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Menthol and filter ventilation in cigarettes: prevalence estimates and relationships with harm perception and smoking exposure
  1. Dana Mowls Carroll1,2,
  2. Lorna Bittencourt1,
  3. Katelyn M Tessier2,
  4. Ayaantuu Usman2,
  5. Irina Stepanov1,2,
  6. Dorothy K Hatsukami3
  1. 1Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
  2. 2Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
  3. 3Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Dana Mowls Carroll, Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA; dcarroll{at}


Introduction Menthol and filter ventilation (FV) contribute to cigarette appeal. This observational study examines the US prevalence of menthol versus non-menthol cigarette use by FV and how harm perceptions, cigarettes per day and biomarkers of exposure vary.

Methods Population Assessment of Tobacco and Health Study (2013–2014) was merged with FV levels of cigarettes and restricted to daily smoking adults who had a usual cigarette variety and did not regularly use other tobacco (N=1614). Weighted descriptive statistics identified the prevalence of menthol and non-menthol use by low (0.02%–10.04%), moderate (10.05%–23.40%), high (23.41%–28.12%) and very high FV (28.13%–61.10%). Weighted linear regression was used to examine differences in outcomes by menthol/FV adjusted for potential confounders.

Results The prevalence of a usual brand that was non-menthol, low FV was the lowest at 2.91%. Using non-menthol cigarettes with high and very high FV (≥23.4%) vs low FV (≤10.04%) was associated with a greater likeliness of misperceiving one’s cigarette variety to be less harmful than other varieties (p values<0.05). Total nicotine equivalent, biomarker for nicotine exposure, was elevated (p values<0.05) among three non-menthol groups (low, moderate and very high FV) compared with two menthol groups (moderate, very high FV).

Conclusion The well-documented harm misperception linked to higher FV is more apparent in those using non-menthol than menthol cigarettes. Increased exposures were observed among some non-menthol cigarette users compared with some menthol cigarette users. These results should by no means delay a menthol ban but rather motivate concerted public health efforts to accompany the menthol ban to maximise smoking cessation.

  • Addiction
  • Carcinogens
  • Public policy
  • End game

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  • Contributors DH, KT and DMC conceptulised the study. LB and DMC wrote the first draft. KT conducted statistical analysis. DMC lead the revisions. ISS provided a data resource. All authors reviewed, edited and approved of the final paper.

  • Funding This work was supported by NCI of the NIH under award numbers P01 CA217806 (to DH) and R01 CA179246 (to ISS). Research reported in this article was also supported by NIMHD of the NIH under award number K01MD014795 (to DMC) and NIH grant P30 CA77598 using the Biostatistics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health award number UM1TR004405 and the National Cancer Institute, grant T32 CA163184 (LB).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.