1074)   $10000–$24999  30.8% (468)  29.8% (27)  24.1% (196)  23.3% (762)  26.2% (160)  24.8% (147)  29.1% (1160)  25.6% (1460)   $25000–$49999  20.9% (304)  36.2% (32)  26.7% (189)  25.7% (796)  29.9% (146)  26.9% (159)  24.4% (916)  26.9% (1442)   $50000+  16.0% (213)  9.7% (8)  32.5% (214)  33.7% (967)  23.6% (120)  33.1% (176)  21.6% (756)  29.9% (1532)  Education   <High School  19.1% (329)  18.5% (22)  10.2% (90)  14.7% (539)  9.4% (62)  11.7% (76)  15.4% (679)  15.2% (964)   HS/GED  43.2% (658)  48.0% (40)  35.5% (280)  39.4% (1276)  30.6% (192)  30.2% (166)  40.1% (1591)  38.5% 2157)   Some college  32.8% (569)  28.2% (30)  43.4% (345)  32.9% (1174)  44.7% (259)  40.3% (265)  35.8% (1544)  33.2% (2127)   Bachelor’s degree or higher  4.9% (74)  5.4% (5)  11.0% (83)  13.0% (406)  15.3% (78)  17.8% (98)  8.7% (347)  13.2% (746)  Cigarettes per day   weighted mean  (standard error)  8.7 (0.2)  11.8 (0.9)  9.6 (0.3)  10.4 (0.2)  8.0 (0.4)  8.6 (0.3)  9.3 (0.2)  10.6 (0.1)  Nicotine dependence   High (<5 min)  57.9% (936)  56.7% (55)  53.5% (433)  52.0% (1793)  54.0% (325)  48.5% (302)  54.9% (2294)  50.7% (3102)   Moderate (5–29 min)  27.5% (464)  30.2% (30)  30.1% (239)  30.9% (1058)  32.1% (189)  35.1% (211)  29.0% (1236)  32.3% (1935)   Low (>30 min)  14.7% (240)  13.2% (13)  16.4% (131)  17.1% (573)  14.0% (78)  16.4% (96)  16.1% (660)  17.0% (1011)  Number of times tried to quit in the past year   weighted mean  (standard error)  2.2 (0.3)  1.2 (0.2)  1.9 (0.3)  2.2 (0.5)  1.5 (0.1)  1.7 (0.8)  4.4 (1.6)  1.9 (0.3)  Harm perceptions of your brand compared to other brands   No difference  74.7% (1218)  90.4% (89)  86.0% (686)  85.8% (2927)  85.1% (501)  88.0% (534)  79.8% (3330)  83.9% (5056)   Less harmful  3.6% (60)  3.3% (3)  5.2% (39)  8.2% (269)  3.8% (20)  6.5% (38)  6.6% (256)  11.2% (652)   More harmful  21.6% (356)  6.3% (6)  8.8% (77)  6.0% (211)  11.1% (69)  5.5% (33)  13.6% (585)  4.9% (306)  PATH Wave 1 Data (weighted column %; unweighted n). Current smokers defined as those who consumed at least 100 cigarettes in their lifetime and who currently smoked “somedays” or “every day.” Camel Crush cigarettes coded as menthol. “Don’t know” and “refused” responses coded as missing. View Large Table 1. Demographic and Tobacco Use Characteristics of Menthol Smokers Across the Top Three Cigarette Brands (Newport, Marlboro, and Camel) and Among All Cigarette Brands Total   Newport (1738)  Marlboro (4227)  Camel (1201)  All brands (10238)  Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   94.2% (1640)   5.8% (98)   17.7% (803)   82.3% (3424)   45.5% (592)   54.5% (609)   38.8% (4190)   61.2% (6048)   Age   18–24  19.1% (488)  14.8% (25)  25.8% (289)  15.1% (779)  36.1%% (284)  19.2% (166)  19.1% (1208)  12.6% (1168)   25–34  32.8% (478)  39.8% (33)  38.8% (262)  23.8% (760)  39.7% (198)  35.2% (193)  30.6% (1159)  22.2% (1264)   35–44  30.0% (304)  18.1% (16)  15.5% (116)  23.4% (752)  16.5% (68)  19.6% (105)  17.5% (655)  20.7% (1191)   45+  27.2% (370)  27.3% (24)  20.0% (136)  37.7% (1133)  7.7% (42)  26.1% (145)  32.8% (1168)  44.6% (2424)  Gender   Female  45.7% (808)  35.2% (40)  47.7% (426)  40.2% (1456)  47.1% (297)  33.7% (222)  48.8% (2187)  42.5% (2702)   Male  54.3% (832)  64.8% (58)  50.3% (377)  59.8% (1968)  52.9% (295)  66.3% (387)  51.2% (2003)  57.6% (3346)  Race/Ethnicity   NH White  25.3% (392)  78.4% (72)  76.9% (595)  77.4% (2549)  66.1% (372)  84.5% (498)  49.4% (1982)  80.8% (4710)   NH Black  53.5% (856)  9.3% (9)  4.4% (35)  2.0% (63)  3.6% (20)  2.3% (14)  31.1% (1260)  2.9% (166)   NH other  4.6% (114)  6.6% (11)  6.3% (61)  7.5% (273)  8.7% (56)  5.2% (43)  5.6% (304)  6.3% (448)   Hispanic  16.7% (278)  5.7% (6)  12.4% (112)  13.1% (539)  21.5% (144)  8.0% 54)  14.0% (644)  10.0% (724)  Income   <$10000  32.3% (536)  24.3% (26)  16.7% (138)  17.4% (609)  20.4% (120)  15.2% (105)  25.0% (1006)  17.6% (1074)   $10000–$24999  30.8% (468)  29.8% (27)  24.1% (196)  23.3% (762)  26.2% (160)  24.8% (147)  29.1% (1160)  25.6% (1460)   $25000–$49999  20.9% (304)  36.2% (32)  26.7% (189)  25.7% (796)  29.9% (146)  26.9% (159)  24.4% (916)  26.9% (1442)   $50000+  16.0% (213)  9.7% (8)  32.5% (214)  33.7% (967)  23.6% (120)  33.1% (176)  21.6% (756)  29.9% (1532)  Education   <High School  19.1% (329)  18.5% (22)  10.2% (90)  14.7% (539)  9.4% (62)  11.7% (76)  15.4% (679)  15.2% (964)   HS/GED  43.2% (658)  48.0% (40)  35.5% (280)  39.4% (1276)  30.6% (192)  30.2% (166)  40.1% (1591)  38.5% 2157)   Some college  32.8% (569)  28.2% (30)  43.4% (345)  32.9% (1174)  44.7% (259)  40.3% (265)  35.8% (1544)  33.2% (2127)   Bachelor’s degree or higher  4.9% (74)  5.4% (5)  11.0% (83)  13.0% (406)  15.3% (78)  17.8% (98)  8.7% (347)  13.2% (746)  Cigarettes per day   weighted mean  (standard error)  8.7 (0.2)  11.8 (0.9)  9.6 (0.3)  10.4 (0.2)  8.0 (0.4)  8.6 (0.3)  9.3 (0.2)  10.6 (0.1)  Nicotine dependence   High (<5 min)  57.9% (936)  56.7% (55)  53.5% (433)  52.0% (1793)  54.0% (325)  48.5% (302)  54.9% (2294)  50.7% (3102)   Moderate (5–29 min)  27.5% (464)  30.2% (30)  30.1% (239)  30.9% (1058)  32.1% (189)  35.1% (211)  29.0% (1236)  32.3% (1935)   Low (>30 min)  14.7% (240)  13.2% (13)  16.4% (131)  17.1% (573)  14.0% (78)  16.4% (96)  16.1% (660)  17.0% (1011)  Number of times tried to quit in the past year   weighted mean  (standard error)  2.2 (0.3)  1.2 (0.2)  1.9 (0.3)  2.2 (0.5)  1.5 (0.1)  1.7 (0.8)  4.4 (1.6)  1.9 (0.3)  Harm perceptions of your brand compared to other brands   No difference  74.7% (1218)  90.4% (89)  86.0% (686)  85.8% (2927)  85.1% (501)  88.0% (534)  79.8% (3330)  83.9% (5056)   Less harmful  3.6% (60)  3.3% (3)  5.2% (39)  8.2% (269)  3.8% (20)  6.5% (38)  6.6% (256)  11.2% (652)   More harmful  21.6% (356)  6.3% (6)  8.8% (77)  6.0% (211)  11.1% (69)  5.5% (33)  13.6% (585)  4.9% (306)  Total   Newport (1738)  Marlboro (4227)  Camel (1201)  All brands (10238)  Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   Menthol   Nonmenthol   94.2% (1640)   5.8% (98)   17.7% (803)   82.3% (3424)   45.5% (592)   54.5% (609)   38.8% (4190)   61.2% (6048)   Age   18–24  19.1% (488)  14.8% (25)  25.8% (289)  15.1% (779)  36.1%% (284)  19.2% (166)  19.1% (1208)  12.6% (1168)   25–34  32.8% (478)  39.8% (33)  38.8% (262)  23.8% (760)  39.7% (198)  35.2% (193)  30.6% (1159)  22.2% (1264)   35–44  30.0% (304)  18.1% (16)  15.5% (116)  23.4% (752)  16.5% (68)  19.6% (105)  17.5% (655)  20.7% (1191)   45+  27.2% (370)  27.3% (24)  20.0% (136)  37.7% (1133)  7.7% (42)  26.1% (145)  32.8% (1168)  44.6% (2424)  Gender   Female  45.7% (808)  35.2% (40)  47.7% (426)  40.2% (1456)  47.1% (297)  33.7% (222)  48.8% (2187)  42.5% (2702)   Male  54.3% (832)  64.8% (58)  50.3% (377)  59.8% (1968)  52.9% (295)  66.3% (387)  51.2% (2003)  57.6% (3346)  Race/Ethnicity   NH White  25.3% (392)  78.4% (72)  76.9% (595)  77.4% (2549)  66.1% (372)  84.5% (498)  49.4% (1982)  80.8% (4710)   NH Black  53.5% (856)  9.3% (9)  4.4% (35)  2.0% (63)  3.6% (20)  2.3% (14)  31.1% (1260)  2.9% (166)   NH other  4.6% (114)  6.6% (11)  6.3% (61)  7.5% (273)  8.7% (56)  5.2% (43)  5.6% (304)  6.3% (448)   Hispanic  16.7% (278)  5.7% (6)  12.4% (112)  13.1% (539)  21.5% (144)  8.0% 54)  14.0% (644)  10.0% (724)  Income   <$10000  32.3% (536)  24.3% (26)  16.7% (138)  17.4% (609)  20.4% (120)  15.2% (105)  25.0% (1006)  17.6% (1074)   $10000–$24999  30.8% (468)  29.8% (27)  24.1% (196)  23.3% (762)  26.2% (160)  24.8% (147)  29.1% (1160)  25.6% (1460)   $25000–$49999  20.9% (304)  36.2% (32)  26.7% (189)  25.7% (796)  29.9% (146)  26.9% (159)  24.4% (916)  26.9% (1442)   $50000+  16.0% (213)  9.7% (8)  32.5% (214)  33.7% (967)  23.6% (120)  33.1% (176)  21.6% (756)  29.9% (1532)  Education   <High School  19.1% (329)  18.5% (22)  10.2% (90)  14.7% (539)  9.4% (62)  11.7% (76)  15.4% (679)  15.2% (964)   HS/GED  43.2% (658)  48.0% (40)  35.5% (280)  39.4% (1276)  30.6% (192)  30.2% (166)  40.1% (1591)  38.5% 2157)   Some college  32.8% (569)  28.2% (30)  43.4% (345)  32.9% (1174)  44.7% (259)  40.3% (265)  35.8% (1544)  33.2% (2127)   Bachelor’s degree or higher  4.9% (74)  5.4% (5)  11.0% (83)  13.0% (406)  15.3% (78)  17.8% (98)  8.7% (347)  13.2% (746)  Cigarettes per day   weighted mean  (standard error)  8.7 (0.2)  11.8 (0.9)  9.6 (0.3)  10.4 (0.2)  8.0 (0.4)  8.6 (0.3)  9.3 (0.2)  10.6 (0.1)  Nicotine dependence   High (<5 min)  57.9% (936)  56.7% (55)  53.5% (433)  52.0% (1793)  54.0% (325)  48.5% (302)  54.9% (2294)  50.7% (3102)   Moderate (5–29 min)  27.5% (464)  30.2% (30)  30.1% (239)  30.9% (1058)  32.1% (189)  35.1% (211)  29.0% (1236)  32.3% (1935)   Low (>30 min)  14.7% (240)  13.2% (13)  16.4% (131)  17.1% (573)  14.0% (78)  16.4% (96)  16.1% (660)  17.0% (1011)  Number of times tried to quit in the past year   weighted mean  (standard error)  2.2 (0.3)  1.2 (0.2)  1.9 (0.3)  2.2 (0.5)  1.5 (0.1)  1.7 (0.8)  4.4 (1.6)  1.9 (0.3)  Harm perceptions of your brand compared to other brands   No difference  74.7% (1218)  90.4% (89)  86.0% (686)  85.8% (2927)  85.1% (501)  88.0% (534)  79.8% (3330)  83.9% (5056)   Less harmful  3.6% (60)  3.3% (3)  5.2% (39)  8.2% (269)  3.8% (20)  6.5% (38)  6.6% (256)  11.2% (652)   More harmful  21.6% (356)  6.3% (6)  8.8% (77)  6.0% (211)  11.1% (69)  5.5% (33)  13.6% (585)  4.9% (306)  PATH Wave 1 Data (weighted column %; unweighted n). Current smokers defined as those who consumed at least 100 cigarettes in their lifetime and who currently smoked “somedays” or “every day.” Camel Crush cigarettes coded as menthol. “Don’t know” and “refused” responses coded as missing. View Large Differences in the prevalence of menthol versus nonmenthol cigarette smoking emerged across the top three brands. The majority of Newport smokers identified a menthol variety as their usual cigarette type (94%), compared with 46% of Camel smokers who identified menthol as their usual variety, and 18% of Marlboro smokers. Camel smokers who used a menthol variety had a higher prevalence of users who were young adults (aged 18–24) compared to smokers of other brands who used a menthol variety (36% for Camel, 26% for Marlboro, and 19% for Newport). Newport smokers of a menthol variety were primarily African-American (53.5%), while Marlboro and Camel smokers of a menthol variety were primarily white (76.9% for Marlboro and 66.1% for Camel). Prevalence estimates of harm perceptions are also reported in Table 1. Across all brands, most menthol smokers (80%) perceived their brand to be equally as harmful as other brands (ie, no difference in harm), 14% of menthol smokers perceived their brand to be more harmful than other brands, and 7% of menthol smokers perceived their brand to be less harmful. Among nonmenthol smokers, 84% perceived their brand to be equally harmful as other brands, 5% perceived their brand to be more harmful, and 11% perceived their brand to be less harmful. Table 2 shows crude and adjusted odds ratios of correlates of menthol cigarette smoking across the top three brands and all cigarette brands from logistic regression models. Across all cigarette brands, menthol smoking was associated with younger age, female gender, nonWhite race/ethnicity, and lower education. Across the top three brands, female gender was the only correlate consistently associated with menthol cigarette smoking in adjusted models for Newport, Marlboro, and Camel. There were age variations in menthol cigarette smoking across the three brands as well. Specifically, for both Marlboro and Camel smokers, all age groups were more likely than the oldest age group (45+) to use menthol (vs. nonmenthol) versions of these brands; whereas for Newport cigarettes, only young adults (ages 18–24) were more likely than the oldest adults (45+) to use menthol cigarette versions of this brand. Table 2. Crude and Adjusted Odds Ratios or Correlates of Menthol Smoking Across the Top Three Cigarette Brands and All Cigarette Brands; n = 11402 Current Adult Cigarette Smokers, PATH Wave 1   Newport menthol (vs. Newport nonmenthol)   Marlboro menthol (vs. Marlboro nonmenthol)   Camel menthol (vs. Camel nonmenthol)   All brands (menthol vs. nonmenthol)   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Age, n = 10237   18–24  1.29[0.60, 2.79]  2.87 [1.30, 6.30]  3.21 [2.48, 4.17]  3.72 [2.82, 4.90]  6.33 [4.32, 9.53]  6.20 [3.84, 10.01]  2.07 [1.79, 2.38]  2.79 [2.38, 3.26]   25–34  0.83 [0.43, 1.58]  1.54 [0.70, 3.37]  3.06 [2.36, 3.98]  3.49 [2.66, 4.57]  3.81 [2.51, 5.77]  3.91 [2.53, 6.03]  1.88 [1.66, 2.13]  2.53 [2.22, 2.87]   35–44  1.16 [0.57, 2.37]  1.67 [0.75, 3.75]  1.24 [0.94, 1.64]  1.31 [0.98, 1.77]  2.84 [1.75, 4.61]  2.90 [1.70, 4.93]  1.13 [1.00, 1.33]  1.39 [1.18, 1.64]   45+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.54 [1.02, 2.34]  2.18 [1.31, 3.64]  1.47 [1.21, 1.78]  1.65 [1.34, 2.01]  1.75 [1.37, 2.24]  1.92 [1.41, 2.60]  1.29 [1.18,1.40]  1.61 [1.45, 1.78]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238   NH White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   NH Black  17.79 [7.83, 40.45]  24.07 [8.78, 65.97]  2.26 [1.29, 3.93]  3.42 [1.91, 6.12]  1.97[0.89,4.33]  2.45 [0.94, 6.36]  17.64 [14.43, 21.57]  22.22 [17.94, 27.52]   NH Other  2.16 [1.23, 3.80]  2.08 [1.13, 3.81]  0.85 [0.54, 1.33]  0.83 [0.51, 1.37]  2.14[1.12,4.10]  2.00 [0.95, 4.21]  1.46 [1.12, 1.91]  1.41 [1.01, 1.88]   Hispanic  9.13 [3.32, 15.09]  15.34 [5.22, 45.06]  0.95 [0.73, 1.23]  1.12 [0.86, 1.46]  3.45[2.17,5.51]  3.16 [1.88, 5.30]  2.28 [1.97, 2.65]  2.29 [1.95, 2.68]  Income, n = 9401   Less than $10000  0.81 [0.26, 2.49]  0.27 [0.07, 1.04]  0.99 [0.75, 1.31]  0.82 [0.59, 1.13]  1.89 [1.21, 2.94]  1.42 [0.88, 2.32]  1.97 [1.70, 2.29]  1.07 [0.91, 1.25]   $10000–$24999  0.63 [0.23, 1.72]  0.33 [0.11, 1.01]  1.07 [0.83, 1.39]  0.89 [0.67, 1.16]  1.48 [1.05, 2.08]  1.21 [0.83, 1.77]  1.57 [1.40, 1.78]  1.08 [0.96, 1.22]   $25000–$49999  0.35 [0.13, 0.95]  0.22 [0.07, 0.68]  1.08 [0.84, 1.39]  0.95 [0.71, 1.26]  1.56 [1.08, 2.25]  1.49 [0.99, 2.22]  1.26 [1.10, 1.43]  0.99 [0.85, 1.14]   $50000+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Education, n = 10,165   <High school  1.13 [0.34, 3.83]  1.16 [0.28, 4.79]  0.82 [0.55, 1.22]  0.83 [0.54, 1.26]  0.93[0.56, 1.55]  0.77 [0.43, 1.38]  1.52 [1.28, 1.80]  0.99 [0.80, 1.24]   HS/GED  0.98 [0.32, 3.05]  1.26 [0.37, 4.35]  1.07 [0.75, 1.53]  1.07 [0.76, 1.52]  1.18 [0.76, 1.82]  1.12 [0.69, 1.84]  1.57 [1.31, 1.87]  1.26 [1.04, 1.53]   Some college  1.27 [0.40, 4.07]  1.51 [0.44, 5.13]  1.57 [1.12, 2.19]  1.50 [1.07, 2.10]  1.29 [0.87, 1.90]  1.08 [0.71, 1.66]  1.62 [1.40, 1.89]  1.31 [1.09, 1.57]   Bachelor’s or higher  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Cigarettes per day, n = 10238   Cigarettes per day  0.95 [0.92, 0.98]  0.97 [0.94, 1.01]  0.99 [0.98, 1.00]  1.00 [0.99, 1.01]  0.99[0.97,1.01]  1.01 [0.99, 1.03]  0.98 [0.98, 0.99]  1.00 [0.99, 1.01]  Nicotine Dependence n = 10238   High (<5 min)  0.92 [0.47, 1.80]  0.79 [0.36, 1.72]  1.08 [0.85, 1.37]  1.04 [0.81, 1.34]  1.31 [0.91, 1.90]]  1.08 [0.71, 1.64]  1.14 [1.02, 1.27]  0.93 [0.80, 1.09]   Moderate (5–29 min)  0.82 [0.41, 1.63]  0.94 [0.40, 2.19]  1.02 [0.80, 1.31]  1.00 [0.74, 1.37]  1.08 [0.75, 1.54]  1.02 [0.67, 1.55]  0.94 [0.84, 1.06]  0.96 [0.85, 1.09]   Low (>30 min)  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Number of quit attempts in past year, n = 10186   Times tried to quit  1.06 [0.98, 1.15]  1.03 [0.96, 1.10]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  1.00 [0.98, 1.02]  1.00 [0.99, 1.01]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  Harm Perceptions of your own brand compared to other cigarette brands n = 10185  No difference  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   Less harmful  1.3 [0.25, 7.09]  0.96 [0.14, 6.47]  0.63 [0.44, 0.91]  0.68 [0.43, 1.08]  0.60 [0.34, 1.07]  0.77 [0.41, 1.52]  0.62 [0.53, 0.72]  0.60 [0.49, 0.74]   More harmful  4.16 [1.59, 10.88]  11.54 [3.12, 42.71]  1.47 [1.13, 1.92]  1.39 [1.01, 1.91]  2.10 [1.31, 3.38]  2.96 [1.77, 4.98]  2.94 [2.52, 3.43]  2.80 [2.31, 3.40]    Newport menthol (vs. Newport nonmenthol)   Marlboro menthol (vs. Marlboro nonmenthol)   Camel menthol (vs. Camel nonmenthol)   All brands (menthol vs. nonmenthol)   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Age, n = 10237   18–24  1.29[0.60, 2.79]  2.87 [1.30, 6.30]  3.21 [2.48, 4.17]  3.72 [2.82, 4.90]  6.33 [4.32, 9.53]  6.20 [3.84, 10.01]  2.07 [1.79, 2.38]  2.79 [2.38, 3.26]   25–34  0.83 [0.43, 1.58]  1.54 [0.70, 3.37]  3.06 [2.36, 3.98]  3.49 [2.66, 4.57]  3.81 [2.51, 5.77]  3.91 [2.53, 6.03]  1.88 [1.66, 2.13]  2.53 [2.22, 2.87]   35–44  1.16 [0.57, 2.37]  1.67 [0.75, 3.75]  1.24 [0.94, 1.64]  1.31 [0.98, 1.77]  2.84 [1.75, 4.61]  2.90 [1.70, 4.93]  1.13 [1.00, 1.33]  1.39 [1.18, 1.64]   45+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.54 [1.02, 2.34]  2.18 [1.31, 3.64]  1.47 [1.21, 1.78]  1.65 [1.34, 2.01]  1.75 [1.37, 2.24]  1.92 [1.41, 2.60]  1.29 [1.18,1.40]  1.61 [1.45, 1.78]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238   NH White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   NH Black  17.79 [7.83, 40.45]  24.07 [8.78, 65.97]  2.26 [1.29, 3.93]  3.42 [1.91, 6.12]  1.97[0.89,4.33]  2.45 [0.94, 6.36]  17.64 [14.43, 21.57]  22.22 [17.94, 27.52]   NH Other  2.16 [1.23, 3.80]  2.08 [1.13, 3.81]  0.85 [0.54, 1.33]  0.83 [0.51, 1.37]  2.14[1.12,4.10]  2.00 [0.95, 4.21]  1.46 [1.12, 1.91]  1.41 [1.01, 1.88]   Hispanic  9.13 [3.32, 15.09]  15.34 [5.22, 45.06]  0.95 [0.73, 1.23]  1.12 [0.86, 1.46]  3.45[2.17,5.51]  3.16 [1.88, 5.30]  2.28 [1.97, 2.65]  2.29 [1.95, 2.68]  Income, n = 9401   Less than $10000  0.81 [0.26, 2.49]  0.27 [0.07, 1.04]  0.99 [0.75, 1.31]  0.82 [0.59, 1.13]  1.89 [1.21, 2.94]  1.42 [0.88, 2.32]  1.97 [1.70, 2.29]  1.07 [0.91, 1.25]   $10000–$24999  0.63 [0.23, 1.72]  0.33 [0.11, 1.01]  1.07 [0.83, 1.39]  0.89 [0.67, 1.16]  1.48 [1.05, 2.08]  1.21 [0.83, 1.77]  1.57 [1.40, 1.78]  1.08 [0.96, 1.22]   $25000–$49999  0.35 [0.13, 0.95]  0.22 [0.07, 0.68]  1.08 [0.84, 1.39]  0.95 [0.71, 1.26]  1.56 [1.08, 2.25]  1.49 [0.99, 2.22]  1.26 [1.10, 1.43]  0.99 [0.85, 1.14]   $50000+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Education, n = 10,165   <High school  1.13 [0.34, 3.83]  1.16 [0.28, 4.79]  0.82 [0.55, 1.22]  0.83 [0.54, 1.26]  0.93[0.56, 1.55]  0.77 [0.43, 1.38]  1.52 [1.28, 1.80]  0.99 [0.80, 1.24]   HS/GED  0.98 [0.32, 3.05]  1.26 [0.37, 4.35]  1.07 [0.75, 1.53]  1.07 [0.76, 1.52]  1.18 [0.76, 1.82]  1.12 [0.69, 1.84]  1.57 [1.31, 1.87]  1.26 [1.04, 1.53]   Some college  1.27 [0.40, 4.07]  1.51 [0.44, 5.13]  1.57 [1.12, 2.19]  1.50 [1.07, 2.10]  1.29 [0.87, 1.90]  1.08 [0.71, 1.66]  1.62 [1.40, 1.89]  1.31 [1.09, 1.57]   Bachelor’s or higher  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Cigarettes per day, n = 10238   Cigarettes per day  0.95 [0.92, 0.98]  0.97 [0.94, 1.01]  0.99 [0.98, 1.00]  1.00 [0.99, 1.01]  0.99[0.97,1.01]  1.01 [0.99, 1.03]  0.98 [0.98, 0.99]  1.00 [0.99, 1.01]  Nicotine Dependence n = 10238   High (<5 min)  0.92 [0.47, 1.80]  0.79 [0.36, 1.72]  1.08 [0.85, 1.37]  1.04 [0.81, 1.34]  1.31 [0.91, 1.90]]  1.08 [0.71, 1.64]  1.14 [1.02, 1.27]  0.93 [0.80, 1.09]   Moderate (5–29 min)  0.82 [0.41, 1.63]  0.94 [0.40, 2.19]  1.02 [0.80, 1.31]  1.00 [0.74, 1.37]  1.08 [0.75, 1.54]  1.02 [0.67, 1.55]  0.94 [0.84, 1.06]  0.96 [0.85, 1.09]   Low (>30 min)  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Number of quit attempts in past year, n = 10186   Times tried to quit  1.06 [0.98, 1.15]  1.03 [0.96, 1.10]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  1.00 [0.98, 1.02]  1.00 [0.99, 1.01]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  Harm Perceptions of your own brand compared to other cigarette brands n = 10185  No difference  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   Less harmful  1.3 [0.25, 7.09]  0.96 [0.14, 6.47]  0.63 [0.44, 0.91]  0.68 [0.43, 1.08]  0.60 [0.34, 1.07]  0.77 [0.41, 1.52]  0.62 [0.53, 0.72]  0.60 [0.49, 0.74]   More harmful  4.16 [1.59, 10.88]  11.54 [3.12, 42.71]  1.47 [1.13, 1.92]  1.39 [1.01, 1.91]  2.10 [1.31, 3.38]  2.96 [1.77, 4.98]  2.94 [2.52, 3.43]  2.80 [2.31, 3.40]  Bold = significant at p < .05 level or lower. View Large Table 2. Crude and Adjusted Odds Ratios or Correlates of Menthol Smoking Across the Top Three Cigarette Brands and All Cigarette Brands; n = 11402 Current Adult Cigarette Smokers, PATH Wave 1   Newport menthol (vs. Newport nonmenthol)   Marlboro menthol (vs. Marlboro nonmenthol)   Camel menthol (vs. Camel nonmenthol)   All brands (menthol vs. nonmenthol)   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Age, n = 10237   18–24  1.29[0.60, 2.79]  2.87 [1.30, 6.30]  3.21 [2.48, 4.17]  3.72 [2.82, 4.90]  6.33 [4.32, 9.53]  6.20 [3.84, 10.01]  2.07 [1.79, 2.38]  2.79 [2.38, 3.26]   25–34  0.83 [0.43, 1.58]  1.54 [0.70, 3.37]  3.06 [2.36, 3.98]  3.49 [2.66, 4.57]  3.81 [2.51, 5.77]  3.91 [2.53, 6.03]  1.88 [1.66, 2.13]  2.53 [2.22, 2.87]   35–44  1.16 [0.57, 2.37]  1.67 [0.75, 3.75]  1.24 [0.94, 1.64]  1.31 [0.98, 1.77]  2.84 [1.75, 4.61]  2.90 [1.70, 4.93]  1.13 [1.00, 1.33]  1.39 [1.18, 1.64]   45+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.54 [1.02, 2.34]  2.18 [1.31, 3.64]  1.47 [1.21, 1.78]  1.65 [1.34, 2.01]  1.75 [1.37, 2.24]  1.92 [1.41, 2.60]  1.29 [1.18,1.40]  1.61 [1.45, 1.78]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238   NH White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   NH Black  17.79 [7.83, 40.45]  24.07 [8.78, 65.97]  2.26 [1.29, 3.93]  3.42 [1.91, 6.12]  1.97[0.89,4.33]  2.45 [0.94, 6.36]  17.64 [14.43, 21.57]  22.22 [17.94, 27.52]   NH Other  2.16 [1.23, 3.80]  2.08 [1.13, 3.81]  0.85 [0.54, 1.33]  0.83 [0.51, 1.37]  2.14[1.12,4.10]  2.00 [0.95, 4.21]  1.46 [1.12, 1.91]  1.41 [1.01, 1.88]   Hispanic  9.13 [3.32, 15.09]  15.34 [5.22, 45.06]  0.95 [0.73, 1.23]  1.12 [0.86, 1.46]  3.45[2.17,5.51]  3.16 [1.88, 5.30]  2.28 [1.97, 2.65]  2.29 [1.95, 2.68]  Income, n = 9401   Less than $10000  0.81 [0.26, 2.49]  0.27 [0.07, 1.04]  0.99 [0.75, 1.31]  0.82 [0.59, 1.13]  1.89 [1.21, 2.94]  1.42 [0.88, 2.32]  1.97 [1.70, 2.29]  1.07 [0.91, 1.25]   $10000–$24999  0.63 [0.23, 1.72]  0.33 [0.11, 1.01]  1.07 [0.83, 1.39]  0.89 [0.67, 1.16]  1.48 [1.05, 2.08]  1.21 [0.83, 1.77]  1.57 [1.40, 1.78]  1.08 [0.96, 1.22]   $25000–$49999  0.35 [0.13, 0.95]  0.22 [0.07, 0.68]  1.08 [0.84, 1.39]  0.95 [0.71, 1.26]  1.56 [1.08, 2.25]  1.49 [0.99, 2.22]  1.26 [1.10, 1.43]  0.99 [0.85, 1.14]   $50000+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Education, n = 10,165   <High school  1.13 [0.34, 3.83]  1.16 [0.28, 4.79]  0.82 [0.55, 1.22]  0.83 [0.54, 1.26]  0.93[0.56, 1.55]  0.77 [0.43, 1.38]  1.52 [1.28, 1.80]  0.99 [0.80, 1.24]   HS/GED  0.98 [0.32, 3.05]  1.26 [0.37, 4.35]  1.07 [0.75, 1.53]  1.07 [0.76, 1.52]  1.18 [0.76, 1.82]  1.12 [0.69, 1.84]  1.57 [1.31, 1.87]  1.26 [1.04, 1.53]   Some college  1.27 [0.40, 4.07]  1.51 [0.44, 5.13]  1.57 [1.12, 2.19]  1.50 [1.07, 2.10]  1.29 [0.87, 1.90]  1.08 [0.71, 1.66]  1.62 [1.40, 1.89]  1.31 [1.09, 1.57]   Bachelor’s or higher  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Cigarettes per day, n = 10238   Cigarettes per day  0.95 [0.92, 0.98]  0.97 [0.94, 1.01]  0.99 [0.98, 1.00]  1.00 [0.99, 1.01]  0.99[0.97,1.01]  1.01 [0.99, 1.03]  0.98 [0.98, 0.99]  1.00 [0.99, 1.01]  Nicotine Dependence n = 10238   High (<5 min)  0.92 [0.47, 1.80]  0.79 [0.36, 1.72]  1.08 [0.85, 1.37]  1.04 [0.81, 1.34]  1.31 [0.91, 1.90]]  1.08 [0.71, 1.64]  1.14 [1.02, 1.27]  0.93 [0.80, 1.09]   Moderate (5–29 min)  0.82 [0.41, 1.63]  0.94 [0.40, 2.19]  1.02 [0.80, 1.31]  1.00 [0.74, 1.37]  1.08 [0.75, 1.54]  1.02 [0.67, 1.55]  0.94 [0.84, 1.06]  0.96 [0.85, 1.09]   Low (>30 min)  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Number of quit attempts in past year, n = 10186   Times tried to quit  1.06 [0.98, 1.15]  1.03 [0.96, 1.10]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  1.00 [0.98, 1.02]  1.00 [0.99, 1.01]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  Harm Perceptions of your own brand compared to other cigarette brands n = 10185  No difference  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   Less harmful  1.3 [0.25, 7.09]  0.96 [0.14, 6.47]  0.63 [0.44, 0.91]  0.68 [0.43, 1.08]  0.60 [0.34, 1.07]  0.77 [0.41, 1.52]  0.62 [0.53, 0.72]  0.60 [0.49, 0.74]   More harmful  4.16 [1.59, 10.88]  11.54 [3.12, 42.71]  1.47 [1.13, 1.92]  1.39 [1.01, 1.91]  2.10 [1.31, 3.38]  2.96 [1.77, 4.98]  2.94 [2.52, 3.43]  2.80 [2.31, 3.40]    Newport menthol (vs. Newport nonmenthol)   Marlboro menthol (vs. Marlboro nonmenthol)   Camel menthol (vs. Camel nonmenthol)   All brands (menthol vs. nonmenthol)   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Crude OR [95% CI]   Adjusted OR [95% CI]   Age, n = 10237   18–24  1.29[0.60, 2.79]  2.87 [1.30, 6.30]  3.21 [2.48, 4.17]  3.72 [2.82, 4.90]  6.33 [4.32, 9.53]  6.20 [3.84, 10.01]  2.07 [1.79, 2.38]  2.79 [2.38, 3.26]   25–34  0.83 [0.43, 1.58]  1.54 [0.70, 3.37]  3.06 [2.36, 3.98]  3.49 [2.66, 4.57]  3.81 [2.51, 5.77]  3.91 [2.53, 6.03]  1.88 [1.66, 2.13]  2.53 [2.22, 2.87]   35–44  1.16 [0.57, 2.37]  1.67 [0.75, 3.75]  1.24 [0.94, 1.64]  1.31 [0.98, 1.77]  2.84 [1.75, 4.61]  2.90 [1.70, 4.93]  1.13 [1.00, 1.33]  1.39 [1.18, 1.64]   45+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.54 [1.02, 2.34]  2.18 [1.31, 3.64]  1.47 [1.21, 1.78]  1.65 [1.34, 2.01]  1.75 [1.37, 2.24]  1.92 [1.41, 2.60]  1.29 [1.18,1.40]  1.61 [1.45, 1.78]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238   NH White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   NH Black  17.79 [7.83, 40.45]  24.07 [8.78, 65.97]  2.26 [1.29, 3.93]  3.42 [1.91, 6.12]  1.97[0.89,4.33]  2.45 [0.94, 6.36]  17.64 [14.43, 21.57]  22.22 [17.94, 27.52]   NH Other  2.16 [1.23, 3.80]  2.08 [1.13, 3.81]  0.85 [0.54, 1.33]  0.83 [0.51, 1.37]  2.14[1.12,4.10]  2.00 [0.95, 4.21]  1.46 [1.12, 1.91]  1.41 [1.01, 1.88]   Hispanic  9.13 [3.32, 15.09]  15.34 [5.22, 45.06]  0.95 [0.73, 1.23]  1.12 [0.86, 1.46]  3.45[2.17,5.51]  3.16 [1.88, 5.30]  2.28 [1.97, 2.65]  2.29 [1.95, 2.68]  Income, n = 9401   Less than $10000  0.81 [0.26, 2.49]  0.27 [0.07, 1.04]  0.99 [0.75, 1.31]  0.82 [0.59, 1.13]  1.89 [1.21, 2.94]  1.42 [0.88, 2.32]  1.97 [1.70, 2.29]  1.07 [0.91, 1.25]   $10000–$24999  0.63 [0.23, 1.72]  0.33 [0.11, 1.01]  1.07 [0.83, 1.39]  0.89 [0.67, 1.16]  1.48 [1.05, 2.08]  1.21 [0.83, 1.77]  1.57 [1.40, 1.78]  1.08 [0.96, 1.22]   $25000–$49999  0.35 [0.13, 0.95]  0.22 [0.07, 0.68]  1.08 [0.84, 1.39]  0.95 [0.71, 1.26]  1.56 [1.08, 2.25]  1.49 [0.99, 2.22]  1.26 [1.10, 1.43]  0.99 [0.85, 1.14]   $50000+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Education, n = 10,165   <High school  1.13 [0.34, 3.83]  1.16 [0.28, 4.79]  0.82 [0.55, 1.22]  0.83 [0.54, 1.26]  0.93[0.56, 1.55]  0.77 [0.43, 1.38]  1.52 [1.28, 1.80]  0.99 [0.80, 1.24]   HS/GED  0.98 [0.32, 3.05]  1.26 [0.37, 4.35]  1.07 [0.75, 1.53]  1.07 [0.76, 1.52]  1.18 [0.76, 1.82]  1.12 [0.69, 1.84]  1.57 [1.31, 1.87]  1.26 [1.04, 1.53]   Some college  1.27 [0.40, 4.07]  1.51 [0.44, 5.13]  1.57 [1.12, 2.19]  1.50 [1.07, 2.10]  1.29 [0.87, 1.90]  1.08 [0.71, 1.66]  1.62 [1.40, 1.89]  1.31 [1.09, 1.57]   Bachelor’s or higher  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Cigarettes per day, n = 10238   Cigarettes per day  0.95 [0.92, 0.98]  0.97 [0.94, 1.01]  0.99 [0.98, 1.00]  1.00 [0.99, 1.01]  0.99[0.97,1.01]  1.01 [0.99, 1.03]  0.98 [0.98, 0.99]  1.00 [0.99, 1.01]  Nicotine Dependence n = 10238   High (<5 min)  0.92 [0.47, 1.80]  0.79 [0.36, 1.72]  1.08 [0.85, 1.37]  1.04 [0.81, 1.34]  1.31 [0.91, 1.90]]  1.08 [0.71, 1.64]  1.14 [1.02, 1.27]  0.93 [0.80, 1.09]   Moderate (5–29 min)  0.82 [0.41, 1.63]  0.94 [0.40, 2.19]  1.02 [0.80, 1.31]  1.00 [0.74, 1.37]  1.08 [0.75, 1.54]  1.02 [0.67, 1.55]  0.94 [0.84, 1.06]  0.96 [0.85, 1.09]   Low (>30 min)  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Number of quit attempts in past year, n = 10186   Times tried to quit  1.06 [0.98, 1.15]  1.03 [0.96, 1.10]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  1.00 [0.98, 1.02]  1.00 [0.99, 1.01]  1.00 [1.00, 1.00]  1.00 [1.00, 1.00]  Harm Perceptions of your own brand compared to other cigarette brands n = 10185  No difference  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   Less harmful  1.3 [0.25, 7.09]  0.96 [0.14, 6.47]  0.63 [0.44, 0.91]  0.68 [0.43, 1.08]  0.60 [0.34, 1.07]  0.77 [0.41, 1.52]  0.62 [0.53, 0.72]  0.60 [0.49, 0.74]   More harmful  4.16 [1.59, 10.88]  11.54 [3.12, 42.71]  1.47 [1.13, 1.92]  1.39 [1.01, 1.91]  2.10 [1.31, 3.38]  2.96 [1.77, 4.98]  2.94 [2.52, 3.43]  2.80 [2.31, 3.40]  Bold = significant at p < .05 level or lower. View Large Adjusted logistic regression models also showed several correlates of menthol smoking that were unique to each of the top three brands. Among Newport smokers, those with income between $25000–$49999 compared to those with the highest income ($50000+) were less likely to smoke menthol cigarettes as their usual variety; however, income was not a significant correlate of menthol smoking for the two other brands or across all cigarette brands. Compared to White smokers, Newport smokers who were either African-American, Hispanic, or of Other race/ethnicity were more likely to use menthol than nonmenthol cigarettes; African-American Marlboro smokers were more likely to use menthol than nonmenthol cigarettes (aOR = 3.42; 95% CI = 1.91–6.12), and Hispanic smokers using Camel were more likely to use menthol than nonmenthol cigarettes (aOR = 3.16; 95% CI = 1.88–5.30). Smokers with some college education compared to those with a bachelor degree or higher were more likely to be use Marlboro menthol than nonmenthol cigarettes (aOR = 1.57; 95% CI = 1.12–2.19); however, education was unrelated to menthol use for both Newport and Camel smokers. CPD, nicotine dependence, and number of past-year quit attempts were unrelated to menthol use across the top three brands and all brands in adjusted models. Association between Menthol Smoking and Harm Perceptions of One’s Own Brand Table 3 shows adjusted risk ratios (aRR) from multinomial logistic regression models of the main effects of menthol status on harm perceptions of one’s own brand of cigarettes (less harm or more harm vs. no difference), and interactions with age, race, and gender. Across all brands, main effects showed that menthol smokers were more likely than nonmenthol smokers to perceive their brand as more harmful (vs. no different in harm) compared to other cigarette brands. Across the top three brands, this same association was found for Newport cigarette brand (aRR = 11.51; 95% CI = 3.34–39.70), Marlboro (aRR = 1.39; 95% CI = 1.01, 1.91), and Camel cigarette brand (aRR = 2.54; 95% CI = 1.52–4.25). Table 3. Adjusted Multinomial Logistic Regression Models of the Main and Interactive Effects of Menthol Smoking Status, Age, Gender, and Race on Harm Perceptions of One’s Own Cigarette Brand Compared with Other Cigarette Brands   Newport   Marlboro   Camel   All brands   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   3.71% less harm   20.74% more harm   7.62% less harm   6.83% more harm   4.77% less harm   8.55% more harm   9.16% less harm   8.55% more harm   Main effects  Menthol smoking status, n = 10185   Menthol  0.72 [0.12, 4.38]  11.51 [3.34, 39.7]  0.62 [0.39, 0.97]  1.39 [1.01, 1.91]  0.63 [0.33, 1.19]  2.54 [1.52, 4.25]  0.54 [0.44, 0.66]  2.87 [2.36, 3.48]   Nonmenthol  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Age, n = 10237   18–24  0.83 [0.34, 2.06]  1.23 [0.93, 1.64]  0.57 [0.39, 0.84]  1.45 [1.11, 1.91]  0.55[0.27, 1.15]  1.34 [0.85, 2.14]  0.67 [0.54, 0.84]  1.38 [1.16, 1.65]   25+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.21 [0.64, 2.27]  0.95 [0.69, 1.31]  1.10 [0.85, 1.42]  0.69 [0.52, 0.93]  0.68 [0.34, 1.32]  0.64 [0.39, 1.04]  1.15 [0.97, 1.37]  0.72 [0.60, 0.87]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238  White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   African- American  2.80 [0.79, 9.86]  0.33 [0.24, 0.44]  2.85 [1.30, 6.26]  2.06 [0.74, 5.76]  1.92 [0.35, 10.45]  1.28 [0.27, 6.08]  1.51 [1.13, 2.02]  0.93 [0.75, 1.16]   Other  6.80 [1.43, 32.35]  0.99 [0.56, 1.75]  1.16 [0.65, 2.05]  1.13 [0.64, 1.99]  0.80 [0.23, 2.77]  0.25 [0.07, 0.87]  1.17 [0.77, 1.76]  1.16 [0.81, 1.67]   Hispanic  3.20 [0.81, 12.64]  0.55 [0.37, 0.83]  1.08 [0.68, 1.73]  1.12 [0.72, 1.74]  1.25 [0.43, 3.59]  0.81 [0.36, 1.83]  1.08 [0.84, 1.39]  1.10 [0.84, 1.44]  Interaction Model 1: Menthol × Age  Menthol × Age (overall)  Adjusted Wald Test, F(2,98) = 0.61, p = .54   Menthol × 18–24  —  —  —  —  —  —  0.75 [0.44, 1.29]  0.94 [0.68, 1.30]  Interaction Model 2: Menthol × Gender  Menthol × Gender (overall)  Adjusted Wald Test, F(2,98) = 4.73, p = 0.01   Menthol × female  —  —  —  —  —  —  0.78 [0.54, 1.12]  1.66 [1.13, 2.45]  Interaction Model 3: Menthol × Race  Menthol × Race (overall)  Adjusted Wald Test, F(6,94) = 3.17, p = 0.01   Menthol × Black  —  —  —  —  —  --  0.53 [0.28, 0.98]  0.27 [0.13, 0.59]   Menthol × Other  —  —  —  —  —  —  1.11 [0.55, 2.23]  0.66 [0.37, 1.20]   Menthol × Hispanic  —  —  —  —  —  —  1.27 [0.69, 2.34]  0.79 [0.49, 1.30]    Newport   Marlboro   Camel   All brands   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   3.71% less harm   20.74% more harm   7.62% less harm   6.83% more harm   4.77% less harm   8.55% more harm   9.16% less harm   8.55% more harm   Main effects  Menthol smoking status, n = 10185   Menthol  0.72 [0.12, 4.38]  11.51 [3.34, 39.7]  0.62 [0.39, 0.97]  1.39 [1.01, 1.91]  0.63 [0.33, 1.19]  2.54 [1.52, 4.25]  0.54 [0.44, 0.66]  2.87 [2.36, 3.48]   Nonmenthol  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Age, n = 10237   18–24  0.83 [0.34, 2.06]  1.23 [0.93, 1.64]  0.57 [0.39, 0.84]  1.45 [1.11, 1.91]  0.55[0.27, 1.15]  1.34 [0.85, 2.14]  0.67 [0.54, 0.84]  1.38 [1.16, 1.65]   25+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.21 [0.64, 2.27]  0.95 [0.69, 1.31]  1.10 [0.85, 1.42]  0.69 [0.52, 0.93]  0.68 [0.34, 1.32]  0.64 [0.39, 1.04]  1.15 [0.97, 1.37]  0.72 [0.60, 0.87]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238  White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   African- American  2.80 [0.79, 9.86]  0.33 [0.24, 0.44]  2.85 [1.30, 6.26]  2.06 [0.74, 5.76]  1.92 [0.35, 10.45]  1.28 [0.27, 6.08]  1.51 [1.13, 2.02]  0.93 [0.75, 1.16]   Other  6.80 [1.43, 32.35]  0.99 [0.56, 1.75]  1.16 [0.65, 2.05]  1.13 [0.64, 1.99]  0.80 [0.23, 2.77]  0.25 [0.07, 0.87]  1.17 [0.77, 1.76]  1.16 [0.81, 1.67]   Hispanic  3.20 [0.81, 12.64]  0.55 [0.37, 0.83]  1.08 [0.68, 1.73]  1.12 [0.72, 1.74]  1.25 [0.43, 3.59]  0.81 [0.36, 1.83]  1.08 [0.84, 1.39]  1.10 [0.84, 1.44]  Interaction Model 1: Menthol × Age  Menthol × Age (overall)  Adjusted Wald Test, F(2,98) = 0.61, p = .54   Menthol × 18–24  —  —  —  —  —  —  0.75 [0.44, 1.29]  0.94 [0.68, 1.30]  Interaction Model 2: Menthol × Gender  Menthol × Gender (overall)  Adjusted Wald Test, F(2,98) = 4.73, p = 0.01   Menthol × female  —  —  —  —  —  —  0.78 [0.54, 1.12]  1.66 [1.13, 2.45]  Interaction Model 3: Menthol × Race  Menthol × Race (overall)  Adjusted Wald Test, F(6,94) = 3.17, p = 0.01   Menthol × Black  —  —  —  —  —  --  0.53 [0.28, 0.98]  0.27 [0.13, 0.59]   Menthol × Other  —  —  —  —  —  —  1.11 [0.55, 2.23]  0.66 [0.37, 1.20]   Menthol × Hispanic  —  —  —  —  —  —  1.27 [0.69, 2.34]  0.79 [0.49, 1.30]  Bold = significant at p < .05 level. Interactions examined in separate models. Other covariates not shown in the table included income, education, cigarettes per day, nicotine dependence, number of quit attempts in the past year. aRR = adjusted risk ratio. View Large Table 3. Adjusted Multinomial Logistic Regression Models of the Main and Interactive Effects of Menthol Smoking Status, Age, Gender, and Race on Harm Perceptions of One’s Own Cigarette Brand Compared with Other Cigarette Brands   Newport   Marlboro   Camel   All brands   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   3.71% less harm   20.74% more harm   7.62% less harm   6.83% more harm   4.77% less harm   8.55% more harm   9.16% less harm   8.55% more harm   Main effects  Menthol smoking status, n = 10185   Menthol  0.72 [0.12, 4.38]  11.51 [3.34, 39.7]  0.62 [0.39, 0.97]  1.39 [1.01, 1.91]  0.63 [0.33, 1.19]  2.54 [1.52, 4.25]  0.54 [0.44, 0.66]  2.87 [2.36, 3.48]   Nonmenthol  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Age, n = 10237   18–24  0.83 [0.34, 2.06]  1.23 [0.93, 1.64]  0.57 [0.39, 0.84]  1.45 [1.11, 1.91]  0.55[0.27, 1.15]  1.34 [0.85, 2.14]  0.67 [0.54, 0.84]  1.38 [1.16, 1.65]   25+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.21 [0.64, 2.27]  0.95 [0.69, 1.31]  1.10 [0.85, 1.42]  0.69 [0.52, 0.93]  0.68 [0.34, 1.32]  0.64 [0.39, 1.04]  1.15 [0.97, 1.37]  0.72 [0.60, 0.87]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238  White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   African- American  2.80 [0.79, 9.86]  0.33 [0.24, 0.44]  2.85 [1.30, 6.26]  2.06 [0.74, 5.76]  1.92 [0.35, 10.45]  1.28 [0.27, 6.08]  1.51 [1.13, 2.02]  0.93 [0.75, 1.16]   Other  6.80 [1.43, 32.35]  0.99 [0.56, 1.75]  1.16 [0.65, 2.05]  1.13 [0.64, 1.99]  0.80 [0.23, 2.77]  0.25 [0.07, 0.87]  1.17 [0.77, 1.76]  1.16 [0.81, 1.67]   Hispanic  3.20 [0.81, 12.64]  0.55 [0.37, 0.83]  1.08 [0.68, 1.73]  1.12 [0.72, 1.74]  1.25 [0.43, 3.59]  0.81 [0.36, 1.83]  1.08 [0.84, 1.39]  1.10 [0.84, 1.44]  Interaction Model 1: Menthol × Age  Menthol × Age (overall)  Adjusted Wald Test, F(2,98) = 0.61, p = .54   Menthol × 18–24  —  —  —  —  —  —  0.75 [0.44, 1.29]  0.94 [0.68, 1.30]  Interaction Model 2: Menthol × Gender  Menthol × Gender (overall)  Adjusted Wald Test, F(2,98) = 4.73, p = 0.01   Menthol × female  —  —  —  —  —  —  0.78 [0.54, 1.12]  1.66 [1.13, 2.45]  Interaction Model 3: Menthol × Race  Menthol × Race (overall)  Adjusted Wald Test, F(6,94) = 3.17, p = 0.01   Menthol × Black  —  —  —  —  —  --  0.53 [0.28, 0.98]  0.27 [0.13, 0.59]   Menthol × Other  —  —  —  —  —  —  1.11 [0.55, 2.23]  0.66 [0.37, 1.20]   Menthol × Hispanic  —  —  —  —  —  —  1.27 [0.69, 2.34]  0.79 [0.49, 1.30]    Newport   Marlboro   Camel   All brands   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   Less harm (vs. no difference) aRR [95% CI]   More harm (vs. no difference) aRR [95% CI]   3.71% less harm   20.74% more harm   7.62% less harm   6.83% more harm   4.77% less harm   8.55% more harm   9.16% less harm   8.55% more harm   Main effects  Menthol smoking status, n = 10185   Menthol  0.72 [0.12, 4.38]  11.51 [3.34, 39.7]  0.62 [0.39, 0.97]  1.39 [1.01, 1.91]  0.63 [0.33, 1.19]  2.54 [1.52, 4.25]  0.54 [0.44, 0.66]  2.87 [2.36, 3.48]   Nonmenthol  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Age, n = 10237   18–24  0.83 [0.34, 2.06]  1.23 [0.93, 1.64]  0.57 [0.39, 0.84]  1.45 [1.11, 1.91]  0.55[0.27, 1.15]  1.34 [0.85, 2.14]  0.67 [0.54, 0.84]  1.38 [1.16, 1.65]   25+  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Gender, n = 10238   Female  1.21 [0.64, 2.27]  0.95 [0.69, 1.31]  1.10 [0.85, 1.42]  0.69 [0.52, 0.93]  0.68 [0.34, 1.32]  0.64 [0.39, 1.04]  1.15 [0.97, 1.37]  0.72 [0.60, 0.87]   Male  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Race/Ethnicity, n = 10238  White  Ref  Ref  Ref  Ref  Ref  Ref  Ref  Ref   African- American  2.80 [0.79, 9.86]  0.33 [0.24, 0.44]  2.85 [1.30, 6.26]  2.06 [0.74, 5.76]  1.92 [0.35, 10.45]  1.28 [0.27, 6.08]  1.51 [1.13, 2.02]  0.93 [0.75, 1.16]   Other  6.80 [1.43, 32.35]  0.99 [0.56, 1.75]  1.16 [0.65, 2.05]  1.13 [0.64, 1.99]  0.80 [0.23, 2.77]  0.25 [0.07, 0.87]  1.17 [0.77, 1.76]  1.16 [0.81, 1.67]   Hispanic  3.20 [0.81, 12.64]  0.55 [0.37, 0.83]  1.08 [0.68, 1.73]  1.12 [0.72, 1.74]  1.25 [0.43, 3.59]  0.81 [0.36, 1.83]  1.08 [0.84, 1.39]  1.10 [0.84, 1.44]  Interaction Model 1: Menthol × Age  Menthol × Age (overall)  Adjusted Wald Test, F(2,98) = 0.61, p = .54   Menthol × 18–24  —  —  —  —  —  —  0.75 [0.44, 1.29]  0.94 [0.68, 1.30]  Interaction Model 2: Menthol × Gender  Menthol × Gender (overall)  Adjusted Wald Test, F(2,98) = 4.73, p = 0.01   Menthol × female  —  —  —  —  —  —  0.78 [0.54, 1.12]  1.66 [1.13, 2.45]  Interaction Model 3: Menthol × Race  Menthol × Race (overall)  Adjusted Wald Test, F(6,94) = 3.17, p = 0.01   Menthol × Black  —  —  —  —  —  --  0.53 [0.28, 0.98]  0.27 [0.13, 0.59]   Menthol × Other  —  —  —  —  —  —  1.11 [0.55, 2.23]  0.66 [0.37, 1.20]   Menthol × Hispanic  —  —  —  —  —  —  1.27 [0.69, 2.34]  0.79 [0.49, 1.30]  Bold = significant at p < .05 level. Interactions examined in separate models. Other covariates not shown in the table included income, education, cigarettes per day, nicotine dependence, number of quit attempts in the past year. aRR = adjusted risk ratio. View Large Age, Race/Ethnicity, and Gender as Moderators of the Association between Menthol Smoking and Harm Perceptions Significant interactions of menthol status with gender and race emerged. Age did not emerge as a moderator. Explicating the menthol status by gender interaction (Figure 1) showed that, among both men and women, a greater proportion of nonmenthol versus menthol smokers perceived their cigarette as less harmful than other brands and a lower proportion perceived their brand as more harmful. However, the difference between menthol and nonmenthol smokers’ harm perceptions was not as large for men as it was for women. Among men, slightly twice as many menthol (15.8%) compared to nonmenthol smokers (6.8%) perceived their cigarette brand as more harmful; whereas for women, four times as many menthol (12.6%) versus nonmenthol (3.2%) smokers perceived their brand as more harmful. Figure 1. View largeDownload slide Gender differences in the proportion of menthol and nonmenthol smokers (across all cigarette brands) reporting their cigarette brand as less harmful or more harmful than other brands. Figure 1. View largeDownload slide Gender differences in the proportion of menthol and nonmenthol smokers (across all cigarette brands) reporting their cigarette brand as less harmful or more harmful than other brands. Further, female nonmenthol smokers were the most likely to perceive their cigarette brand as less harmful than all other menthol × gender groups (13%), whereas male menthol smokers were the most likely to perceive their cigarette brand as more harmful (15%), compared to all other menthol x gender groups. Among menthol smokers, relatively few males and females perceived their brand as less harmful than other brands (6.5% for both sexes). Explicating the menthol status by race interaction (Figure 2) showed that, across all racial/ethnic groups, perceptions that one’s usual brand of cigarettes was less harmful or more harmful was roughly equivalent across menthol smokers, with a greater percentage of menthol smokers perceiving their cigarette brand as more harmful than less harmful. Among nonmenthol smokers, a greater percentage of African-American nonmenthol smokers perceived their cigarette as less harmful than other brands compared to smokers of all other race/ethnicities (25% vs. 12.9% Other, 11.7% Hispanic, and 11.1% White). Finally, within menthol smokers, perceptions that one’s usual brand of cigarettes was less harmful or more harmful was roughly equivalent across all racial/ethnic groups. Figure 2. View largeDownload slide Racial/ethnic differences in the proportion of menthol and nonmenthol smokers (across all brands) reporting their cigarette brand as less harmful or more harmful than other brands. Figure 2. View largeDownload slide Racial/ethnic differences in the proportion of menthol and nonmenthol smokers (across all brands) reporting their cigarette brand as less harmful or more harmful than other brands. Discussion In the current study, menthol smokers comprised nearly 40% of current adult smokers reporting a regular brand. Menthol smokers overwhelmingly used Newport as their preferred brand of cigarettes. Bivariate prevalence estimates showed that most menthol and nonmenthol smokers perceive their cigarette as equally harmful as other brands. However, in adjusted multinomial models, across all cigarette brands and within Newport and Camel brands, the risk of perceiving one’s cigarette brand as more harmful than other brands (compared with no difference) was greater among menthol smokers versus nonmenthol smokers. Harm perceptions of one’s own cigarette brand did not differ across menthol smoking status among Marlboro smokers. Findings are consistent with several other large-scale surveys, which found that, in young adult and adult samples, menthol cigarettes were more likely to be perceived as more, rather than less risky, compared with nonmenthol cigarettes, controlling for other covariates.30–32 Interactions also revealed that the association between menthol smoking and perceptions of harm of one’s own brand varies by race and gender. Specifically, male menthol smokers were most likely to perceive their brand as “more harmful” than other brands, while female nonmenthol smokers were most likely to perceive their cigarette as less harmful than other brands. With respect to menthol’s interaction with race, African-American nonmenthol smokers were most likely to perceive their cigarettes as less harmful than other brands relative to any other menthol by race/ethnicity group of smokers. Both female menthol smokers and African-American menthol smokers were more likely than nonmenthol smokers of these same groups to perceive their brand as more harmful than other brands. This corresponds to several population-based studies showing higher menthol use among these groups.42–44 Based on tobacco documents showing that menthol cigarettes were marketed as less harmful than nonmenthol cigarettes, and these messages targeted African-American and female consumers, we would have expected these sub-groups of menthol smokers to be more likely to report that their usual brand as less harmful than other brands. Surprisingly, the association between menthol status and harm perceptions did not differ by older or young adults in the current study. We would have thought that young adult menthol smokers compared to older groups of menthol smokers would be more likely to perceive menthol cigarettes as less harmful than other brands because of targeted tobacco marketing to younger users and because menthol is associated with cigarette initiation. Analyses of correlates across the top three brands suggests that not all menthol smokers are the same. As documented in other national samples,21,23,42,45 adjusted models of correlates of menthol use, aggregating across all cigarette brands showed that younger age, female gender, nonWhite race/ethnicities, and lower educational attainment were significant correlates of menthol cigarette smoking aggregated across all three brands. CPD, nicotine dependence severity, and quit attempts were not correlated with menthol use, across all brands or within the top three brands. Adjusted models also revealed correlates of menthol smoking that were unique to smokers of each of the top three brands. Correlates of Newport menthol smoking included nonWhite race, lower/middle income, and younger age, suggesting that marketing strategies differ across brands and may target different sub-groups.44 It is worth noting that, across all three brands, female gender was consistently associated with menthol cigarette smoking and the association between menthol cigarette smoking and cigarette harm perceptions differed by gender. Prior research regarding harm perceptions by gender are inconsistent. Tobacco industry documents indicate that female smokers are more health conscious than male smokers and thus may be more attracted to cigarettes they believe are less harmful.46 As noted in a study by Richardson and colleagues,19 menthol advertisements were frequently found in publications with a primarily female readership. Additionally, in a prior national study, female smokers were more likely than male smokers to not know whether menthol cigarettes were more or less harmful than nonmenthol cigarettes.47 Given these prior findings, the reasons why women and men differentially misperceive the harms of menthol versus nonmenthol cigarettes should be examined in future studies. That menthol smokers were more likely to perceive their usual brand as more harmful than other brands is a misperception worth noting, as there is no evidence that menthol cigarettes are more or less harmful than other cigarettes,48,49 though they may facilitate smoking initiation and be harder to quit.39,50 Moreover, consistent with other prior work,31,32 menthol smokers were more likely than nonmenthol smokers to misperceive their cigarette brand as more harmful than other brands (compared to no difference in harm). There could be several explanations for these findings. First, counter-marketing campaigns like the “Tips From Former Smokers” campaign, may have raised awareness of the harms of smoking overall.51,52 Increased awareness of smoking-related harms may come as a greater “surprise” for menthol smokers, who have historically been exposed to messages about menthol’s medicinal and health-enhancing effects,53 and who may have initiated cigarette smoking with the misperception that menthol was less harmful to their health than nonmenthol cigarettes, a hypothesis consistent with recent focus group work among young adults.30 Second, perceptions of harm may be influenced by individual differences in the interpretation and understanding of what constitutes harm, although this conjecture goes beyond the data. We cannot determine whether menthol smokers interpret smoking-related harm as greater addiction to cigarette smoking (ie, finding it harder to quit smoking) or if harm is perceived as negative health consequences associated with smoking. Perhaps perceiving one’s own cigarette as more harmful, ie, more difficult to quit smoking, negatively affects a smoker’s belief in his/her ability to quit. Future work should examine the association between harm perceptions of one’s usual brand with cessation attempts as a function of menthol smoking status. Finally, some younger menthol smokers might perceive their cigarette brand as more harmful because they view menthol as a chemical additive that increases the “harshness” of the throat hit from inhalation,30 as well as hold myths that menthol contains fiber glass that harms the lungs.54 While menthol smokers may be more likely to perceive their cigarette brand as more harmful to their health, it is important to note that these harm perceptions have not necessarily helped reduced their smoking at rates greater than nonmenthol smokers. Evidence-based interventions for smoking cessation continue to be underutilized among racial/ethnic minority smokers, many of whom use menthol, and this may be one reason why menthol smokers continue to smoke despite knowledge of the negative consequences of their own smoking.55 Messaging campaigns targeting menthol smokers should enhance motivation to quit by building upon existing negative health perceptions of cigarette smoking and target beliefs that smokers may have about their self-efficacy to quit smoking.56 It is possible that menthol smokers who already perceive their brand as more harmful than other brands may show increased motivation and interest in quitting smoking if menthol cigarettes were banned and thus unavailable to them. Previous research shows that menthol smokers are open to this, with many saying they would quit smoking if menthol cigarettes were banned.57,58 This study had several limitations. First, we did not measure the impact of exposure to marketing, or counter-marketing, which may affect harm perceptions in different populations. Measures of tobacco marketing in the PATH Wave 1 survey did not specifically assess menthol marketing. Second, data are cross-sectional and causal interpretations cannot be made. We are unclear whether harm perceptions affect cigarette consumption and brand choice, or whether brand choice affects perceptions of harm of one’s own brand. Third, aside from menthol use, we were not able to assess other sub-brand factors that could be related to lower harm perceptions, found in prior studies,33 such as the use of “light” cigarettes like in Marlboro or Camel Gold or Silver. Because the use of the term “light” was banned by the tobacco control act, there are now a variety of ways in which “light” is designated, including color, the look of the pack or the product, or other descriptors. These indicators are idiosyncratic and vary within and across brands, making it difficult to reliably identify all light versus full flavored cigarettes. Fourth, this study focused solely on adult established smokers, thus findings cannot generalize to understanding how perceptions of menthol versus nonmenthol cigarettes differ among youth. In conclusion, results highlight brand-specific correlates of menthol cigarette smoking, suggesting that population-level interventions should not take a “one size fits all” approach. The findings also paint a concerning picture for menthol cigarette smokers: even though they perceive their own brand as more harmful than other brands, they are not more likely than nonmenthol smokers to quit smoking, all other factors being held equal. 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Nicotine and Tobacco ResearchOxford University Press

Published: Jan 27, 2018

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