People who smoke menthol flavored cigarettes, known as menthols, have a much higher level of addiction than non-menthol smokers, and consequently find it more difficult to quit smoking, according to a Supplement in the medical journal Addiction. Menthols in the USA are popular among African-Americans and young adults.

The Supplement has data from 11 recent studies on smoking cessation rates among regular menthol cigarette users and factors that may influence them to smoke menthols.

The TPSAC (Tobacco Products Scientific Advisory Committee, part of the FDA, ordered a review of menthols and their impact on public health – the review is currently underway. The review is also looking into the effects menthols may have on ethnic/racial groups and young people. Authorities say it will be finalized and presented to the FDA in March 2012.

Other cigarette flavorings, such as grape, pineapple, strawberry and chocolate were banned last year in the USA. Menthols, by far the most popular flavored cigarettes, were not included in the ban.

Kola Okuyemi, MD, MPH, senior editor of the Supplement, said:

    “These manuscripts, along with those in the prior literature, show that menthol cigarette smoking disproportionately impacts populations at risk of initiating smoking, young people, and tobacco-related health disparities. These papers add to the body of evidence that informs future research and policy directions regarding mentholated cigarettes.” The findings support the statement made to the FDA by Gardiner and Clark that “Given the overwhelming disease and death caused by smoking, menthol has no redeeming value other than it makes the poison go down more easily.”

According to some studies, a disproportionate number of young people and African-Americans are targeted in tobacco advertising.

The following populations in America are more likely to smoke menthols:

  • African-Americans
  • Females
  • Young people
  • Unemployed individuals
  • People with a lower level of education

An African-American smoker aged from 18 to 24 has four times the chance of being a menthol smoker than an African-American smoker aged 65+.

Not only does the Supplement reveal that menthol smokers have a much lower success rate when trying to quit, compared to non-menthol smokers, it also reports on new findings that indicate that race is linked to how menthols affect a person’s attempt to give up.

Menthol cigarette smoking is linked to a lower chance of giving up smoking, the authors write. They quote a study which found that African-American and Hispanic menthol smokers are more likely to be seriously thinking about giving up smoking and are more hopeful about being successful, but a significantly lower proportion of them end up giving up for long – compared to non-menthol smokers.

Cheryl G. Healton, DrPH, president and CEO of Legacy, said:

    “The tobacco industry has a long history of promoting menthol cigarettes to minorities and it shows. The menthol smoking rates among minority communities are disproportionately high, and to add insult to injury, once they do decide to quit, it is often more challenging for them to do so successfully. We believe that the comprehensive findings of this special issue along with past research provide the FDA with the necessary information to ban menthol.”

The authors say that research indicates that menthol cigarettes may be more damaging than other cigarettes, despite tobacco industry statements to the contrary. They quote a Lorillard Tobacco company statement: “A menthol cigarette is just another cigarette – and should be treated no differently.”

A study found that addiction among smokers who have just a few cigarettes a day was considerably higher among menthol smokers. The same was found among smokers who do not have cigarettes everyday – the menthol non-daily smokers were found to be more addicted than the non-menthol non-daily smokers.

The authors wrote:

    “While menthol smokers smoke fewer cigarettes each day compared to non-menthol smokers, current menthol and non-menthol smokers have similar health outcomes.”

Another study found that there was a 70% smaller chance of menthol smokers being covered by smoke-free policies both at home and work, compared to non-menthol smokers.

The Supplement quotes a study which linked cigarette prices with smoking rates – the higher the price, the lower the smoking rate. However, a 10% increase in menthol cigarette prices was found to drive only 2.3% of menthol smokers to non-menthols.

The conclusion could be that non-menthol cigarettes are not proper substitutes to menthols. If this is the case, would banning menthols lead to a significant number of people giving up, rather than switching to non-menthols, the authors wonder.

Special Issue:
“The Role of Mentholated Cigarettes in Smoking Behaviors in United States Populations – December 2010”
Addiction Volume 105, Issue Supplement s1 Pages 1-140

Written by Christian Nordqvist