Menthol and Cigarettes
- Tobacco companies add menthol to commercial tobacco products to make them seem less harsh and more appealing to young people and to people who have never used tobacco products.
- Nicotine is the addictive drug in cigarettes and other tobacco products. Menthol enhances the effects of nicotine on the brain and can make tobacco products even more addictive. In recent years, tobacco companies also have increased the amount of nicotine in some menthol cigarettes.
- Menthol in cigarettes can make it more difficult to quit smoking. People who smoke menthol cigarettes can be less likely to successfully quit than people who smoke non-menthol cigarettes.
- Tobacco companies aggressively market menthol-flavored tobacco products to different groups of people, especially Black people. This marketing contributes to targeted population groups being more likely to smoke menthol cigarettes than other population groups.
- Young people, racial and ethnic minority groups, LGBTQ+ people, women, people with a low income, and people with mental health conditions also are more likely to smoke menthol cigarettes than other population groups.
- We can help reduce menthol tobacco use and help people quit using tobacco products by:
- Increasing equitable access to evidence-based quitting resources, including counseling and medication.
- Implementing policies that prohibit or decrease sales of menthol tobacco products.
Menthol is a chemical compound found naturally in peppermint and other similar plants. Menthol can also be produced in a lab.
Menthol can change the way the brain registers the sensations of taste and pain. In cigarettes, menthol creates a cooling sensation in the throat and airways, making the smoke feel less harsh and easier to inhale. Menthol is also used in other commercial tobacco products, such as e-cigarettes, cigars, hookah tobacco, smokeless tobacco, nicotine pouches, and heated tobacco products.
According to federal law, tobacco manufacturers cannot market cigarettes with “characterizing flavors,” except for menthol- or tobacco-flavored cigarettes. Almost all the cigarettes sold in the United States contain some natural or lab-created menthol. However, there is usually more menthol in cigarettes marketed specifically as “menthol” compared to other cigarettes. In 2019 and in 2020, sales of menthol-flavored cigarettes made up 37% of all cigarette sales in the U.S.—the highest proportion since major tobacco companies were first required to report those data to the federal government in 1967.
Menthol cigarettes, including how and to whom they are marketed and sold, are a significant risk to public health and advancing health equity due to their role in initiation, progression to regular smoking and dependence, reduced cessation success, and in contributing to health disparities.
The tobacco industry targets menthol cigarette marketing to certain populations through advertisements, giveaways, lower prices, lifestyle branding, and event sponsorships. For example, tobacco companies have heavily marketed in Black-owned publications, through sponsorship of jazz concerts and certain civil rights groups, through advertisements showing people dressed in clothing popular with rap and hip-hop artists, and in neighborhoods with more Black residents. These aggressive marketing tactics likely have contributed to some groups of people having higher rates of use than others. Given how menthol interacts with nicotine, people who smoke menthol cigarettes are also more likely to continue smoking, which puts them at higher risk of getting tobacco-related diseases.
The tobacco industry uses similar strategies to market menthol cigars. For example, tobacco companies published advertisements in newspapers with a large proportion of readers who were Black persons. More recently, the industry has advertised menthol cigars on social media and has used hip-hop and rap artists, models, and music that are appealing to youth.
No tobacco product is safe, including those with menthol. Despite this, tobacco companies market menthol cigarettes as “smoother” than other cigarettes, and marketing messages imply that menthol cigarettes are a “healthier” alternative.
Menthol makes cigarettes more appealing and easier to smoke. In addition, menthol enhances the addictive effects of nicotine in the brain. The amount of nicotine, the addictive drug in tobacco products, in menthol cigarettes has increased in recent years.
Menthol in cigarettes makes it more likely that youth and young adults will try smoking and that those who start smoking will continue to smoke on a regular basis.
Tobacco companies have conducted extensive research on menthol. They adjust the amounts of menthol in cigarette brands to make each brand most appealing to the people they target. For example, the companies lowered the amount of menthol in some brands to make them more appealing to young people who smoke and those just starting to smoke. The companies increased the amount of menthol in other brands to make them more appealing to older people.
Menthol in other tobacco products can also lead to continued use of those products. For example, youth and young adults whose first cigar was flavored with mint or menthol were 72% more likely to use cigars a year or more later compared to youth and young adults who reported their first cigar was not flavored.
People who smoke menthol cigarettes can be less likely to successfully quit than people who smoke non-menthol cigarettes. For example, young adults and adults who smoke menthol cigarettes make more attempts to quit smoking than those who smoke non-menthol cigarettes. 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. This could be partly due to the way in which menthol enhances the addictive effects of nicotine in the brain.
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.
As noted above, the tobacco industry aggressively targets its marketing to certain populations, including young people, women, and racial and ethnic minority groups, particularly Black people. 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. 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. Those who first start with a menthol cigarette are more likely to continue smoking.
In 2021, 39% of middle school and high school students who currently smoked cigarettes reported using menthol cigarettes. In 2019, 51% percent of young adults (18-25 years old) who currently smoked cigarettes reported using menthol cigarettes. That same year, 39% of adults (over 25 years old) who currently smoked cigarettes reported using menthol cigarettes.
In 2021, nearly 8 in 10 youth who reported using tobacco products used flavored varieties. 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.
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.
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. 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. 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.
- 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.
- In 2019, approximately 85% of non-Hispanic Black or African American adults who smoked used menthol cigarettes.
- 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.
The people who smoke menthol cigarettes make more attempts to quit smoking than those who smoke non-menthol cigarettes. 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. This could be due to a number of factors, including the way in which menthol enhances the effects of nicotine in the brain. African American people who smoke menthol cigarettes may be even less successful in quitting than other populations. 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.
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.
- Women who smoke are more likely to use menthol cigarettes (44%) than men who smoke (35%).
- People who identify as lesbian, gay, bisexual or transgender (LGBT) who smoke are more likely to smoke menthol cigarettes than heterosexual people who smoke. 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%). 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%).
- 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.
- Young adults with serious mental health conditions use menthol tobacco products at disproportionately high rates. 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. 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.
Federal law prohibits cigarettes to be marketed with characterizing flavors, except tobacco or menthol. As of April 2022, over 150 U.S. communities have implemented laws prohibiting the sale of menthol and other flavored tobacco products. In 2019, Massachusetts became the first U.S. state to prohibit the sale of menthol and other flavored tobacco products.
Studies of local U.S. policies have shown that restricting the sale of flavored tobacco products reduces the proportion of youth who try or use tobacco products. Evidence from other countries supports the public health benefits of removing menthol cigarettes from the marketplace. For example, after a 2017 law prohibiting the sale of menthol cigarettes was implemented in Ontario, Canada, adults who smoked menthol cigarette reported high rates of quit attempts and quit successes. Adults who had smoked menthol cigarettes daily before the law went into effect and tried quitting smoking were more likely to report having quit cigarettes than adults who had smoked non-menthol cigarettes.
STATES, COMMUNITIES, TRIBES, AND TERRITORIES CAN fairly and equitably implement evidence-based, population-level strategies such as:
- Licensing retailers who sell any types of tobacco products, to better understand who is selling menthol and other tobacco products and to aid with equitable implementation and enforcement of tobacco control policies.
- Prohibiting sales of menthol and other tobacco products.
- Raising the price of menthol and other tobacco products and prohibiting price discounts.
- Curbing the advertising and marketing of menthol and other tobacco products to young people.
- Ensuring that all people who use tobacco products have access to evidence-based quitting resources, including counseling and medication, to help them successfully quit, and tailoring of cessation messages to better reach people who use menthol products.
- Developing educational initiatives that describe targeted tobacco industry marketing tactics and warn about the risks of tobacco product use, including menthol products.
PARENTS AND TEACHERS CAN:
- Learn about menthol and its relationship to tobacco product use and nicotine dependence among young people, how menthol products are disproportionately marketed to specific groups of people, and the risks of using tobacco products.
- Take advantage of quitting resources in their community, if they use tobacco products.
- Talk to children, teens, and young adults about why all forms of tobacco products are harmful for them.
- Develop and equitably implement and enforce tobacco-free school policies that address all types of tobacco products and that incorporate non-punitive penalties or restorative justice principles.
- Implement school prevention and cessation programs that are free from tobacco industry influence, that include education about menthol products, and that can be tailored to groups that the tobacco industry targets with menthol marketing.
HEALTH PROFESSIONALS CAN:
- Learn about menthol and its relationship to tobacco use, nicotine dependence, and reduced cessation success. Learn about how menthol products are disproportionately marketed to and used by specific groups of people.
- Learn about the different types of tobacco products and the risks of using tobacco products.
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