Box 7

The Special Case of Menthol

Menthol in tobacco products enables initiation into and development of tobacco dependence because of its anaesthetic and cooling effects; this allows the tobacco smoke to be inhaled with less harshness or irritation which in turn increases its addiction potential.1 There is also some evidence that menthol leads to smoking behavior that amplifies its negative health effects (e.g., deeper or longer inhalation).2 Menthol is disproportionately used by African American vs. White populations and contributes to the disparity in some tobacco related diseases.3

 

Despite prognosis of enormous potential of averting deaths,4 efforts to eliminate menthol in cigarettes at the federal level have stalled. Currently, only two states (Massachusetts in June 2020 and California in November 2022) and several counties and cities in 6 states (Colorado, Illinois, Maine, Minnesota, Ohio, Oregon and New York) and Washington, D.C., have prohibited the sale of menthol cigarettes. Research has shown that restricting menthol cigarette sales at the state level reduces cigarette sales [Figure 4.2.20] and smoking.5 Menthol bans that cover larger jurisdictions and with limited or no exemptions are more impactful for cessation whereas less comprehensive bans may induce purchases of unflavored tobacco products, online purchases, and cross-border shopping among some people who smoke menthol.6

Sources

  1. U.S. Food and Drug Administration. Scientific Review of the Effects of Menthol in Cigarettes on Tobacco Addiction: 1980-2021. Center for Tobacco Products; 2022. Accessed July 17, 2024. https://www.fda.gov/media/157642/download
  2. Ahijevych, Karen, and Bridgette E. Garrett. "The role of menthol in cigarettes as a reinforcer of smoking behavior." Nicotine & Tobacco Research 12.Suppl 2 (2010): S110-S116.
  3. Goodwin, Renee D., et al. "Menthol cigarette use among adults who smoke cigarettes, 2008–2020: rapid growth and widening inequities in the United States." Nicotine and Tobacco Research 25.4 (2023): 692-698.
  4. Levy DT, Meza R, Yuan Z, Li Y, Cadham C, Sanchez-Romero LM, Travis N, Knoll M, Liber AC, Mistry R, et al. Public health impact of a U.S. ban on menthol in cigarettes and cigars: a simulation study. Tobacco Control 2023;32(e1):e37–e44.
  5. Asare, S., Majmundar, A., Xue, Z., Jemal, A., & Nargis, N. (2023). Association of comprehensive menthol flavor ban with current cigarette smoking in Massachusetts from 2017 to 2021. JAMA Internal Medicine, 183(4), 383-386.
  6. Mills, S. D., Peddireddy, S., Kurtzman, R., Hill, F., Catalan, V., Bissram, J. S., & Ribisl, K. M. (2024). The Impact of Menthol Cigarette Bans: A Systematic Review and Meta-Analysis. Nicotine and Tobacco Research, ntae011.