Risk Perceptions of Menthol Cigarettes compared to Regular Cigarettes among New Jersey AdultsOlivia Wackowski, MPH, M. Jane Lewis, DrPH, Cristine D. Delnevo, MPH, PhD, University of Medicine & Dentistry of New Jersey - School of Public Health

IntroductionIntroduction

MethodsMethods

Completion of this work was financially supported in part through funding from New Jersey Department of Health and Senior Services through funding from New Jersey’s cigarette excise tax. The interpretations of data, and conclusions expressed in this manuscript are those of the authors and do not necessarily represent the views of the New Jersey Department of Health and Senior Services.

Summary of ResultsSummary of Results

DATA SOURCE:• 2005 New Jersey Adult Tobacco Survey (NJATS), a point-in-

time survey monitoring tobacco use behavior, knowledge, attitudes.

• Random-digit-dial (RDD) telephone survey over-sampling for young adults (aged 18-24), current smokers, and recent quitters.

• 3062 adults completed the 2005 NJATS, February to April 2005.

MEASURE:• 2005 survey asked all respondents to indicate how risky they

thought menthol cigarettes are compared to regular cigarettes. Response categories included: somewhat less risky, about the same, somewhat more risky, don’t know.

STATISTICAL ANALYSIS:• Sample weights adjusted for non-response, varying

probabilities of selection, including those resulting from oversampling.

• Differences between estimates considered statistically significant at the p = 0.05 level if 95% confidence intervals did not overlap.

ResultsResults

OBJECTIVE:To examine current risk perceptions of menthol cigarettes as compared to non-menthol cigarettes among New Jersey adults.

BACKGROUND:Menthol cigarettes may be perceived as less risky because of:

Advertising• earliest marketing promoted menthol cigarettes as “throat cigarettes”, use of medicinal themes

• later marketed with themes of coolness, naturalness

Physiological characteristics: • menthol cigarettes create cooling sensation in smokers, may feel smoother and less harsh

• associated mildness/smoothness may be interpreted as meaning menthol cigarettes have fewer health risks

Cultural reasons:• menthol found in “Vick’s Vaporub”, decongestant known for use among low income Hispanics, African Americans

• may work to transfer health related beliefs to menthol cigarettes

LimitationsLimitations

ImplicationsImplications

Corresponding Author: Olivia Wackowski, MPHE-mail: Olivia.Wackowski@umdnj.edu

This study produced unexpected findings. Why might so many people believe that menthol cigarettes are somewhat more risky? Possible reasons include:

1) Smokers sense that they inhale menthol cigarettes more deeply and feel effects of menthol cigarettes more strongly. (But does not explain age differences)

2) Urban legends/rumors about menthol cigarettes such as KKK association & fiberglass contamination

- 2 studies found young adults mentioned fiberglass issue - Tobacco documents show awareness of fiberglass rumor

More research is needed to explore if these findings exist in broader sample, to decipher what the risk perceptions are, how they develop, and how they may contribute to smoking behavior.

• Few respondents (3.4%) believed menthol cigarettes to be somewhat less risky than regular cigarettes

• In contrast, a sizeable number (22.2%) believed menthols to be somewhat more risky than regular cigarettes

• Current smokers about twice as likely to believe as

non-smokers

• Among smokers, non-menthol smokers more likely to believe this than menthol smokers

• Among all groups, this belief was predominant among young adults

• Data based on self-report, which may be subject to under- or overreporting

• Survey not designed to test hypothesis related to menthol cigarettes and risk perceptions

• Findings of NJ adults may not be generalizable to other areas

Menthol Smokers Non-Menthol SmokersSomewhat

Less Risky

About

the Same

Somewhat

More Risky

Don’t

Know

Somewhat

Less Risky

About

the Same

Somewhat

More Risky

Don’t

Know

Gender

Male 0.3 57.7 26.8 15.2 1.4 42.2 50.8 5.6

Female 3.7 63.5 27.7 5.1 3.2 41.9 42.6 12.3

Race

White 3.6 65.8 26.0 4.9 1.8 44.0 45.4 8.7

Black 0 53.2 28.9 17.8 4.1 14.7 74.1 7.1

Hispanic 1.8 62.9 24.7 10.6 0 48.3 42.6 9.1

Other 0 49.3 38.9 11.8 8.7 41.6 45.3 4.4

Age Group

18-24 0 52.0 44.9 3.1 0 37.3 57.8 4.9

24-44 2.0 65.2 25.4 7.4 2.5 36.3 58.3 2.8

45-64 2.8 62.2 19.7 15.2 1.5 55.8 35.7 7.1

65+ 6.8 56.8 17.9 18.7 3.5 34.8 24.4 37.3

Total 2.2 60.9 27.3 9.6 2.2 42.1 47.3 8.4

0

10

20

30

40

50

60

70

Less Risky About Same More Risky Don't Know

Perc

ent %

Non-smokers

Current smokers

Figure 1. Prevalence of risk perceptions about menthol cigarettes among current smokers and non-smokers, 2005 NJATS

Table 1. Prevalence of risk perceptions about menthol cigarettes among menthol smokers and non-menthol smokers, 2005 NJATS

Table 2. Prevalence and adjusted odds ratio of believing menthol cigarettes to be somewhat more risky than regular cigarettes, 2005

All Respondents (n=3062)* Adjusted odds ratio†

% OR (95% CI)‡ Smoker Status Regular cig. Smoker 47.3 4.75 (3.29-6.86) Menthol cig. smoker 27.3 1.64 (1.10-2.44) Former smoker 23.2 1.93 (1.26-2.95) Never smoker 16.1 1.00 Referent Gender Female 19.0 1.00 Referent Male 26.0 1.27 (0.96-1.68) Race/Ethnicity White 22.6 1.00 Referent Black 26.9 1.31 (0.70-2.46) Hispanic 15.8 0.54 (0.34-0.84) Other 21.6 0.94 (0.56-1.58) Age 18-24 33.4 4.27 (2.60-7.02) 25-44 28.5 2.59 (1.72-3.88) 45-64 15.9 1.19 (0.83-1.71) 65+ 13.1 1.00 Referent Education Level Less than college 23.1 1.18 (0.87-1.61) College or more 19.9 1.00 Referent Overall 22.2 *Unweighted n †Adjusted for all variables presented in the table ‡95% CIs that do not include 1.0 indicated significance at the p<0.05 level

Salem ad, 1957