Skip to main content

Smoking intensity and intent to continue smoking among menthol and non-menthol adolescent smokers in Canada



Research suggests that menthol cigarette use is associated with nicotine dependence. However, findings on the relationship between menthol smoking status and quantity of cigarettes smoked are less clear. The objective of this paper was to examine whether menthol cigarette smoking is associated with higher smoking intensity and intention to continue smoking among adolescents.


A nationally representative sample of 4,736 Canadian students in grades 9–12 was drawn from the 2010–2011 Canadian Youth Smoking Survey. Associations between smoking intensity and menthol smoking were examined using linear regression. A logistic regression was used to examine whether menthol smoking increased the odds that a student reported intention to continue smoking.


Thirty-two percentage of smokers in grades 9–12 smoked menthol cigarettes in the last 30 days. Unadjusted average number of cigarettes reported by menthol smokers was 6.86 compared with 4.59 among non-menthol smokers (p < 0.001). Multivariable results showed that the average number of cigarettes smoked by menthol smokers was greater than non-menthol smokers (β = 1.92; 95 % CI = 1.16–2.68). Similar results were found using the total number of cigarettes smoked in the past week. Additionally, menthol smokers had greater odds of reporting intent to continue smoking compared with non-menthol smokers (OR = 2.95; 95 % CI = 2.24–3.90). These results were similar when separate analyses were conducted for established smokers and experimental smokers.


The findings of this study along with existing evidence suggest the need for banning mentholated tobacco products in Canada, in part because of its significant effect on adolescent smoking.

This is a preview of subscription content, access via your institution.


  1. 1.

    Youth Smoking Survey (2010-11) Supplementary Tables, Youth Smoking Survey 2010-11. Retrieved from

  2. 2.

    Chassin L, Presson CC, Sherman SJ, Edwards DA (1990) The natural history of cigarette smoking: predicting young-adult smoking outcomes from adolescent smoking patterns. Health Psychol 9(6):701–716. doi:10.1037/0278-6133.9.6.701

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Khuder S, Dayal H, Mutgi A (1999) Age at smoking onset and its effect on smoking cessation. Addict Behav 24(5):673–677. doi:10.1016/S0306-4603(98)00113-0

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Health Canada (2010) Retrieved from

  5. 5.

    Food and Drug Administration (2013) Preliminary scientific evaluation of the possible public health effects of menthol versus nonmenthol cigarettes. Retrieved from

  6. 6.

    Nonnemaker J, Hersey J, Homsi G, Busey A, Allen J, Vallone D (2013) Initiation with menthol cigarettes and youth smoking uptake. Addiction 108(1):171–178. doi:10.1111/j.1360-0443.2012.04045.x

    PubMed  Article  Google Scholar 

  7. 7.

    Giovino GA, Villanti AC, Mowery PD, Sevilimedu V, Niaura RS, Vallone DM, Abrams DB (2013) Differential trends in cigarette smoking in the USA: is menthol slowing progress? Tobacco control, tobaccocontrol-2013. doi: 10.1136/tobaccocontrol-2013-051159

  8. 8.

    Hersey JC, Ng SW, Nonnemaker JM, Mowery P, Thomas KY, Vilsaint MC, Haviland ML (2006) Are menthol cigarettes a starter product for youth? Nicotine Tob Res 8(3):403–413. doi:10.1080/14622200600670389

    PubMed  Article  Google Scholar 

  9. 9.

    Villanti AC, Giovino GA, Barker DC, Mowery PD, Sevilimedu V, Abrams DB (2012) Menthol brand switching among adolescents and young adults in the National Youth Smoking Cessation Survey. Am J Public Health 102(7):1310–1312. doi:10.2105/AJPH.2011.300632

    PubMed Central  PubMed  Article  Google Scholar 

  10. 10.

    Lee YO, Glantz SA (2011) Menthol: putting the pieces together. Tob control 20(Suppl 2):ii1–ii7. doi:10.1136/tc.2011.043604

    PubMed Central  PubMed  Google Scholar 

  11. 11.

    Klausner K (2011) Menthol cigarettes and smoking initiation: a tobacco industry perspective. Tob Control 20(Suppl 2):ii12–ii19. doi:10.1136/tc.2010.041954

    PubMed Central  PubMed  Google Scholar 

  12. 12.

    Kreslake JM, Wayne GF, Connolly GN (2008) The menthol smoker: tobacco industry research on consumer sensory perception of menthol cigarettes and its role in smoking behavior. Nicotine Tob Res 10(4):705–715. doi:10.1080/14622200801979134

    PubMed  Article  Google Scholar 

  13. 13.

    Yerger VB (2011) Menthol’s potential effects on nicotine dependence: a tobacco industry perspective. Tob Control 20(Suppl 2):ii29–ii36. doi:10.1136/tc.2010.041970

    PubMed Central  PubMed  Google Scholar 

  14. 14.

    Anderson SJ (2011) Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents. Tob Control 20(Suppl 2):ii20–ii28. doi:10.1136/tc.2010.041939

    PubMed Central  PubMed  Google Scholar 

  15. 15.

    Manske SR, Rynard V, Minaker L (2013) Flavoured tobacco use among Canadian youth: evidence from Canada’s 2010/2011 Youth Smoking Survey. Waterloo: Propel Centre for Population Health Impact, 1‐2. Retrieved from

  16. 16.

    Ahijevych K, Garrett BE (2010) The role of menthol in cigarettes as a reinforcer of smoking behavior. Nicotine Tob Res 12(suppl 2):S110–S116. doi:10.1093/ntr/ntq203

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    Richter P, Beistele D, Pederson L, O’Hegarty M (2008) Small-group discussions on menthol cigarettes: listening to adult African American smokers in Atlanta, Georgia. Ethn Health 13:171–182. doi:10.1080/13557850701784694

    PubMed  Article  Google Scholar 

  18. 18.

    Gundersen DA, Delnevo CD, Wackowski O (2009) Exploring the relationship between race/ethnicity, menthol smoking, and cessation, in a nationally representative sample of adults. Prev Med 49(6):553–557. doi:10.1016/j.ypmed.2009.10.003

    PubMed  Article  Google Scholar 

  19. 19.

    Levy DT, Blackman K, Tauras J, Chaloupka FJ, Villanti AC, Niaura RS, Abrams DB (2011) Quit attempts and quit rates among menthol and nonmenthol smokers in the United States. Am J Public Health 101(7):1241–1247. doi:10.2105/AJPH.2011.300178

    PubMed Central  PubMed  Article  Google Scholar 

  20. 20.

    Delnevo CD, Gundersen DA, Hrywna M, Echeverria SE, Steinberg MB (2011) Smoking-cessation prevalence among US smokers of menthol versus non-menthol cigarettes. Am J Prev Med 41(4):357–365. doi:10.1016/j.amepre.2011.06.039

    PubMed  Article  Google Scholar 

  21. 21.

    Okuyemi KS, Faseru B, Cox Sanderson L, Bronars CA, Ahluwalia JS (2007) Relationship between menthol cigarettes and smoking cessation among African American light smokers. Addiction 102:1979–1986. doi:10.1111/j.1360-0443.2007.02010.x

    PubMed  Article  Google Scholar 

  22. 22.

    Gandhi KK, Foulds J, Steinberg MB, Lu SE, Williams JM (2009) Lower quit rates among African American and Latino menthol smokers at a tobacco treatment clinic. Int J Clin Pract 63:360–367. doi:10.1111/j.1742-1241.2008.01969.x

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Fu SS, Okuyemi KS, Partin MR, Ahluwalia JS, Nelson DB, Clothier BA et al (2008) Menthol cigarettes and smoking cessation during an aided quit attempt. Nicotine Tob Res 10:457–462. doi:10.1080/14622200801901914

    PubMed  Article  Google Scholar 

  24. 24.

    Hyland A, Garten S, Giovino GA (2002) Mentholated cigarettes and smoking cessation: findings from COMMIT. Tob Control 11:135–139. doi:10.1136/tc.11.2.135

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  25. 25.

    Muscat JE, Richie JP, Stellman SD (2002) Mentholated cigarettes and smoking habits in whites and blacks. Tob Control 11:368–371. doi:10.1136/tc.11.4.368

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  26. 26.

    Fagan P, Moolchan ET, Hart A Jr, Rose A, Lawrence D, Shavers VL, Gibson JT (2010) Nicotine dependence and quitting behaviors among menthol and non-menthol smokers with similar consumptive patterns. Addiction 105(s1):55–74. doi:10.1111/j.1360-0443.2010.03190.x

    PubMed  Article  Google Scholar 

  27. 27.

    Wackowski O, Delnevo CD (2007) Menthol cigarettes and indicators of tobacco dependence among adolescents. Addict Behav 32(9):1964–1969. doi:10.1016/j.addbeh.2006.12.023

    PubMed  Article  Google Scholar 

  28. 28.

    Collins CC, Moolchan ET (2006) Shorter time to first cigarette of the day in menthol adolescent cigarette smokers. Addict Behav 31(8):1460–1464. doi:10.1016/j.addbeh.2005.10.001

    PubMed  Article  Google Scholar 

  29. 29.

    Muscat JE, Chen G, Knipe A, Stellman SD, Lazarus P, Richie JP (2009) Effects of menthol on tobacco smoke exposure, nicotine dependence, and NNAL glucuronidation. Cancer Epidemiol Biomark Prev 18(1):35–41. doi:10.1158/1055-9965.EPI-08-0744

    CAS  Article  Google Scholar 

  30. 30.

    Elton-Marshall TE, Leatherdale ST, Manske SR, Wong K, Ahmed R, Burkhalter R (2011) Research methods of the Youth Smoking Survey (YSS).Chronic Dis Inj Can 32(1):47–54. Retrieved from

  31. 31.

    University of Waterloo (2011) Youth Smoking Survey (YSS): 2010/2011 YSS Microdata User Guide. Waterloo: Propel Centre for Population Health Impact, 1-50. Retrieved from

  32. 32.

    Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK (1996) Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol 15:355–361. doi:10.1037//0278-6133.15.5.355

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Azagba S, Sharaf MF (2014) Binge drinking and marijuana use among menthol and non-menthol adolescent smokers: findings from the Youth Smoking Survey. Addict Behav 39(3):740–743

    PubMed  Article  Google Scholar 

  34. 34.

    Giovino GA, Sidney S, Gfroerer JC, O’Malley PM, Allen JA, Richter PA, Cummings KM (2004) Epidemiology of menthol cigarette use. Nicotine Tob Res 6(Suppl 1):S67–S81. doi:10.1080/14622203710001649696

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Mendiondo MS, Alexander LA, Crawford T (2010) Health profile differences for menthol and non-menthol smokers: findings from the national health interview survey. Addiction 105(s1):124–140. doi:10.1111/j.1360-0443.2010.03202.x

    PubMed  Article  Google Scholar 

Download references


We thank two anonymous reviewers of this journal and Dr. Stanton Glantz for providing invaluable suggestions and comments. This work was supported by a research grant from the Canadian Cancer Society Research Institute (Grant Number 2011-701019). The Youth Smoking Survey is a product of the pan-Canadian capacity building project funded through a contribution agreement between Health Canada and the Propel Centre for Population Health Impact from 2004 to 2007 and a contract between Health Canada and the Propel Centre for Population Health Impact from 2008–2011. The YSS consortium includes Canadian tobacco control researchers from all provinces and provided training opportunities for university students at all levels. The views expressed herein do not necessarily represent the views of Health Canada.

Conflict of interest


Author information



Corresponding author

Correspondence to Sunday Azagba.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Azagba, S., Minaker, L.M., Sharaf, M.F. et al. Smoking intensity and intent to continue smoking among menthol and non-menthol adolescent smokers in Canada. Cancer Causes Control 25, 1093–1099 (2014).

Download citation


  • Tobacco
  • Smoking intensity
  • Menthol
  • Adolescent smokers