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
It is estimated that approximately 40% of excess deaths due to menthol cigarette smoking in the U.S. between 1980 - 2018 were those of African Americans, despite African Americans making up only about 12% of the U.S. population.17
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
- Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults – United States, 2020. MMWR Morb Mortal Wkly Rep. Mar 18 2022;71(11):397-405. doi:10.15585/mmwr.mm7111a1
- U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2014.
- Goodwin RD, Ganz O, Weinberger AH, Smith PH, Wyka K, Delnevo CD. Menthol Cigarette Use Among Adults Who Smoke Cigarettes, 2008-2020: Rapid Growth and Widening Inequities in the United States. Nicotine Tob Res. Mar 22 2023;25(4):692-698. doi:10.1093/ntr/ntac214
- Seaman EL, Corcy N, Chang JT, et al. Menthol Cigarette Smoking Trends among United States Adults, 2003-2019. Cancer Epidemiol Biomarkers Prev. Oct 4 2022;31(10):1959-1965. doi:10.1158/1055-9965.EPI-22-0095
- Tobacco Products Scientific Advisory Committee. Menthol Cigarettes and Public Health: Review of the Scientific Evidence and Recommendations. Rockville, MD: US Department of Health and Human Services, Food and Drug Administration; 2011.
- U.S. Food and Drug Administration. Preliminary Scientific Evaluation of the Possible Public Health Effects of Menthol Versus Nonmenthol Cigarettes. 2013.
- Gardiner P, Clark PI. Menthol cigarettes: moving toward a broader definition of harm. Nicotine Tob Res. 2010;12(Suppl 2):S85–S93.
- Anderson SJ. Marketing of Menthol Cigarettes and Consumer Perceptions: A Review of Tobacco Industry Documents. Tob Control. 2011;20 Suppl 2(Suppl_2):ii20–ii28. doi: 10.1136/tc.2010.041939
- U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 1994.
- U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2012.
- Villanti, AC, Johnson AL, Halenar MJ, et al. (2021). Menthol and Mint Cigarettes and Cigars: Initiation and Progression in Youth, Young Adults and Adults in Waves 1-4 of the PATH Study, 2013-2017. Nicotine Tob Res. 2021;23(8):1318–1326. doi: 10.1093/ntr/ntaa224
- Villanti AC, Johnson AL, Glasser AM, et al. Association of Flavored Tobacco Use With Tobacco Initiation and Subsequent Use Among US Youth and Adults, 2013-2015. JAMA Netw Open. 2019;2(10):e1913804. doi:10.1001/jamanetworkopen.2019.13804
- D’Silva J, Cohn AM, Johnson AL, Villanti AC. Differences in subjective experiences to first use of menthol and nonmenthol cigarettes in a national sample of young adult cigarette smokers, Nicotine Tob Res. 20(9):1062-1068, 2018.
- Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students – National Youth Tobacco Survey, United States, 2021. MMWR Surveillance Summaries. 2021;71(5):1-29.
- Watkins SL, Pieper F, Chaffee BW, et al. Flavored Tobacco Product Use Among Young Adults by Race and Ethnicity: Evidence From the Population Assessment of Tobacco and Health Study. Journal of Adolescent Health. 2022;71(2): 226–232. https://doi.org/10.1016/j.jadohealth.2022.02.013
- Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Substance Abuse & Mental Health Data Archive. National Survey on Drug Use and Health, 2019 [accessed 2022 May 9].
- Mendez D, Le TTT. Consequences of a Match Made in Hell: the Harm Caused by Menthol Smoking to the African American Population Over 1980–2018. Tob Control. 2021;0:1–3. doi:10.1136/ tobaccocontrol-2021-056748
- Sawdey MD, Chang JT, Cullen KA, et al. Trends and Associations of Menthol Cigarette Smoking Among US Middle and High School Students—National Youth Tobacco Survey, 2011–2018. Nicotine Tob Res. 2020;22(10):1726–1735. doi: 10.1093/ntr/ntaa054
- Yan X, Salloum RG, Leong M, et al. Racial and Ethnic Differences in Initiation of Menthol Tobacco Smoking and Subsequent Tobacco Use in the Population Assessment of Tobacco and Health Study, Waves 1–4 (2013–2018), Nicotine & Tobacco Research. 2023;ntad055. https://doi.org/10.1093/ntr/ntad055
- U.S. Census Bureau. Overview of Race and Hispanic Origin: 2010. 2010 Census Briefs, March 2011. https://www.census.gov/content/dam/Census/library/publications/2011/dec/c2010br-02.pdf
- Levy DT, Blackman K, Tauras J, et al. Quit Attempts and Quit Rates Among Menthol and Nonmenthol Smokers in the United States. Am J Public Health. 2011;101(7):1241-1247. doi:10.2105/AJPH.2011.300178
- U.S. Food and Drug Administration. Scientific Review of the Effects of Menthol in Cigarettes on Tobacco Addiction: 1980-2021. 2022.
- Nollen NL, Mayo MS, Sanderson Cox L, et al. Factors That Explain Differences in Abstinence Between Black and White Smokers: A Prospective Intervention Study. J Natl Cancer Inst. 2019;111(10):1078-1087. doi:10.1093/jnci/djz001
- Mukherjea A, Wackowski OA, Lee YO, Delnevo CD. Asian American, Native Hawaiian and Pacific Islander tobacco use patterns. Am J Health Behav. 2014;38(3):362-369. doi:10.5993/AJHB.38.3.5
- Fallin A, Goodin AJ, King BA. Menthol cigarette smoking among lesbian, gay, bisexual, and transgender adults. Am J Prev Med. 2015;48(1):93-97.
- Ehlke SJ, Ganz O, Kendzor DE, Cohn AM. Differences between adult sexual minority females and heterosexual females on menthol smoking and other smoking behaviors: Findings from Wave 4 (2016-2018) of the population assessment of tobacco and health study. Addict Behav. 2022;129:107265. doi: 10.1016/j.addbeh.2022.107265
- Ganz O, Delnevo CD. Cigarette Smoking and the Role of Menthol in Tobacco Use Inequalities for Sexual Minorities. Nicotine & Tobacco Research. 2021;23(11): 1942–1946. doi: https://doi.org/10.1093/ntr/ntab101
- Cohn AM, Johnson AL, Hair E, Rath JM, Villanti A. Menthol Tobacco Use Is Correlated with Mental Health Symptoms in a National Sample of Young Adults: Implications for Future Health Risks and Policy Recommendations. Tobacco Induced Diseases. 2016; 14(1):1. doi: https://doi.org/10.1186/s12971-015-0066-3
- Brunette MF, Ferron JC, Geiger P, Villanti A. Menthol Cigarette Use in Young Adult Smokers with Severe Mental Illnesses. Nicotine & Tobacco Research. 2019;21(5):691-694. doi: https://doi.org/10.1093/ntr/nty064
- Hickman, NJ, Delucchi KL, Prochaska JJ. Menthol Use Among Smokers with Psychological Distress: Findings from the 2008 and 2009 National Survey on Drug Use and Health. Tobacco Control. 2014;23:7-13. doi: https://doi.org/10.1136/tobaccocontrol-2012-050479
- Ganz O, Cohn AM, Goodwin RD, et al. Internalizing problems are associated with initiation and past 30-Day use of flavored tobacco products. Addict Behav. 2022;125:107162. doi: 10.1016/j.addbeh.2021.107162