Social and Physical Environmental Characteristics Associated With Adult Current Cigarette Smoking.

INTRODUCTION: Our objective was to identify social and physical environmental factors associated with current cigarette smoking among adults by metropolitan county in the United States. METHODS: We linked cigarette smoking data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) Selected Metropolitan Area Risk Trends (SMART) data set to 7 social and physical environmental characteristics: county type (metropolitan designation), primary care physician density, income inequality, percentage of the population that was a racial/ethnic minority, violent crime rate, education, and percentage of county residents with low income and no health insurance, all obtained from several county data sets. Spatial regression and hierarchical logistic regression modeling were performed. RESULTS: Results showed that metropolitan counties with a high proportion of non-Hispanic white adults (P < .001), lower education levels (high school graduate or less) (P < .001), and high violent crime rates (P < .001) had a higher adult cigarette smoking prevalence than other metropolitan counties. Spatial models showed 63.3% of the variability in county cigarette smoking prevalence was explained by these 3 factors as well as county type (based on population size of the of metropolitan area), primary care physician density, and percentage of county residents with low income and no health insurance. At an individual level, results showed that as the density (population) of primary care physicians increased in a county, the odds of being a current smoker decreased (OR, 0.980; P = .02). CONCLUSION: We found a significant association between adult cigarette smoking and county social and physical environmental factors. These place-based factors, especially social environmental characteristics, may reveal tobacco-related disparities to be considered when developing strategies to reduce tobacco use.

Socioeconomic Differences in Cigarette Smoking Among Sociodemographic Groups.

We examined variations in cigarette smoking by socioeconomic status (education and poverty status) in relation to population sociodemographic characteristics (age, race/ethnicity, region and sex). We analyzed data from a nationally representative sample of US adults by using combined data from the National Survey on Drug Use and Health (2011-2014). Low socioeconomic status was generally associated with increased cigarette smoking prevalence by age, race/ethnicity, and region, irrespective of sex. The only exceptions were for Asian and Hispanic women, where low educational attainment was not associated with a high prevalence of cigarette smoking, and among Hispanic men and Asian women, where there was no association between poverty status and smoking. Efforts to reach smokers of low socioeconomic status by using proven tobacco control strategies could reduce disparities in cigarette smoking and smoking-related disease and death.

Reasons for Electronic Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2016.

Electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among U.S. middle school and high school students in 2016 (1). CDC and the Food and Drug Administration (FDA) analyzed data from the 2016 National Youth Tobacco Survey (NYTS) to assess self-reported reasons for e-cigarette use among U.S. middle school (grades 6-8) and high school (grades 9-12) student e-cigarette users. Among students who reported ever using e-cigarettes in 2016, the most commonly selected reasons for use were 1) use by "friend or family member" (39.0%); 2) availability of "flavors such as mint, candy, fruit, or chocolate" (31.0%); and 3) the belief that "they are less harmful than other forms of tobacco such as cigarettes" (17.1%). The least commonly selected reasons were 1) "they are easier to get than other tobacco products, such as cigarettes" (4.8%); 2) "they cost less than other tobacco products such as cigarettes" (3.2%); and 3) "famous people on TV or in movies use them" (1.5%). Availability of flavors as a reason for use was more commonly selected by high school users (32.3%) than by middle school users (26.8%). Efforts to prevent middle school and high school students from initiating the use of any tobacco product, including e-cigarettes, are important to reduce tobacco product use among U.S. youths (2).

A comprehensive examination of own- and cross-price elasticities of tobacco and nicotine replacement products in the U.S.

While much is known about the demand for cigarettes, research on the demand for non-cigarette tobacco products and the cross-price impacts among those products is limited. This study aims to comprehensively examine the own- and cross-price elasticities of demand for tobacco and nicotine replacement products (NRPs) in the U.S. We analyzed market-level quarterly data on sales and prices of 15 different types of tobacco products and NRPs from 2007 to 2014, compiled from retail store scanner data. Fixed effects models with controls were used to estimate their own-price elasticities and cross-price elasticities between cigarettes and the other 14 products. Our results show that, except for cigars, the demand for combustible tobacco products was generally elastic, with the estimated own-price elasticity >1 (10% increase in prices reduces sales by >10%). The own-price elasticities for smokeless tobacco products were smaller than those for combustible tobacco, although not always significant. The demand for electronic cigarettes and NRPs was found to be elastic. The cross-price elasticities with respect to cigarettes were positive for cigarillos, little cigars, loose tobacco, pipe tobacco, electronic cigarettes and NRPs, but only results for little cigars, loose tobacco, pipe tobacco, and dissolvable lozenges were consistently significant. Our findings suggest demand for tobacco products and NRPs was responsive to changes in their own prices. Substitutions or positive cross-price impacts between cigarettes and certain other products exist. It is important that tobacco control policies take into account both own- and cross-price impacts among tobacco products and NRTs.

Quit Methods Used by US Adult Cigarette Smokers, 2014-2016.

To quantify the prevalence of 10 quit methods commonly used by adult cigarette smokers, we used data from a nationally representative longitudinal (2014-2016) online survey of US adult cigarette smokers (n = 15,943). Overall, 74.7% of adult current cigarette smokers used multiple quit methods during their most recent quit attempt. Giving up cigarettes all at once (65.3%) and reducing the number of cigarettes smoked (62.0%) were the most prevalent methods. Substituting some cigarettes with e-cigarettes was used by a greater percentage of smokers than the nicotine patch, nicotine gum, or other cessation aids approved by the US Food and Drug Administration. Further research into the effectiveness of e-cigarettes as a cessation aid is warranted.

Disparities in Adult Cigarette Smoking - United States, 2002-2005 and 2010-2013.

Although cigarette smoking has substantially declined since the release of the 1964 Surgeon General's report on smoking and health,* disparities in tobacco use exist among racial/ethnic populations (1). Moreover, because estimates of U.S. adult cigarette smoking and tobacco use are usually limited to aggregate racial or ethnic population categories (i.e., non-Hispanic whites [whites]; non-Hispanic blacks or African Americans [blacks]; American Indians and Alaska Natives [American Indians/Alaska Natives]; Asians; Native Hawaiians or Pacific Islanders [Native Hawaiians/Pacific Islanders]; and Hispanics/Latinos [Hispanics]), these estimates can mask differences in cigarette smoking prevalence among subgroups of these populations. To assess the prevalence of and changes in cigarette smoking among persons aged ≥18 years in six racial/ethnic populations and 10 select subgroups in the United States,(†) CDC analyzed self-reported data collected during 2002-2005 and 2010-2013 from the National Survey on Drug Use and Health (NSDUH) (2) and compared differences between the two periods. During 2010-2013, the overall prevalence of cigarette smoking among the racial/ethnic populations and subgroups ranged from 38.9% for American Indians/Alaska Natives to 7.6% for both Chinese and Asian Indians. During 2010-2013, although cigarette smoking prevalence was relatively low among Asians overall (10.9%) compared with whites (24.9%), wide within-group differences in smoking prevalence existed among Asian subgroups, from 7.6% among both Chinese and Asian Indians to 20.0% among Koreans. Similarly, among Hispanics, the overall prevalence of current cigarette smoking was 19.9%; however, within Hispanic subgroups, prevalences ranged from 15.6% among Central/South Americans to 28.5% among Puerto Ricans. The overall prevalence of cigarette smoking was higher among men than among women during both 2002-2005 (30.0% men versus 23.9% women) and 2010-2013 (26.4% versus 21.1%) (p<0.05). These findings highlight the importance of disaggregating tobacco use estimates within broad racial/ethnic population categories to better understand and address disparities in tobacco use among U.S. adults.

Does a Race-Gender-Age Crossover Effect Exist in Current Cigarette Smoking Between Non-Hispanic Blacks and Non-Hispanic Whites? United States, 2001-2013.

INTRODUCTION: For years, national US surveys have found a lower prevalence of cigarette smoking among non-Hispanic (NH) black adolescents and young adults than their NH white counterparts while finding either similar or higher prevalence in NH blacks among older adults. We present results from four US surveys, including one supplemented by cotinine data, to determine if a race-gender-age crossover effect exists between NH black and NH white current cigarette smokers. METHODS: We present NH black and NH white current cigarette smoking estimates in the National Youth Tobacco Survey (2004-2013), National Survey on Drug Use and Health (2002-2013), National Health Interview Survey (2001-2013), and National Health and Nutrition Examination Survey (2001-2012). RESULTS: All surveys consistently found that NH black females aged 12-25 years had a lower smoking prevalence than NH white females of the same age while NH black males aged 26 years or older had a higher smoking prevalence than NH white males of the same age. Results were inconsistent between surveys for current smoking estimates for males 12-25 years and females aged 26 years or older. CONCLUSION: Our results are inconclusive in consistently detecting the existence of a race-gender-age crossover effect for current cigarette smoking between NH blacks and NH whites. National birth cohort studies are better suited to detect a race-gender-age crossover effect in smoking prevalence between these two racial groups.

Not Just Cigarettes: A More Comprehensive Look at Marijuana and Tobacco Use Among African American and White Youth and Young Adults.

INTRODUCTION: Cigarettes, cigars, and marijuana have generally been studied in isolation yet their use does not occur in isolation. Focus on cigarette smoking may overstate the observation that African American youth and young adults are less likely to smoke any combustible product compared with their white counterparts. Assessing cigarette, cigar, and marijuana use trends may help identify the extent of this difference. METHODS: Data from the 2002-2012 National Survey on Drug Use and Health (N = 25 541 to N = 28 232) were used to investigate past 30-day cigarette, cigar, and marijuana use trends among African American and white youth (12-17) and young adults (18-25). Logistic regressions assessed trends in combustible tobacco (cigarettes and cigars) and marijuana use, alone and in combination. RESULTS: From 2002-2012, the absolute difference in cigarette smoking prevalence between African American and white youth (9.6%-4.2%) and young adults (19.0%-10.5%) narrowed. Any combustible tobacco/marijuana use was significantly lower among African Americans than whites but, relative to cigarettes, the absolute difference was much smaller among youth (7.2%-2.2%) and young adults (15.8%-5.6%). Among any combustible tobacco/marijuana users, using two or more substances ranged from 31.4% to 40.3% among youth and 29.1% to 39.8% among young adults. CONCLUSION: Any combustible tobacco/marijuana use trends suggest the smoking prevalence difference between African American and white youth and young adults is real, but less pronounced than when assessing cigarette smoking alone. Policies and programs addressing smoking behaviors may benefit from broadening focus to monitor and address cigar and marijuana use as well. IMPLICATIONS: Trends in any use of cigarettes, cigars, and/or marijuana suggest the difference in smoking prevalence between African American and white youth and young adults is real, but less pronounced than when cigarette smoking is assessed alone. In 2012, more than 10% of African American and white youth, more than a third of African American young adults, and nearly half of white young adults reported past 30-day use of cigarette, cigars, and/or marijuana. Public health programs aimed at reducing these behaviors among youth and young adults could be informed by considering detailed, race-specific information regarding tobacco and marijuana use patterns.

Is Every Smoker Interested in Price Promotions? An Evaluation of Price-Related Discounts by Cigarette Brands.

CONTEXT: Raising unit price is one of the most effective ways of reducing cigarette consumption. A large proportion of US adult smokers use generic brands or price discounts in response to higher prices, which may mitigate the public health impacts of raising unit price. OBJECTIVE: The main purpose of this study was to evaluate the retail price impact and the determinants of price-related discount use among US adult smokers by their most commonly used cigarette brand types. METHODS: Data from the 2009-2010 National Adult Tobacco Survey, a telephone survey of US adults 18 years or older, was used to assess price-related discount use by cigarette brands. Price-related discounts included coupons, rebates, buy 1 get 1 free, 2 for 1, or any other special promotions. Multivariate logistic regression was used to assess sociodemographic and tobacco use determinants of discount use by cigarette brands. RESULTS: Discount use was most common among premium brand users (22.1%), followed by generic (13.3%) and other brand (10.8%) users. Among premium brand users, those who smoked 10 to 20 cigarettes per day were more likely to use discounts, whereas elderly smokers, non-Hispanic blacks, those with greater annual household income, dual users of cigarettes and other combustible tobacco products, and those who had no quit intentions were less likely to do so. Among generic brand users, those who had no quit intentions and those who smoked first cigarette within 60 minutes after waking were more likely to use discounts. CONCLUSIONS: Frequent use of discounts varies between smokers of premium and generic cigarette brands. Setting a high minimum price, together with limiting the use of coupons and promotions, may uphold the effect of cigarette excise taxes to reduce smoking prevalence.

Combustible and Smokeless Tobacco Use Among High School Athletes - United States, 2001-2013.

Athletes are not a typical at-risk group for smoking combustible tobacco products, because they are generally health conscious and desire to remain fit and optimize athletic performance (1). In contrast, smokeless tobacco use historically has been associated with certain sports, such as baseball (2). Athletes might be more likely to use certain tobacco products, such as smokeless tobacco, if they perceive them to be harmless (3); however, smokeless tobacco use is not safe and is associated with increased risk for pancreatic, esophageal, and oral cancers (4). Tobacco use among youth athletes is of particular concern, because most adult tobacco users first try tobacco before age 18 years (5). To examine prevalence and trends in current (≥1 day during the past 30 days) use of combustible tobacco (cigarettes, cigars) and smokeless tobacco (chewing tobacco, snuff, or dip [moist snuff]) products among athlete and nonathlete high school students, CDC analyzed data from the 2001­2013 National Youth Risk Behavior Surveys. Current use of any tobacco (combustible or smokeless tobacco) significantly declined from 33.9% in 2001 to 22.4% in 2013; however, current smokeless tobacco use significantly increased from 10.0% to 11.1% among athletes, and did not change (5.9%) among nonathletes. Furthermore, in 2013, compared with nonathletes, athletes had significantly higher odds of being current smokeless tobacco users (adjusted odds ratio [AOR] = 1.77, p<0.05), but significantly lower odds of being current combustible tobacco users (AOR = 0.80, p<0.05). These findings suggest that opportunities exist for development of stronger tobacco control and prevention measures targeting youth athletes regarding the health risks associated with all forms of tobacco use.

Frequency of Tobacco Use Among Middle and High School Students--United States, 2014.

The use of tobacco products during adolescence increases the risk for adverse health effects and lifelong nicotine addiction. In 2014, an estimated 4.6 million middle and high school students were current users of any tobacco product, of whom an estimated 2.2 million were current users of two or more types of tobacco products. Symptoms of nicotine dependence are increased for multiple tobacco product users compared with single-product users. CDC and the Food and Drug Administration (FDA) analyzed data from the 2014 National Youth Tobacco Survey (NYTS) to determine how frequently (the number of days in the preceding 30 days) U.S. middle school (grades 6­8) and high school (grades 9­12) students used cigarettes, e-cigarettes, cigars, and smokeless tobacco products. Among current users (≥1 day during the preceding 30 days) in high school, frequent use (≥20 days during the preceding 30 days) was most prevalent among smokeless tobacco users (42.0%), followed by cigarette smokers (31.6%), e-cigarette users (15.5%), and cigar smokers (13.1%); a similar pattern was observed for those who used during all 30 days. Among current users in middle school, frequent use was greatest among smokeless tobacco users (29.2%), followed by cigarette smokers (20.0%), cigar smokers (13.2%) and e-cigarette users (11.8%). Current use of two or more types of tobacco products was common, even among students who used tobacco products 1­5 days during the preceding 30 days: 77.3% for cigar smokers, 76.9% for cigarette smokers, 63.4% for smokeless tobacco users, and 54.8% for e-cigarettes users. Preventing youths from initiating the use of any tobacco product is important to tobacco use prevention and control strategies in the United States. Monitoring the frequency and patterns of tobacco use among youths, including the use of two or more tobacco products, is important to inform evidence-based interventions to prevent and reduce all forms of tobacco use among youths.

Current cigarette smoking among adults - United States, 2005-2014.

Tobacco smoking is the leading cause of preventable disease and death in the United States, resulting in approximately 480,000 premature deaths and more than $300 billion in direct health care expenditures and productivity losses each year (1). To assess progress toward achieving the Healthy People 2020 objective of reducing the percentage of U.S. adults who smoke cigarettes to ≤12.0%,* CDC assessed the most recent national estimates of smoking prevalence among adults aged ≥18 years using data from the 2014 National Health Interview Survey (NHIS). The percentage of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 16.8% in 2014. Among daily cigarette smokers, declines were observed in the percentage who smoked 20­29 cigarettes per day (from 34.9% to 27.4%) or ≥30 cigarettes per day (from 12.7% to 6.9%). In 2014, prevalence of cigarette smoking was higher among males, adults aged 25­44 years, multiracial persons and American Indian/Alaska Natives, persons who have a General Education Development certificate, live below the federal poverty level, live in the Midwest, are insured through Medicaid or are uninsured, have a disability or limitation, or are lesbian, gay, or bisexual. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, high impact mass media campaigns, and barrier-free access to quitting assistance, are critical to reduce cigarette smoking and smoking-related disease and death among U.S. adults.

Vital signs: disparities in nonsmokers' exposure to secondhand smoke--United States, 1999-2012.

Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndrome (SIDS), respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers. No risk-free level of SHS exposure exists. SHS exposure causes more than 41,000 deaths among nonsmoking adults and 400 deaths in infants each year, and approximately $5.6 billion annually in lost productivity. Although population exposure to SHS has declined over the past 2 decades, many nonsmokers remain exposed to SHS in workplaces, public places, homes, and vehicles.

Tobacco use among middle and high school students - United States, 2011-2014.

Tobacco use and addiction most often begin during youth and young adulthood. Youth use of tobacco in any form is unsafe. To determine the prevalence and trends of current (past 30-day) use of nine tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookahs, tobacco pipes, snus, dissolvable tobacco, and bidis) among U.S. middle (grades 6-8) and high school (grades 9-12) students, CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2014 National Youth Tobacco Surveys (NYTS). In 2014, e-cigarettes were the most commonly used tobacco product among middle (3.9%) and high (13.4%) school students. Between 2011 and 2014, statistically significant increases were observed among these students for current use of both e-cigarettes and hookahs (p<0.05), while decreases were observed for current use of more traditional products, such as cigarettes and cigars, resulting in no change in overall tobacco use. Consequently, 4.6 million middle and high school students continue to be exposed to harmful tobacco product constituents, including nicotine. Nicotine exposure during adolescence, a critical window for brain development, might have lasting adverse consequences for brain development, causes addiction, and might lead to sustained tobacco use. For this reason, comprehensive and sustained strategies are needed to prevent and reduce the use of all tobacco products among youths in the United States.

Intentions to smoke cigarettes among never-smoking US middle and high school electronic cigarette users: National Youth Tobacco Survey, 2011-2013.

INTRODUCTION: Electronic cigarette (e-cigarette) use is increasing rapidly, and the impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among US youth who had never smoked conventional cigarettes. METHODS: We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6-12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke; all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and noncombustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses that assessed associations with smoking intentions among never-cigarette-smoking youth. RESULTS: Between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased 3-fold, from 79,000 to more than 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds for having smoking intentions than never users (adjusted odds ratio = 1.70, 95% confidence interval = 1.24-2.32). Those who ever used other combustibles, ever used noncombustibles, or reported pro-tobacco advertisement exposure also had increased odds for smoking intentions. CONCLUSION: In 2013, more than a quarter million never-smoking youth used e-cigarettes. E-cigarette use is associated with increased intentions to smoke cigarettes, and enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes.

A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking.

OBJECTIVES: We examined the influence of tobacco control policies (tobacco control program expenditures, smoke-free air laws, youth access law compliance, and cigarette prices) on youth smoking outcomes (smoking susceptibility, past-year initiation, current smoking, and established smoking). METHODS: We combined data from the 2002 to 2008 National Surveys on Drug Use and Health with state and municipality population data from the US Census Bureau to assess the associations between state tobacco control policy variables and youth smoking outcomes, focusing on youths aged 12 to 17 years. We also examined the influence of policy variables on youth access when these variables were held at 2002 levels. RESULTS: Per capita funding for state tobacco control programs was negatively associated with all 4 smoking outcomes. Smoke-free air laws were negatively associated with all outcomes except past-year initiation, and cigarette prices were associated only with current smoking. We found no association between these outcomes and retailer compliance with youth access laws. CONCLUSIONS: Smoke-free air laws and state tobacco control programs are effective strategies for curbing youth smoking.

E-Cigarette Use Among persons With Diagnosed HIV in the U.S.

Introduction: E-cigarettes emerged in the U.S. market in the late 2000s. In 2017, E-cigarette use among U.S. adults was 2.8%, with higher use among some population groups. Limited studies have assessed E-cigarette use among persons with diagnosed HIV. The purpose of this study is to describe the national prevalence estimates of E-cigarette use among persons with diagnosed HIV by selected sociodemographic, behavioral, and clinical characteristics. Methods: Data were collected between June 2018 and May 2019 as part of the Medical Monitoring Project, an annual cross-sectional survey that produces nationally representative estimates of behavioral and clinical characteristics of persons with diagnosed HIV in the U.S. Statistically significant differences (p<0.05) were determined using chi-square tests. Data were analyzed in 2021. Results: Among persons with diagnosed HIV, 5.9% reported currently using E-cigarettes, 27.1% had ever used them but were not using them currently, and 72.9% had never used them. Current use of E-cigarettes was highest among persons with diagnosed HIV who currently smoke conventional cigarettes (11.1%), those with major depression (10.8%), those aged 25-34 years (10.5%), those who reported injectable and noninjectable drug use in the past 12 months (9.7%), those diagnosed <5 years ago (9.5%), those who self-reported sexual orientation as other (9.2%), and non-Hispanic White people (8.4%). Conclusions: Overall, findings suggest that a greater proportion of persons with diagnosed HIV used E-cigarettes than the overall U.S. adult population and that higher rates were observed among certain subgroups, including those who currently smoke cigarettes. E-cigarette use among persons with diagnosed HIV warrants continued attention because of its potential impact on HIV-related morbidity and mortality.

Customizing survey instruments and data collection to reach Hispanic/Latino adults in border communities in Texas.

OBJECTIVES: We sought to modify an instrument and to use it to collect information on smoking knowledge, attitudes, beliefs, and behaviors among Hispanics/Latinos, and to adapt survey methods to obtain high participation levels. Methods. Promotoras (outreach workers) conducted face-to-face interviews with 1485 Hispanic adults (July 2007-April 2008). The project team used GeoFrame field enumeration methods to develop a sampling frame from households in randomly selected colonias (residential areas along the Texas-Mexico border that may lack some basic necessities (e.g. portable water), in El Paso, Texas. RESULTS: The revised questionnaire included 36 unchanged items from the State Adult Tobacco Survey, 7 modified items, and 17 new items focusing on possible culturally specific quitting methods, secondhand smoke issues, and attitudes and knowledge about tobacco use that might be unique for Hispanic/Latino groups. The eligibility rate was 90.2%, and the conservative combined completed screener and interview response rate was 80.0%. CONCLUSIONS: Strategic, targeted, carefully designed methods and surveys can achieve high reach and response rates in hard-to-reach populations. Similar procedures could be used to obtain cooperation of groups who may not be accessible with traditional methods.

Menthol cigarette use among racial and ethnic groups in the United States, 2004-2008.

INTRODUCTION: Understanding the patterns of menthol cigarette use can be useful in developing and justifying policies designed to prevent and reduce cigarette use and exposure to tobacco smoke. This report provides an update and summary of the demographic distribution and trends of menthol cigarette use in the United States. METHODS: Data from the 2004-2008 National Survey on Drug Use and Health were analyzed to estimate menthol cigarette use among current smokers by race/ethnicity, sex, and age (12 years and older). A t-test was used to compare estimates for menthol and nonmenthol use by demographic group. Trend analyses were conducted to examine differences in menthol cigarette use by race/ethnicity and age from 2004 to 2008. RESULTS: Over half of menthol cigarette smokers were female (52.2%), and approximately 29.4% of all menthol smokers were Black, which was almost 10 times the percentage of nonmenthol smokers who were Black (3.0%, p < .01). Prevalence of past month menthol cigarette use was highest among current smokers aged 12-17 years (44.7%) and decreased as age group increased. From 2004 to 2008, menthol cigarette use increased significantly among White smokers aged 12-17 years (from 40.3% in 2004 to 46.0% in 2008, p < .01). Menthol cigarette use among young adult smokers aged 18-25 years increased for Hispanics (from 33.9% in 2004 to 42.4% in 2008, p < .01) and Whites (from 26.7% to 32.5%, p < .01). CONCLUSIONS: Demographic disparities in menthol cigarette use persist in the United States. Continued monitoring and improvement of existing surveillance systems to identify patterns and trends in menthol cigarette use are needed.

Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004.

Cotinine, a metabolite of nicotine, is widely used to distinguish smokers from nonsmokers in epidemiologic studies and smoking-cessation clinical trials. As the magnitude of secondhand smoke exposure declines because of proportionally fewer smokers and more clean-indoor-air regulations, the optimal cotinine cutpoint with which to distinguish smokers from nonsmokers is expected to change. The authors analyzed data on 3,078 smokers and 13,078 nonsmokers from the National Health and Nutrition Examination Survey for 1999-2004. Optimal serum cotinine concentrations for discriminating smokers from nonsmokers were determined using receiver operator characteristic curve analysis. Optimal cotinine cutpoints were 3.08 ng/mL (sensitivity = 96.3%, specificity = 97.4%) and 2.99 ng/mL (sensitivity = 86.5%, specificity = 93.1%) for adults and adolescents, respectively. Among adults, optimal cutpoints differed by race/ethnicity: They were 5.92 ng/mL, 4.85 ng/mL, and 0.84 ng/mL for non-Hispanic blacks, non-Hispanic whites, and Mexican Americans, respectively. Among adolescents, cutpoints were 2.77 ng/mL, 2.95 ng/mL, and 1.18 ng/mL for non-Hispanic blacks, non-Hispanic whites, and Mexican Americans, respectively. Use of the currently accepted cutpoint of 14 ng/mL overestimates the number of nonsmokers in comparison with the proposed new overall cutpoint of 3 ng/mL or the race/ethnicity-specific cutpoints of 1-6 ng/mL.