Menthol Smoking and Nicotine Dependence among Black/African American Women Smokers Living in Low-Resource, Rural Communities

Int J Environ Res Public Health. 2021 Oct 16;18(20):10877. doi: 10.3390/ijerph182010877.


Black/African American women from low-resource, rural communities bear a disproportionate burden of tobacco-related morbidity and mortality. This study examined associations between menthol smoking and socioeconomic deprivation with nicotine dependence and quitting behaviors among Black/African American women cigarette and/or little cigar/cigarillo smokers, aged 18-50 living in low-resource, rural communities. Baseline survey data from a randomized controlled behavioral/intervention trial (#NCT03476837) were analyzed (n = 146). Outcomes included time to first tobacco product (cigarette/little cigar/cigarillo) use within 5 min of waking, Fagerstrom Test for Nicotine Dependence (FTND) score, and ever attempting to quit cigarettes. Socioeconomic deprivation measures included education, income, and receiving supplemental nutritional assistance (SNAP) program benefits. In adjusted regression analyses, menthol smoking was associated with both greater FTND scores and time to first tobacco product use within 5 min of waking, but not ever attempting to quit cigarettes. Regardless of menthol status, only 25.0% of smokers reported that they would quit smoking if menthol cigarettes were banned. The proportion of smokers who smoked their first tobacco product within 5 min of waking increased slightly with greater socioeconomic deprivation. Additional research and targeted efforts are needed to reduce nicotine dependence among Black/African American women smokers living in rural, low-resource communities where access to cessation services is limited.

Keywords: African Americans; cessation; cigarette; cigarillo; little cigar; low income; menthol; nicotine dependence; rural; tobacco.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Black or African American
  • Female
  • Humans
  • Menthol
  • Rural Population
  • Smokers
  • Smoking
  • Smoking Cessation*
  • Tobacco Products*
  • Tobacco Use Disorder* / epidemiology


  • Menthol