Menthol Smoking and Related Health Disparities

Fewer people now smoke cigarettes than in recent decades,^1,2 but the proportion of people who smoke and use menthol cigarettes has increased, particularly among population groups that experience tobacco-related disparities.^3,4

The tobacco industry aggressively targets its marketing to certain populations, including young people, women, and racial and ethnic minority groups, particularly Black people.^5,6,7,8 These groups are more likely to smoke menthol cigarettes compared to other population groups.

Nearly all people who smoke cigarettes begin in adolescence or young adulthood.^9,10 Studies show that youth and young adults are more likely to try a menthol cigarette as their first cigarette, rather than a non-menthol cigarette.^11,12,13 Those who first start with a menthol cigarette are more likely to continue smoking.^11,12

In 2021, 39% of middle school and high school students who currently smoked cigarettes reported using menthol cigarettes.¹⁴ In 2020, 53% of young adults (18-25 years old) who currently smoked cigarettes reported using menthol cigarettes.³ That same year, less than 42% of adults over 35 years old who currently smoked cigarettes reported using menthol cigarettes.³

In 2021, nearly 8 in 10 youth (grades 6-12) who reported using tobacco products used flavored varieties.¹⁴ In addition to menthol-flavored cigarettes, other menthol-flavored tobacco products are popular among youth. Among middle and high school students:

• 50.2% of those who used flavored nicotine pouches used menthol pouches.
• 38.2% of those who used flavored smokeless tobacco used menthol smokeless tobacco.
• 28.8% of those who used flavored e-cigarettes used menthol e-cigarettes.
• 21.0% of those who used flavored cigars used menthol cigars.¹⁴

In 2018-2019, among adults 18-34 years old:

• 93.1% of those who used flavored smokeless tobacco used mint/menthol smokeless tobacco.
• 45.1% of those who used flavored hookah used mint/menthol hookah.
• 35.7% of those who used flavored e-cigarettes used mint/menthol e-cigarettes.
• 20.8% of those who used flavored cigars used mint/menthol cigars.
• 11.1% of those who used flavored blunts (the hollowed-out tobacco leaf wrapper of a cigar filled with marijuana) used mint/menthol blunts.¹⁵

Non-Hispanic Black or African American people who smoke cigarettes, regardless of age, are more likely to smoke menthol cigarettes than people of other races or ethnicities who smoke cigarettes.¹⁶ It is estimated that between 1980 – 2018, 1.5 million African Americans began smoking menthol cigarettes and 157,000 African Americans died prematurely because of menthol cigarettes.¹⁷

• In 2018, 51.4% of non-Hispanic Black and 50.6% of Hispanic high school and middle school students who smoked used menthol cigarettes, compared to 42.8% of non-Hispanic White youth.¹⁸
• In 2018-2019, approximately 70% of Black or African American adults 18-34 years old who currently smoked cigarettes used menthol cigarettes, compared to 39% of White adults in that same age group.¹⁵
• A survey of people ages 12 years and older who used a menthol cigarette, menthol cigar, or menthol cigarillo as their first tobacco product between 2014 and 2018 found that 24.7% of those surveyed were non-Hispanic Black people and 29.3% were Hispanic people. These were significantly higher proportions as compared to the U.S. population. The study authors noted that census data at the time showed that 12.6% of the U.S. population were Black or African American people and 16.3% were Hispanic people.¹⁹ That same census year, 14.6% of the U.S. population were non-Hispanic Black people.²⁰
• A survey conducted between 2013 and 2015 showed that among non-Hispanic Black adults who smoke, approximately 93% used menthol cigarettes when they first tried smoking. Among non-Hispanic White adults who smoke, 44% used menthol cigarettes when they first tried smoking.¹³
• In 2020, approximately 81% of non-Hispanic Black adults who currently smoked cigarettes used menthol cigarettes, compared to 34% of non-Hispanic White adults.³

People who smoke menthol cigarettes make more attempts to quit smoking than those who smoke non-menthol cigarettes.²¹ However, the proportion of people who tried and succeeded in quitting non-menthol cigarettes is greater than the proportion of people who have tried and succeeded in quitting menthol cigarettes.²¹ This could be due to a number of factors, including the way in which menthol enhances the effects of nicotine in the brain.²² African American people who smoke menthol cigarettes may be even less successful in quitting than other population groups.⁶ Black or African American people can face barriers when trying to find and use proven quit smoking treatments. Also, the conditions in which non-Hispanic Black people live, learn, work and play may make it harder to quit.²³

Additional studies of tobacco product use are needed to assess menthol cigarette use among people of different racial and ethnic minority population groups, and among people who may belong to more than one group. However, we know that:

• In 2018-2019, approximately 53% of Hispanic and Latino adults 18-34 years old who currently smoked cigarettes used menthol cigarettes, compared to 39% of White adults in that same age group.¹⁵
• In 2020, 51% of Hispanic adults ages 18 years and older who currently smoked cigarettes used menthol cigarettes as compared to 34% of non-Hispanic White adults.³
• In 2019, 77% of non-Hispanic Native Hawaiian and Pacific Islander adults and 41% of non-Hispanic Asian adults who currently smoked cigarettes used menthol cigarettes, compared to 30% of non-Hispanic White adults.¹⁶
• Filipino adults and Native Hawaiian and Pacific Islander adults who smoke are more likely to use menthol cigarettes than other groups of Asian adults.²⁴
• In 2020, 50% of female adults who currently smoked used menthol cigarettes, compared to 38% of male adults.³
• People who identify as lesbian, gay, bisexual or transgender (LGBT) who smoke are more likely to smoke menthol cigarettes than heterosexual people who smoke.^25,26 A survey from 2015-2019 of people aged 12 and older showed this difference in menthol use is greater among lesbian or gay female people (51%) as compared to gay male people (44%), and among bisexual female people (54%) as compared to bisexual male people (32%).²⁷ In 2020, 54% of lesbian or gay people and 49% of bisexual people who currently smoked cigarettes used menthol cigarettes, compared to 42% of heterosexual people.³
• People with lower levels of income are more likely to smoke menthol cigarettes than people with higher incomes. For example, in 2020, among adults who smoked cigarettes, 49% of people with a household income less than $20,000 smoked menthol cigarettes, compared to 34% of people with a household income of $75,000 or more.³
• Young adults with serious mental health conditions use menthol tobacco products at disproportionately high rates.^28,29 Similarly, adults who smoke and have mental health conditions are more likely to use menthol cigarettes than those who do not have mental health conditions.³⁰ For example, in 2016-2018, adults who smoked and had more severe internalizing problems, such as depression and anxiety, reported that they were more likely to have used a menthol cigarette as their first cigarette and were more likely to currently use menthol cigarettes, as compared to those with low internalizing problems.³¹
• The proportion of adults who smoke and use menthol cigarettes has increased in the past two decades, even as overall cigarette smoking has decreased. This increase in menthol use has been greater among certain population groups, including younger adults, minoritized racial and ethnic population groups, female adults, and adults with mental health problems.^3,4