Quitting menthol cigarettes is extra hard, but a new U-M study will test the best way to do it

Nearly half of Americans who smoke use menthol cigarettes that are harder to quit, driving up their health risks with every puff. 

Now, a new University of Michigan study will test the best way to help people who smoke menthol break that habit.

The five-year, multimillion dollar study, funded by the nonprofit Patient-Centered Outcomes Research Institute (PCORI), will work with 1,200 adults who smoke menthol cigarettes. 

Half will receive motivational messages from an app along with the chance to get extra incentives to help them quit, if they submit daily breath tests. All participants will have access to coaching through partnership with state-run Quitlines.

With menthol cigarette use especially common among people with low incomes, the study could help reduce the financial toll of smoking on individuals and the Medicaid program that provides health coverage to low-income Americans. 

People who smoke menthol are more likely to be Black, contributing to the extra risk of early death in Black men especially.

“With this funding support, we’ll have the chance to continue our work with the community to see how well the Tobacco Quitline support available to every American does at helping people quit menthol products, and also see the impact of an added incentive program that we’ve tested with our partners in Michigan,” said Lara Coughlin, Ph.D., an addiction psychologist at the U-M Addiction Center and the Michigan Medicine Department of Psychiatry. “Quitting menthol isn’t easy, but we hope to make it easier.”

Comparing two options to support quitting menthol cigarettes

Coughlin and Erin Bonar, Ph.D., also a U-M addiction psychologist, lead a team that developed the Incentives2Quit program, which combines a breath-analyzing carbon monoxide monitor and smartphone app with motivational messaging and small gift card incentives for hitting milestones in remaining tobacco-free. It’s already being used in pregnant women enrolled in Medicaid coverage in Michigan.

The team developed the program using the latest behavioral science. They decided to focus on menthol through conversations with community partners, because menthol cigarettes have mint flavorings that make smoking less irritating and enhance nicotine addiction, making them harder to quit. 

They plan to recruit potential participants from people who call the Quitline program in five states and randomly assign those who enroll to receive a year of follow-up after that initial call or to receive the breath monitor and app with the chance to earn incentives for using Quitline coaches and hitting milestones. 

Quitlines are available nationwide through free calls and texts, and web-based support. They can help people who smoke or vape any form of tobacco get access to counseling about quitting, as well as medicines and patches that can reduce nicotine cravings and are covered by most insurance programs. 

The new project will test the long-term effectiveness of Quitline services, with or without the breath-testing incentive program. It will go beyond assessing impacts on participants’ smoking habits to also measure and compare impacts on their mental health, quality of life and other outcomes.

“Every attempt to quit smoking menthol cigarettes is a good start, but sustaining that over months is particularly key to reducing the health effects of tobacco,” said Coughlin. “Our study will provide evidence that could help states, Quitlines, insurance plans, and others use their resources wisely.”

Key support and partnerships

Coughlin leads the CHOICE Lab, is Mental Health Equity Faculty Lead in the Eisenberg Family Depression Center, and co-leads the MI-ACRE addiction innovation program, in which Bonar directs research strategy. 

Bonar is also The Kathy Fant Brzoznowski Research Professor in Behavioral Health Technology Innovations. This proposal is one of the first successes stemming from generous support from the Brzoznowski family who have committed to helping the U-M Department of Psychiatry lead the development of technology-driven approaches to addiction and mental health. 

The study also involves U-M Medical School faculty Allison Lin, M.D., M.S., Maureen Walton, Ph.D., Anne Fernandez, Ph.D., Jason Goldstick, Ph.D. and Larry An, M.D. They, and Coughlin and Bonar, are all members of the U-M Institute for Healthcare Policy and Innovation.

The team is partnering with the North American Quitline Consortium and RVO Health, whose Quit For Life virtual support tobacco cessation program is offered by multiple state Quitlines and employers. 

The team is strengthened by support from the Department of Psychiatry and the Rogel Cancer Center along with key partnerships, including with current and former cigarette smokers, and advocates for menthol smoking prevention and cessation, without whom this work would not be possible. 

How to get support in quitting tobacco products of all kinds

People who smoke or use tobacco who want help in quitting can reach their state’s Quitline by calling or texting the national Quitline, which will get their inquiry to the right place. 

Call 1-800-QUIT-NOW (1-800-784-8669), text QUITNOW to 333888 for free help in English and Spanish, or visit https://smokefree.gov/ . For veterans, speakers of Asian languages and people in Canada, more information about how to use specialized Quitline services is at https://www.naquitline.org/page/quitlineprofiles . 

More about the study and PCORI

This study is designed to deliver real-world data on the comparative clinical effectiveness of various patient-centered approaches, aimed at improving health and health care for people with substance use disorders or people with at-risk substance use, while also filling a critical evidence gap.

This study was selected through PCORI’s highly competitive review process in which patients, caregivers and other stakeholders join scientists to evaluate proposals. This funding award has been approved pending completion of a business and programmatic review by PCORI and issuance of a formal award contract.

PCORI is a nonprofit organization with a mission to fund research designed to provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. 

Read about all the studies funded in the new round of patient-centered comparative clinical effectiveness research.