Menthol Smoking and Related Health Disparities
Fewer people now smoke cigarettes than in the past, but the percentage of people from certain population groups who smoke menthol cigarettes has either increased or remains unchanged.1
The tobacco industry aggressively targets its marketing to certain populations, including young people, women, and racial and ethnic minority groups, particularly Black people.2,3,4,5 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.6,7 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.8,9,10 Those who first start with a menthol cigarette are more likely to continue smoking.8,9
In 2021, 39% of middle school and high school students who currently smoked cigarettes reported using menthol cigarettes.11 In 2019, 51% percent of young adults (18-25 years old) who currently smoked cigarettes reported using menthol cigarettes.12 That same year, 39% of adults (over 25 years old) who currently smoked cigarettes reported using menthol cigarettes.12
In 2021, nearly 8 in 10 youth who reported using tobacco products used flavored varieties.11 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.11
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.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.13 For example, from 2004 to 2008, approximately 30% of all persons aged 12 years and older who smoked menthol cigarettes were Black persons, while 3% who smoked non-menthol cigarettes were Black persons.14 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.15
- 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.16
- In 2019, approximately 85% of non-Hispanic Black or African American adults who smoked used menthol cigarettes.13
- A survey conducted between 2013 and 2015 showed that among Black adults who smoke, 93% used menthol cigarettes when they first tried smoking. Among White adults who smoke, 44% used menthol cigarettes when they first tried smoking.10
The people who smoke menthol cigarettes make more attempts to quit smoking than those who smoke non-menthol cigarettes.17 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.17 This could be due to a number of factors, including the way in which menthol enhances the effects of nicotine in the brain.18 African American people who smoke menthol cigarettes may be even less successful in quitting than other populations.18 This could be due to having less access to quit smoking treatments, as well as the conditions in which Black people live, learn, work and play that may make it harder to quit.19
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:
- Approximately 48% of Hispanic adults who smoke use menthol cigarettes as compared to 30% of non-Hispanic White adults.13
- Women who smoke are more likely to use menthol cigarettes (44%) than men who smoke (35%).20
- People who identify as lesbian, gay, bisexual or transgender (LGBT) who smoke are more likely to smoke menthol cigarettes than heterosexual people who smoke.21,22 A survey of LGBT adults in 2009-2010 showed that this difference is even greater among LGBT females (43%) as compared to heterosexual women (32%).21 Similarly, a survey of persons aged 12 and older from 2015-2019 showed this difference is also greater among lesbian or gay females (51%) as compared to gay males (44%), and among bisexual females (54%) as compared to bisexual males (32%).23
- People with lower levels of income are more likely to smoke menthol cigarettes than people with higher incomes. For example, among persons aged 12 years and older who smoke, 44% of persons with a household income less than $30,000 smoke menthol cigarettes, 37% of persons with a household income between $30,000 and $74,999 smoke menthol cigarettes, and 32% of persons with a household income of $75,000 or more smoke menthol cigarettes.20
- Young adults with serious mental health conditions use menthol tobacco products at disproportionately high rates.24,25 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.26 For example, in 2019, 18% of adults who smoke and reported past-month serious psychological stress used menthol cigarettes, compared to 7% of those who smoke and did not report past-month serious psychological distress. 12
- Delnevo CD, Giovenco DP, Villanti AC. Assessment of Menthol and Nonmenthol Cigarette Consumption in the US, 2000 to 2018. JAMA Netw Open. 2020;3(8):e2013601. doi: 10.1001/jamanetworkopen.2020.13601.
- 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.
- National Archives and Records Administration, Federal Register. Tobacco Product Standard for Menthol in Cigarettes. A Proposed Rule by the Food and Drug Administration on 2022 May 4.
- 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].
- Rock VJ, Davis SP, Thorne SL, Asman KJ, Caraballo RS. Menthol Cigarette Use Among Racial and Ethnic Groups in the United States, 2004-2008. Nicotine Tob Res. 2010;12 Suppl 2:S117-S124. doi:10.1093/ntr/ntq204.
- 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.
- 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
- Villanti AC, Mowery PD, Delnevo CD, Niaura RS, Abrams DB, Giovino GA. Changes in the prevalence and correlates of menthol cigarette use in the USA, 2004-2014. Tob Control. 2016;25:ii14-ii20. Doi:10.1136/tobaccocontrol-2016-053329.
- 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.