Determining non-cigarette tobacco, alcohol, and substance use typologies across menthol and non-menthol smokers using latent class analysis
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Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, USA
Department of Oncology, Georgetown University Medical Center, Washington, USA
Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
Amy M. Cohn   

Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street, NW, 4th Floor, Washington, DC, USA
Submission date: 2016-08-17
Acceptance date: 2017-01-04
Publication date: 2017-01-17
Tob. Induc. Dis. 2017;15(January):5
Substance use and mental health are robustly associated with smoking and poor cessation outcomes, but not often examined in combination with menthol cigarette smoking, which is also associated with lower quit rates. This study identified classes of Black and White menthol and non-menthol cigarette smokers based on demographics, alcohol, drug, and other tobacco use behaviors.

Using screening data from two studies, latent class analysis (LCA) was conducted to classify n = 1177 menthol and non-menthol cigarette smokers on demographic characteristics, heavy smoking, alcohol and drug use, desire to quit smoking, other tobacco product use, and use of psychotropic medication.

Three latent classes were identified that differentiated smokers on substance use, menthol cigarette smoking, and other tobacco use behavior. One class consisted primarily of young adults who used a wide array of other tobacco products, reported the highest prevalence of other drug use, and showed the lowest desire to quit smoking cigarettes in the next 6-months. Class 2 comprised primarily of Black male menthol smokers, all of whom used cigarillos in addition to cigarettes, and who displayed moderate drug use. The third class was categorized as primarily older cigarette smokers, who engaged in very little other tobacco use or drug use, but who were most likely to self-report being prescribed psychotropic medication.

LCA allowed for the identification of distinct classes of smokers based on factors related to poor cessation outcomes, including menthol use, that have not previously been examined in combination. Interventions should target specific groups of smokers, rather than take a “one size fits all” approach.

Schroeder SA, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annu Rev Public Health. 2010;31:297–314.
Talati A, Keyes K, Hasin D. Changing relationships between smoking and psychiatric disorders across twentieth century birth cohorts: clinical and research implications. Mol Psychiatr. 2016;(4):464–71. doi:10.1038/mp.2015.224.
Giovino GA, Villanti AC, Mowery PD, Sevilimedu V, Niaura RS, Vallone DM, et al. Differential trends in cigarette smoking in the USA: is menthol slowing progress? Tob Control. 2015;24:28–37. doi:10.1136/tobaccocontrol-2013-051159.
Garten S, Falkner RV. Role of mentholated cigarettes in increased nicotine dependence and greater risk of tobacco-attributable disease. Prev Med. 2004;38:793–8. doi:10.1016/j.ypmed.2004.01.019.
Fagan P, Moolchan ET, Hart Jr A, Rose A, Lawrence D, Shavers VL, et al. Nicotine dependence and quitting behaviors among menthol and non-menthol smokers with similar consumptive patterns. Addiction. 2010;105 Suppl 1:55–74. doi:10.1111/j.1360-0443.2010.03190.x.
Wackowski O, Delnevo CD. Menthol cigarettes and indicators of tobacco dependence among adolescents. Addict Behav. 2007;32:1964–9.
Fagan P, Pohkrel P, Herzog T, Pagano I, Vallone D, Trinidad DR, et al. Comparisons of three nicotine dependence scales in a multiethnic sample of young adult menthol and non-menthol smokers. Drug Alcohol Depend. 2015;149:203–11.
Vickerman KA, Schauer GL, Malarcher AM, Zhang L, Mowery P, Nash CM. Quitline use and outcomes among callers with and without mental health conditions: a 7-month follow-up evaluation in three states. Biomed Res Int. 2015;2015:817298.
Lukowski AV, Morris CD, Young SE, Tinkelman D. Quitline outcomes for smokers in 6 states: rates of successful quitting vary by mental health status. Nicotine Tob Res. 2015;17:924–30.
Neri AJ, Momin BR, Thompson TD, Kahende J, Zhang L, Puckett MC, et al. Use and effectiveness of quitlines versus Web‐based tobacco cessation interventions among 4 state tobacco control programs. Cancer. 2016;122:1126–33.
Leeman RF, McKee SA, Toll BA, Krishnan-Sarin S, Cooney JL, Makuch RW, et al. Risk factors for treatment failure in smokers: relationship to alcohol use and to lifetime history of an alcohol use disorder. Nicotine Tob Res. 2008;10:1793–809.
Delnevo CD, Gundersen DA, Hrywna M, Echeverria SE, Steinberg MB. Smoking-cessation prevalence among U.S. smokers of menthol versus non-menthol cigarettes. Am J Prev Med. 2011;41:357–65. Epub 2011/10/04. doi: 10.1016/j.amepre.2011.06.039.
Glautier S. Measures and models of nicotine dependence: positive reinforcement. Addiction. 2004;99 Suppl 1:30–50. doi:10.1111/j.1360-0443.2004.00736.x.
Lawrence D, Cadman B, Hoffman AC. Sensory properties of menthol and smoking topography. Tob Induc Dis. 2011;9 Suppl 1:S3. doi:10.1186/1617-9625-9-S1-S3.
Ahijevych K, Garrett BE. Menthol pharmacology and its potential impact on cigarette smoking behavior. Nicotine Tob Res. 2004;6 Suppl 1:S17–28. doi:10.1080/14622200310001649469.
Young-Wolff KC, Hickman NJ, Kim R, Gali K, Prochaska JJ. Correlates and prevalence of menthol cigarette use among adults with serious mental illness. Nicotine Tob Res. 2015;17:285–91.
Hickman NJ, Delucchi KL, Prochaska JJ. Menthol use among smokers with psychological distress: findings from the 2008 and 2009 National Survey on Drug Use and Health. Tob Control. 2014;23:7–13.
Cohn AM, Johnson AL, Hair E, Rath JM, Villanti AC. Menthol tobacco use is correlated with mental health symptoms in a national sample of young adults: implications for future health risks and policy recommendations. Tob Induc Dis. 2016;14:1.
Sees KL, Clark HW. When to begin smoking cessation in substance abusers. J Subst Abuse Treat. 1993;10:189–95.
Kabbani N. Not so Cool? Menthol’s discovered actions on the nicotinic receptor and its implications for nicotine addiction. Front Pharmacol. 2013;4. doi: 10.3389/fphar.2013.00095.
Buhler M, Vollstadt-Klein S, Kobiella A, Budde H, Reed LJ, Braus DF, et al. Nicotine dependence is characterized by disordered reward processing in a network driving motivation. Biol Psychiatry. 2010;67:745–52. doi:10.1016/j.biopsych.2009.10.029.
Baker TB, Piper ME, McCarthy DE, Majeskie MR, Fiore MC. Addiction motivation reformulated: an affective processing model of negative reinforcement. Psychol Rev. 2004;111:33–51. doi:10.1037/0033-295X.111.1.33.
Tizabi Y, Copeland RL, Louis VA, Taylor RE. Effects of combined systemic alcohol and central nicotine administration into ventral tegmental area on dopamine release in the nucleus accumbens. Alcohol Clin Exp Res. 2002;26:394–9.
McKee SA, Weinberger AH. How can we use our knowledge of alcohol-tobacco interactions to reduce alcohol use? Annu Rev Clin Psychol. 2013;9:649–74. doi:10.1146/annurev-clinpsy-050212-185549. Epub 2012/11/20.
Kiviniemi MT, Orom H, Giovino GA. Psychological distress and smoking behavior: the nature of the relation differs by race/ethnicity. Nicotine Tob Res. 2011;13:113–9. doi:10.1093/ntr/ntq218. Epub 2010/12/17.
Caraballo RS, Asman K. Epidemiology of menthol cigarette use in the United States. Tob Induc Dis. 2011;9:S1.
Gundersen DA, Delnevo CD, Wackowski O. Exploring the relationship between race/ethnicity, menthol smoking, and cessation, in a nationally representative sample of adults. Prev Med. 2009;49:553–7. doi:10.1016/j.ypmed.2009.10.003.
Rosenbloom J, Rees VW, Reid K, Wong J, Kinnunen T. A cross-sectional study on tobacco use and dependence among women: does menthol matter? Tob Induc Dis. 2012;10:19.
Ahijevych K, Parsley LA. Smoke constituent exposure and stage of change in black and white women cigarette smokers. Addict Behav. 1999;24:115–20.
Muscat JE, Liu HP, Stellman SD, Richie Jr JP. Menthol smoking in relation to time to first cigarette and cotinine: results from a community-based study. Regul Toxicol Pharmacol. 2012;63:166–70. doi:10.1016/j.yrtph.2012.03.012.
Hersey JC, Nonnemaker JM, Homsi G. Menthol cigarettes contribute to the appeal and addiction potential of smoking for youth. Nicotine Tob Res. 2010;12 Suppl 2:S136–46. doi:10.1093/ntr/ntq173.
US Food and Drug Administration. Preliminary scientific evaluation of the possible public health effects of menthol versus nonmenthol cigarettes. 2013. [cited 2016 April 28]. Available from:
Goodman LA. Exploratory latent structure analysis using both identifiable and unidentifiable models. Biometrika. 1974;61:215–31.
Lazarsfeld PF, Henry NW. Latent structure analysis. New York: Houghton Mifflin Co.; 1968.
Sutfin EL, Reboussin BA, McCoy TP, Wolfson M. Are college student smokers really a homogeneous group? A latent class analysis of college student smokers. Nicotine Tob Res. 2009;11(4):444-54.
Furberg H, Sullivan PF, Bulik C, Maes H, Prescott CA, Kendler KS, et al. The types of regular cigarette smokers: a latent class analysis. Nicotine Tob Res. 2005;7:351–60.
Timberlake DS. A latent class analysis of nicotine-dependence criteria and use of alternate tobacco. J Stud Alcohol Drugs. 2008;69:709–17.
Martin RA, Velicer WF, Fava JL. Latent transition analysis to the stages of change for smoking cessation. Addict Behav. 1996;21:67–80.
Guo B, Aveyard P, Fielding A, Sutton S. Using latent class and latent transition analysis to examine the transtheoretical model staging algorithm and sequential stage transition in adolescent smoking. Subst Use Misuse. 2009;44:2028–42.
Xian H, Scherrer JF, Madden PA, Lyons MJ, Tsuang M, True WR, et al. Latent class typology of nicotine withdrawal: genetic contributions and association with failed smoking cessation and psychiatric disorders. Psychol Med. 2005;35:409–19.
Manley MJ, de Jonge P, Kershaw TS, Desai RA, Lin H, Kasl SV. Association of major depression with subtypes of nicotine dependence found among adult daily smokers: a latent class analysis. Drug Alcohol Depend. 2009;104:126–32.
Maldonado-Molina MM, Lanza ST. A framework to examine gateway relations in drug use: an application of latent transition analysis. J Drug Issues. 2010;40:901–24.
NIAAA. The national institute on alcohol abuse and alcoholism five year strategic plan: FY09-14 “alcohol across the lifespan”. 2008. National Institute on Alcohol Abuse and Alcoholism.
National Institute on Alcohol Abuse and Alcoholism. Drinking Levels Defined Bethesda, MD [cited 2016 April 29]. Available from:
Choi WS, Okuyemi KS, Kaur H, Ahluwalia JS. Comparison of smoking relapse curves among African-American smokers. Addict Behav. 2004;29:1679–83.
Rose JS, Chassin L, Presson C, Sherman SJ, Stein MD, Col N. A latent class typology of young women smokers. Addiction. 2007;102:1310–9.
Tannenbaum C, Lexchin J, Tamblyn R, Romans S. Indicators for measuring mental health: towards better surveillance. Healthc Policy. 2009;5:e177–86.
Nylund KL, Asparouhov T, Muthén BO. Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Modeling. 2007;14:535–69.
Hyland A, Li Q, Bauer JE, Giovino GA, Steger C, Cummings KM. Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res. 2004;6:S363–9.
Diemert LM, Bondy SJ, Brown KS, Manske S. Young adult smoking cessation: predictors of quit attempts and abstinence. Am J Public Health. 2013;103:449–53.
Kalkhoran S, Padilla JL, Neilands TB, Ling PM. Multiple tobacco product use among young adult bar patrons in New Mexico. Psychol Med. 2016;83:16–21.
Fix BV, O’Connor RJ, Vogl L, Smith D, Bansal-Travers M, Conway KP, et al. Patterns and correlates of polytobacco use in the United States over a decade: NSDUH 2002–2011. Addict Behav. 2014;39:768–81.
Enofe N, Berg CJ, Nehl EJ. Alternative tobacco use among college students: who is at highest risk? Am J Health Behav. 2014;38:180–9.
Rath JM, Villanti AC, Abrams DB, Vallone DM. Patterns of tobacco use and dual use in US young adults: the missing link between youth prevention and adult cessation. J Environ Public Health. 2012;2012:9. doi:10.1155/2012/679134.
Richardson A, Williams V, Rath J, Villanti AC, Vallone D. The next generation of users: prevalence and longitudinal patterns of tobacco use among US young adults. Am J Public Health. 2014;104:1429–36. doi:10.2105/AJPH.2013.301802.
Vanyukov MM, Tarter RE, Kirisci L, Kirillova GP, Maher BS, Clark DB. Liability to substance use disorders: 1. Common mechanisms and manifestations. Neuroscience & Biobehavioral Reviews. 2003;27:507–15.
Mendiondo MS, Alexander LA, Crawford T. Health profile differences for menthol and non‐menthol smokers: findings from the national health interview survey. Addiction. 2010;105:124–40.
Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013;103:777–80.
Thornicroft G. Most people with mental illness are not treated. Lancet. 2007;370:807–8.
Falk DE, Yi H, Hiller-Sturmhofel S. An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders. Alcohol Res Health. 2006;29:162–71.
D’Silva J, Boyle RG, Lien R, Rode P, Okuyemi KS. Cessation outcomes among treatment-seeking menthol and nonmenthol smokers. Am J Prev Med. 2012;43:S242–8.
Levy DT, Blackman K, Tauras J, Chaloupka FJ, Villanti AC, Niaura RS, et al. Quit attempts and quit rates among menthol and nonmenthol smokers in the United States. Am J Public Health. 2011;101:1241–7. doi:10.2105/AJPH.2011.300178.
Murray RP, Connett JE, Skeans MA, Tashkin DP. Menthol cigarettes and health risks in Lung Health Study data. Nicotine Tob Res. 2007;9:101–7. doi:10.1080/14622200601078418.
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