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Table 14 Main features of the epidemiological studies of cigarette mentholation and lung cancer

From: Systematic review of the epidemiological evidence comparing lung cancer risk in smokers of mentholated and unmentholated cigarettes

Characteristics 1. American Health Foundation study 2. Kaiser Permanente study 3. Los Angeles County study 4. Slone Epidemiology Center study
Source Kabat and Hebert (1991) [68] Sidney et al. (1995) [51] Carpenter et al. (1999) [69] Brooks et al. (2003) [53]
Study design Hospital case-control Prospective cohort Population case-control Hospital case-control
Location USA; New York, Chicago, Detroit, Philadelphia USA; Oakland, California USA; Los Angeles County, California USA; New York, Philadelphia, Massachusetts, Maryland
Timing 1985-1990 1979-1985 followed to 1991 1991-1994 1981-2000
Gender Both Both Both Both
Age Unrestricted 30 to 89 years at baseline 40 to 84 years 40 to 74 years
Smoking Current smokers Current smokers (for 20+ years) Ever smoked Ever smoked (for 20+ years)
Other inclusion criteria None stated None stated Caucasian (non-Hispanic) or African-American people; no previous cancer Menthol details for 60% of smoking history; no history of cancer
Cases 1044 (588M, 456F) 318 (168M, 150F) 337 (202M, 135F) 643 (435M, 208F)
Cases in mentholated cig smokers 259 93 151 114
Definition of cases Histologically confirmed, interviewed within 2 months of diagnosis Incident Histologically confirmed, interviewed within 7 months of diagnosis Confirmed by pathology, interviewed within 12 months of diagnosis
At risk Not applicable 5771M, 5990F Not applicable Not applicable
Controls 1324 (914M, 410F) Not applicable 478 (349M, 129F) 4110 (2123M, 1987F)
Definition of controls Diseases unrelated to smoking Not applicable Licensed drivers (age < 65) and Medicare beneficiaries (age 65+) Diseases unrelated to smoking
Matching of controls Age, gender, race, hospital, date of interview Not applicable Age, gender, race No matching
Menthol variable Time used (< 1, 1-14, 15+ yrs) Time used (0, 1-9, 10-19, 20+ yrs) Pack-years menthol (0, 1-15, 16-31, 32+), % menthol (0, 1-19, 20-74, 75-100), cig type (regular only, menthol only, mixed) Time used (0, 1-15, > 15 years), % years smoked (0, 1-49, 50-100)
Adjustment for race Yes Yes Yes Yes
Adjustment for smoking habits Cigs/day, inhalation, duration Cigs/day, duration Total pack-years, years since quitting Cigs/day, duration, years since quitting, time used filter cigarettes
Adjustment for other variables Age, gender, education, body mass index Age, gender, education Age, gendera Age, gender, year of interview
Results by histological type Squamous cell, small cell, large cell, adenocarcinoma No No No
Study qualityb 5 9 7 6
Characteristics 5. Second American Health Foundation study 6. German study 7. Lung Health study 8. Houston study
Source Stellman et al. (2003) [83] Jöckel et al. (2004) [84] Murray et al. (2007) [56] Etzel et al. (2008) [85]
Study design Hospital case-control Population case-control Prospective clinical trial Population case-control
Location USA; New York, Chicago, Hines, Detroit, Philadelphia Germany; location not known USA and Canada; 10 centres USA; Houston
Timing 1984-1998 Not known 1986-1989 followed for 14 years 1995-2005
Gender Both Both Both Both
Age Unrestricted Unrestricted 35 to 60 years at baseline Unrestricted
Smoking Current smokers Ever smokersc Current smokers Ever smokers
Other inclusion criteria None stated None stated Mild or moderate airways obstruction, no defined exclusiond Black people
Cases 1766 (963M, 803F) 1004 (839M, 165F) 240M+F 454M+F
Cases in mentholated cig smokers 328 50 About 50 198
Definition of cases Histologically confirmed, interviewed within 12 months of diagnosis Incident Cause of death Histologically confirmed, newly diagnosed, untreated, with no prior chemotherapy, radiotherapy or recent blood transfusion
At risk Not applicable Not applicable 3698M, 2185F Not applicable
Controls 1670 (1098M, 572F) 1004 (839M, 165F) Not applicable 353M+F
Definition of controls Diseases unrelated to smoking Population Not applicable Population
Matching of controls Age, gender, hospital, year of interview Age, gender, region Not applicable Age, gender, race
Menthol variable Preference for menthol Ever smoked mentholated cigs Smoked mentholated cigs at baseline Used mentholated cigarettes
Adjustment for race Yes Subjects White people Yes Subjects Black people
Adjustment for smoking habits Pack-years Total amount smoked Baseline cigs/day Current/former
Adjustment for other variables Age, gender, body mass index, education Age, gender, region Age, gender, FEV1, randomization group, education Age, gendere
Results by histological type No No No No
Study qualityb 6 5 8 6
  1. aAdjustment for other variables (fruits, vegetables, occupational exposures, family history, ETS) had no appreciable influence, so these variables were not included in the regression models.
  2. b The studies were scored for study quality using NOS scores [81]. Fuller details are available in additional file 2: Study quality.
  3. c Unclear - see text describing this study.
  4. dExclusions were serious illness, pregnant, usual physician prescribed bronchodilators, beta-adrenergic antagonists of systemic glucocorticoids or admitted to drinking in excess of 25 drinks a week.
  5. eMultivariate modelling was conducted involving a range of smoking variables, environmental exposures, personal and family history of diseases, but the final model did not include use of mentholated cigarettes.