Menthol Cigarette use in Young Adult Smokers with Severe Mental Illnesses.

Introduction: Smokers with severe mental illness (SMI) are more likely to start smoking and less likely to quit. Menthol may facilitate smoking progression, dependence and maintenance by reducing harshness and irritation from smoking and providing a unique sensory experience during use. High rates of menthol use have been reported in smokers with SMI, but information on young adults with SMI has not been reported.

Methods: This study provides a secondary analysis to assess the impact of menthol use in a pilot trial of brief tobacco interventions. Participants were assessed at baseline and again at a three-month follow-up with structured interviews and breath carbon monoxide to confirm self-reported 7-day abstinence at follow-up.

Results: Participants included 81 young adult smokers with SMI, mean age of 24.2 years (SD=3.6; range 18-30). Overall, 58% of the group reported that they recently used a menthol-flavored product. Menthol use was correlated with race (African American [18/21, 85.7%] vs. White [24/53, 45.3%] or Other race [5/7, 71.4%]; X2=10.7, p=.005) and more lifetime psychiatric hospitalizations (t=2.39, p=.02), but not with cigarettes per day, nicotine dependence, quit attempts over the follow-up period, nor with achieving biologically confirmed abstinence at the follow-up assessment.

Conclusions: The high prevalence of menthol flavored cigarette use in this study group is consistent with previous reports of high rates of menthol use among young adults, Blacks, and middle-aged SMI smokers. This study supports existing evidence that policies to restrict menthol flavoring in combustible tobacco products could reduce smoking in young adults with SMI.

Implications: High rates of menthol use have been reported in middle-aged smokers with severe mental illness, but information on young adults with severe mental illness has not been reported. In this study, over half (58%) of 81 young adult smokers with severe mental illness used a menthol-flavored product. Menthol use was associated with race and with history of psychiatric hospitalizations. The research supports existing evidence that policies to restrict menthol flavoring in combustible tobacco products could reduce smoking in young adults with severe mental illness.