The effect of switching on or off menthol use on cigarette consumption, dependence, nicotine exposure and quitting success

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Projective Summary/Abstract While recommendations have been made to ban menthol from cigarettes, more robust evidence is needed on how such a ban would impact smoking behaviors. Moreover, while there is some evidence that menthol differentially impacts non-Hispanic Blacks’ and Hispanics’ smoking behavior, little evidence exists comparing the impact of menthol among females and young adults (18-24 years), who also smoke menthol at higher rates than their counterparts. Data from the longitudinal Population Assessment of Tobacco Use and Health (PATH) Study addresses many limitations presented in the current literature on menthol use and smoking behaviors. The PATH Study’s multi-wave design is nationally representative of the US and provides: 1) high- quality measures of smoking cessation, cigarette consumption, biochemical exposure to nicotine, and tobacco dependence; 2) over-sampling of non-Hispanic Blacks and young adults (18-24 years) to provide representative estimates across these subpopulations; and 3) repeated assessment of switching on and off menthol that, in many ways, mirrors how a randomized control trial would assess the impact of a smoking ban. In addition, because we expect that the non-random assignment of switching on or off menthol could be incited by a variety of factors (e.g., motivation to quit) that also effect cessation and consumption, we will use a modern analytical technique known as propensity score matching (PSM) to address this confounding bias. Using PSM and the adult sample of cigarette smokers in Waves 1-4 in the PATH Study, the proposed study will complete the following aims: Aim 1: Compare quitting success between quit attempters who had switched on or off menthol cigarettes. Aim 2: Compare consumption, nicotine exposure, and dependence between adult smokers who switch on or off menthol cigarettes without successfully quitting. Aim 3: Assess whether race, sex or age modify the effect of switching on or off menthol cigarettes on 30-day cigarettes abstinence, 12-month cigarette abstinence, consumption, dependence, and nicotine exposure. These aims align with the goals of RFA-OD-19-022 by using an existing dataset to address a regulatory question regarding the potential impact of menthol on adult tobacco use and nicotine exposure. We anticipate that the work will result in four conference presentations and three manuscripts aimed at journals read by public health policy makers.