Higher nicotine intake per cigarette by African American smokers: is it a menthol effect?.
However, this study also included a measure of blood cotinine – the main metabolite of nicotine and a good index of total nicotine intake. African American smokers had much higher cotinine concentrations (253 ng/ml) than white/non Latino smokers (208 ng/ml) and Mexican American smokers (94 ng/ml). So the estimated cotinine per cigarette was much higher (33) for African Americans, than both non-Latino whites (15) or Mexican American smokers (17). While there is some evidence that these differences in cotinine levels may relate to metabolic differences, they also appear to be due to real differences in nicotine intake per cigarette, as indicated by higher levels of exhaled carbon-monoxide.
A similar pattern was recently reported among 900 young adult smokers (aged 18-26), among whom whites averaged over 15 cigarettes per day but African Americans, Latinos and Asian smokers averaged 10-11 cigarettes per day. However, African American smokers had blood cotinine levels that were much higher than other groups, and an average cotinine level per cigarette that was more than twice that of non-Latino whites.
Part of these differences in nicotine intake per cigarette may relate to differences in the types of cigarettes smoked by different subgroups. Around 80% of African American smokers smoke a mentholated brand of cigarettes, compared to 25% for non-Latino whites. Menthol stimulates cold receptors and so cools the harshness of cigarette smoke on the throat, enabling a larger inhalation per puff.
If African Americans are inhaling more nicotine per cigarette, this would suggest that they may have increased absorption of other toxic chemicals. The habitual intake of more nicotine from fewer cigarettes may also produce a stronger addiction to cigarettes. Further evidence that is consistent with this idea emerged last year in a paper published in the New England Journal of Medicine which reported a higher rate of lung cancer, and lower rate of “ex-smokers” among African American and Native Hawaiian smokers. Interestingly, Native Hawaiians also have a strong preference for mentholated brands (65-80%). Putting together all of the evidence on this leads me to believe that people who smoke menthol cigarettes are likely to inhale more smoke per cigarette, be more addicted, and be at greater risk of smoking-caused diseases (all other things being equal). These effects are likely to be more marked in people who have had to restrict their cigarette consumption due to the expense of cigarettes, restrictions on smoking in public places or other factors (e.g. those affecting young people, or pregnant smokers). It also seems likely that the tobacco industry has targeted their marketing of menthol brands at groups they perceive as having less disposable income, because the industry knows that menthol cigarettes can get the customer addicted on fewer cigarettes per day.