Project Title: “Differences in Inflammation, Cardiovascular Risk Factors and Respiratory Health with Use of
Menthol Cigarettes: Informing the Regulation of Tobacco Flavorings to Protect Public Health”
Abstract/Project Summary
Despite smoking fewer cigarettes per day, Black men and women are at greater risk for some tobacco-related
diseases including cardiovascular and respiratory diseases, compared to their white counterparts. The
substantially higher prevalence of menthol cigarette use among Black smokers may contribute to these
disparities. The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration
Center for Tobacco Products (CTP) the authority to restrict the manufacture, sale and distribution of menthol
cigarettes as appropriate to protect public health. An important part of the determination for the regulation of
menthol cigarettes concerns the health effects of mentholated relative to nonmentholated cigarettes. Studies
examining differences in health effects with menthol cigarette use have mainly focused on all-cause mortality
and cancer outcomes, with few studies considering cardiovascular or pulmonary outcomes. There is limited
information regarding potential differences in cardiovascular risk factors or respiratory health with menthol
cigarette use and no studies have examined differences in inflammation comparing menthol and nonmenthol
cigarette smokers. Therefore, the main objective of this project is to evaluate differences in systemic
inflammation, cardiovascular risk factors and respiratory health with use of menthol cigarettes among smokers
in the US. To meet this objective, we will leverage existing, publicly accessible interview, physical examination
and biological specimen data from 9,880 adult current smokers who participated in the National Health and
Nutrition Examination Survey (NHANES), a series of nationally-representative surveys of the US population,
from 1999 through 2016. Multivariable adjusted linear and logistic regression models will be used to evaluate
the associations between menthol compared to nonmenthol cigarette use with: (1) markers of systemic
inflammation (C-reactive protein, fibrinogen, white blood cell count, and homocysteine); (2) cardiovascular risk
factors (hypertension, diabetes, and reduced kidney function); and (3) respiratory health outcomes (fractional
exhaled nitric oxide levels, spirometry-defined pulmonary impairment, past year wheeze, and frequent cough
and frequent phlegm). This proposed research will provide needed information to guide the CTP determination
regarding the banning of menthol cigarettes. Findings from this study will provide insight into differences in risk
of tobacco-related diseases that could have implications for the regulation of menthol cigarettes in the US,
including the potential health impacts to Black communities who are burdened by greater menthol cigarette
advertising and promotion.
