Menthol cigarette use in US pregnancies: Prevalence, racial/ethnic disparities, and associated characteristics from the 2010-2019 National Survey on Drug Use and Health (NSDUH).

Introduction: Pregnant people who smoke constitute a uniquely vulnerable population likely to be impacted by a menthol cigarette (MC) ban. However, there are no published reports of prevalence of prenatal MC use in a nationally-representative US sample including racial-ethnic disparities and associated characteristics.

Methods: Participants were 1245 US pregnant people who smoked MC or non-MC (NMC) in the past 30-days from the 2010-2019 National Survey on Drug Use and Health. Prevalence of past 30-day MC use was determined; weighted socio-demographic characteristics, tobacco use, and substance co-use were compared across MC and NMC groups and in multivariable analyses.

Results: Prevalence of MC use among pregnant people who smoked was 52.29% (95% CI: 48.17, 56.41) overall and 92.23% (95% CI: 87.74-96.73) among non-Hispanic Black pregnant people who smoked. A greater proportion of pregnant people who used MCs (vs NMCs) were Non-Hispanic Black or Hispanic, unmarried, sexual minorities, from a large metropolitan area, smoked fewer cigarettes per day and reported later age of initiation. In multivariable analyses, only non-Hispanic Black race remained a significant predictor of MC use; non-Hispanic Black (vs non-Hispanic White) pregnant people who smoked showed 13.88 times (95% CI: 6.30-30.58) greater odds of MC use (p<.01).

Conclusions: This is the first study to determine prevalence and correlates of prenatal MC use in a nationally representative US sample. Given known causal impacts of prenatal smoking on maternal and infant morbidity, results suggest that the planned menthol ban offers opportunities for improving maternal and infant health.

Implications: Using a nationally-representative US sample, this study highlights that more than half of pregnant people who smoke and nearly all of Black pregnant people who smoke in the US use menthol cigarettes. Given high rates of menthol cigarette use and causal links between prenatal cigarette use and maternal and infant morbidity, the menthol cigarette ban proposed by the FDA offers a potential opportunity to develop tailored education and intervention strategies to improve perinatal and infant health.