Associations of Menthol Use with Motivation and Confidence to Quit Smoking

A better understanding of how mentholated cigarette use affects the process of quitting smoking is needed to inform cessation interventions. The literature on the effects of menthol use on smoking cessation, however, is largely mixed, with some studies supporting that menthol smokers are less likely to quit successfully and others finding null effects.1 However, several studies indicate that menthol smokers are more likely to make a quit attempt2 and make more quit attempts3 than non-menthol smokers, but are less likely to quit.4–6 Moreover, some studies suggest that race is an important moderator of the associations of menthol cigarette use and quitting. For example, Black menthol smokers may have a more difficult time quitting smoking than Black non-menthol smokers1,7–10 or than White menthol smokers.7,8 Because the majority of Black smokers use mentholated cigarettes,10 it is important to understand more about why Black menthol users might be at a disadvantage when it comes to quitting. Currently, little is known about the mechanisms that might underlie relations between menthol use status and quitting behaviors, or how these factors might operate differently among Black and White smokers. Some literature suggests that menthol cigarettes, which are heavily marketed to Black smokers, may be perceived as less harmful to consumers and potentially less addictive than non-menthol cigarettes.11 These inaccurate perceptions about reduced health risks and addiction potential might affect menthol smokers’ motivation and confidence to quit smoking. For example, some research suggests that established menthol users may be less motivated than non-menthol users to quit smoking for several reasons, including the relatively greater palatability of mentholated smoking and perceptions that menthol cigarettes are more socially acceptable than non-menthol cigarettes.12,13 Moreover, because misperceptions about the harm of menthol cigarette use might be engendered by racially-targeted tobacco company marketing, relations between menthol cigarette use and motivation and confidence to quit may be particularly prominent among Black menthol smokers. Because motivation to quit smoking and confidence to quit smoking have been associated with quitting behaviors in general and are important components of theories of behavior change, more information about their associations with menthol smoking status, and potential for moderation by race, is of interest.10 We are aware of only one study examining relations between menthol cigarette use and motivation and confidence to quit smoking among a racially/ethnically diverse sample of non-treatment seeking smokers. Contrary to the suggestion that menthol smokers may have lower motivation to quit than non-menthol smokers,12 this study indicated that Black menthol smokers were more likely to report seriously considering quitting smoking within the next 6 months relative to Black non-menthol smokers.5 Likewise, Black menthol smokers in this study were more likely to report they would be somewhat or very likely to succeed at quitting if they were to make a quit attempt as compared to Black non-menthol smokers.5 However, elevated estimations of readiness and confidence appeared to confer no cessation-related benefits, as this study reported that Black menthol smokers were less likely to quit than Black non-menthol smokers.5 Authors of this study suggested that a false sense of confidence in the ability to quit smoking might undermine cessation attempts among Black menthol smokers. However, additional research is needed to replicate these findings, especially when controlling for additional covariates such as the number of years smoking (which may vary between menthol and non-menthol smokers based on menthol marketing strategies targeted toward younger smokers) and income.10,13 The purpose of the current study was to examine the associations of menthol cigarette use with motivation to quit smoking and confidence to quit smoking, respectively, and to examine whether associations were moderated by race, in analyses adjusted for age, sex, race, income, education, and tobacco dependence. A better understanding of the ways in which Black and White menthol and non-menthol smokers differ with regard to factors underlying a quit smoking attempt can help to inform interventions to improve quit rates.