“I think it’s a good idea for the people that’s young, the kids, but for someone like me it’s a bad idea.” – Interviews about a U.S. menthol cigarette ban with people who smoke menthol cigarettes

The use of electronic nicotine delivery systems (ENDS) among youth in the United States has increased rapidly in the past decade. Simultaneously, while youth cigarette smoking has declined considerably, youth are still more likely to use menthol cigarettes than any other age group. We used nationally representative data on 15–17-year-olds from the Population Assessment of Tobacco and Health (PATH) Study and the National Youth Tobacco Survey (NYTS) (2013–2017) to better understand current cigarette (by menthol flavoring) and ENDS use in the US. We calculated weighted population prevalence estimates across years for multiple patterns of current cigarette and ENDS use (i.e., exclusive menthol cigarette, exclusive non-menthol cigarette, exclusive ENDS, dual ENDS and menthol cigarette, and dual ENDS and non-menthol cigarette) by sex, race/ethnicity, parental education level, household income, and homeownership. Overall, both exclusive menthol and non-menthol cigarette use declined from 2013–2017. Exclusive ENDS use increased, particularly among youth who were non-Hispanic White or had a higher socioeconomic status (measured by parental education, household income, and homeownership). Dual use of ENDS with either menthol or non-menthol cigarettes did not change significantly. Monitoring changes in these sociodemographic patterns will help inform future youth tobacco prevention strategies.

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Menthol Cigarettes, Tobacco Dependence, and Smoking Persistence: The Need to Examine Enhanced Cognitive Functioning as a Neuropsychological Mechanism

Nicotine & Tobacco Research ◽

10.1093/ntr/nty264 ◽

2018 ◽

Vol 22 (4) ◽

pp. 466-472 ◽

Cited By ~ 1

Author(s):

Nancy C Jao ◽

Marcia M Tan ◽

Phoenix A Matthews ◽

Melissa A Simon ◽

Robert Schnoll ◽

...

Keyword(s):

Public Health ◽

United States ◽

Cognitive Functioning ◽

Basic Science ◽

Tobacco Dependence ◽

The United States ◽

Science Literature ◽

Cigarette Use ◽

Menthol Cigarette ◽

Menthol Cigarettes

Abstract Introduction Despite the overall decline in the prevalence of cigarette use in the United States, menthol cigarette use among smokers is rising, and evidence shows that it may lead to more detrimental effects on public health than regular cigarette use. One of the mechanisms by which nicotine sustains tobacco use and dependence is due to its cognitive enhancing properties, and basic science literature suggests that menthol may also enhance nicotine’s acute effect on cognition. Aims and Methods The purpose of this review is to suggest that the cognitive enhancing effects of menthol may be a potentially important neuropsychological mechanism that has yet to be examined. In this narrative review, we provide an overview of basic science studies examining neurobiological and cognitive effects of menthol and menthol cigarette smoking. We also review studies examining menthol essential oils among humans that indicate menthol alone has acute cognitive enhancing properties. Finally, we present factors influencing the rising prevalence of menthol cigarette use among smokers and the importance of this gap in the literature to improve public health and smoking cessation treatment. Conclusions Despite the compelling evidence for menthol’s acute cognitive enhancing and reinforcing effects, this mechanism for sustaining tobacco dependence and cigarette use has yet to be examined and validated among humans. On the basis of the basic science evidence for menthol’s neurobiological effects on nicotinic receptors and neurotransmitters, perhaps clarifying menthol’s effect on cognitive performance can help to elucidate the complicated literature examining menthol and tobacco dependence. Implications Menthol cigarette use has continued to be a topic of debate among researchers and policy makers, because of its implications for understanding menthol’s contribution to nicotine dependence and smoking persistence, as well as its continued use as a prevalent flavoring in tobacco and nicotine products in the United States and internationally. As international tobacco regulation policies have begun to target menthol cigarettes, research studies need to examine how flavoring additives, specifically menthol, may acutely influence neurobiological and cognitive functioning as a potential mechanism of sustained smoking behavior to develop more effective treatments.

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Menthol Smoking and Subjective Response To the First Cigarette Smoked

Tobacco Regulatory Science ◽

10.18001/trs.5.6.7 ◽

2019 ◽

Vol 5 (6) ◽

pp. 554-566

Author(s):

Amy M. Cohn ◽

Joanne D'silva

Keyword(s):

Tobacco Use ◽

Abuse Liability ◽

Subjective Response ◽

Cigarette Tobacco ◽

Heavy Smoking ◽

Menthol Cigarette ◽

Logistic Regression Models ◽

Menthol Cigarettes ◽

Potential Abuse ◽

Pleasant Experience

Objectives: Using the Population Assessment of Tobacco and Health (PATH) study, this study examined whether pleasant and unpleasant subjective responses to the first cigarette smoked differed by initiation with a menthol versus non-menthol cigarette and whether subjective response was associated with current tobacco use behaviors, independent of, and in interaction with menthol initiation. Methods: Data were from youth and young adult ever smokers in Wave 2 (2014-2015) of the PATH study. Results: In adjusted multivariable logistic regression models, menthol initiators reported a more pleasant first smoking experience compared to non-menthol initiators and increased odds of past 30-day smoking, non-cigarette tobacco use, and menthol smoking. In adjusted models, pleasant experience was associated with increased odds of past 30-day smoking, non-cigarette tobacco use, and heavy smoking. Unpleasant experience was associated with decreased odds of past 30-day smoking. Interactions of menthol initiation with subjective response were not significant. Conclusions: Smokers who initiate with a menthol cigarette experience a more pleasant first smoking experience, and pleasant experience is associated with regular smoking and use of non-cigarette tobacco products. Findings underscore the potential abuse liability of menthol cigarettes and provide further evidence that a ban on menthol may help reduce tobacco use among young people.

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Abstract P144: Smoking, Menthol Cigarettes and Peripheral Arterial Disease in the 1999– 2004 National Health and Nutrition Examination Survey (NHANES)

Circulation ◽

10.1161/circ.125.suppl_10.ap144 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Miranda R Jones ◽

Benjamin J Apelberg ◽

Ana Navas-Acien

Keyword(s):

Peripheral Arterial Disease ◽

Odds Ratio ◽

Arterial Disease ◽

Cigarette Use ◽

Cigarette Smokers ◽

Menthol Cigarette ◽

Health And Nutrition ◽

Menthol Cigarettes ◽

Never Smokers ◽

Peripheral Arterial

Introduction: Cigarette flavorings, with the exception of menthol, have been banned under the Family Smoking Prevention and Tobacco Control Act. Previous studies have found strong associations between active smoking and peripheral arterial disease. While there is substantial interest in evaluating the health effects of menthol as compared to regular cigarette use, no information is available on the influence of cigarette type (non-menthol or menthol) on the risk of peripheral arterial disease. Objective: To investigate the association of cigarette smoking, menthol cigarette use and the prevalence of peripheral arterial disease in US adults Methods: We studied 5,978 adults 40 years of age and older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999–2004. Information on participant smoking status and cigarette type were derived from self-reported questionnaire data. Peripheral arterial disease was defined as an ankle-brachial blood pressure index <0.9 in at least one leg. Results: The weighted prevalence of peripheral arterial disease in the study population was 4.9%. Fifty percent of participants were never smokers compared to 31%, 14% and 5% of former, current non-menthol and current menthol cigarette smokers, respectively. After adjustment for demographics and cardiovascular risk factors, the odds ratio for peripheral arterial disease was 1.98 (95% CI: 1.41, 2.80), 5.24 (95% CI: 3.41, 8.05), 3.37 (95% CI: 1.86, 6.10) comparing former, current regular cigarette smokers and current menthol cigarette smokers to never smokers. After further adjustment for pack-years and serum cotinine, the odds ratio for peripheral arterial disease was 1.44 (95% CI: 0.97, 2.15), 3.65 (95% CI: 1.57, 8.50) and 2.51 (95% CI: 1.09, 5.80) comparing former, current regular cigarette smokers and current menthol cigarette smokers to never smokers. The significant association between smoking and peripheral arterial disease was similar for smokers of non-menthol and menthol cigarettes (p-value for heterogeneity= 0.53). Conclusions: In a representative sample of the US population, current menthol cigarette use was associated with increased prevalence of peripheral arterial disease with no difference compared to smoking non-menthol cigarettes.

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Recent, national trends in US adolescent use of menthol and non-menthol cigarettes

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056970 ◽

2021 ◽

pp. tobaccocontrol-2021-056970

Author(s):

Richard A Miech ◽

Adam M Leventhal ◽

Lloyd D Johnson

Keyword(s):

Cigarette Smoking ◽

Black Adolescents ◽

Cigarette Use ◽

Floor Effect ◽

Cross Sectional ◽

Menthol Cigarette ◽

Menthol Cigarettes ◽

Monitoring The Future ◽

Nationally Representative ◽

National Trends

ObjectiveIn light of the current U.S. Food and Drug Administration (FDA) proposal to ban menthol cigarettes, this study updates trends in menthol cigarette use among adolescents age 13–18 years up to the year 2020. The study considers a potential role for the ban to reduce black/non-black disparities in menthol cigarette use, as well as a counterargument that a ban is not necessary because menthol use is already diminishing.MethodsData are from annual, cross-sectional, nationally representative Monitoring the Future (MTF) surveys of 85 547 8th, 10th and 12th grade students surveyed between 2012 and 2020. Analyses include trends in past 30-day menthol and non-menthol cigarette smoking among the total adolescent population, as well as stratified by race/ethnicity.ResultsDeclines in adolescent menthol and non-menthol cigarette smoking continued through 2020 so that in 2018–2020 past 30-day prevalence for each was less than 1% for non-Hispanic black adolescents and less than 2.2% for non-black adolescents. For non-Hispanic black adolescents no smoking declines in mentholated or non-mentholated cigarette use from 2015–2017 to 2018–2020 were statistically significant, in part because prevalence levels approached a floor effect and had little room to fall further. Menthol levels were lower for non-Hispanic black versus all other adolescents in all study years.ConclusionsContinuing declines in adolescent menthol prevalence indicate that both menthol prevalence and also black/non-black disparities in its use are steadily decreasing. However, these decreases in adolescence will take decades to reach later ages through generational replacement. Efforts to accelerate menthol decreases will require new initiatives to increase cessation among adult menthol users.

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Changes in retail sales of tobacco products in Ontario after a menthol sales restriction

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056489 ◽

2021 ◽

pp. tobaccocontrol-2021-056489

Author(s):

Elizabeth M Brown ◽

Doris G Gammon ◽

Todd Rogers ◽

Ellen M Coats ◽

Lindsay T Olson ◽

...

Keyword(s):

Tobacco Product ◽

Tobacco Policy ◽

Scanner Data ◽

Retail Sales ◽

Menthol Cigarette ◽

Menthol Cigarettes ◽

Before And After ◽

Per Capita ◽

Product Sales

BackgroundOntario, Canada prohibited menthol tobacco product sales beginning 1 January 2017. We measured retail sales of menthol cigarettes and possible substitute products before and after policy implementation in Ontario.MethodsWe licensed retail scanner data for tobacco product sales in Ontario and British Columbia (BC), a comparison province without a menthol tobacco policy at that time. We assessed changes in per capita unit sales (per 1000 people) from pre-policy (January–June 2016) to post-policy (January–June 2017) periods. Classification of cigarettes as menthol or non-menthol, or having menthol-suggestive descriptors (‘green’, ‘blue’, ‘silver’ and ‘fresh’), was based on scanner data.ResultsOntario menthol cigarette sales decreased 93%, from 596 to 40 packs per capita compared with a 2% decrease (696 to 679 packs per capita) in BC. Menthol capsule cigarette sales remained low in Ontario (<1% of total cigarette sales) but rose sixfold in BC. Although cigar sales data were unavailable, substitution appeared minimal; sales of non-menthol cigarettes increased 0.4% in Ontario (11 470 to 11 519 packs per capita) while vaping product sales decreased. Ontario had a larger increase in sales of cigarettes with menthol-suggestive descriptors (11% increase) than BC (3% increase). In Ontario, nearly all (>99%) pre-policy sales of cigarettes with ‘green’ menthol-suggestive descriptors were menthol cigarettes, but post-policy, 94% of ‘green’ cigarettes sold were non-menthol.ConclusionsOntario’s menthol policy was associated with a decrease in retail sales of cigarettes classified as menthol, with little evidence of product substitution. Understanding changes in sales of cigarettes with menthol-suggestive descriptors would be informative.

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Ban on menthol-flavoured tobacco products predicts cigarette cessation at 1 year: a population cohort study

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054841 ◽

2019 ◽

pp. tobaccocontrol-2018-054841 ◽

Cited By ~ 4

Author(s):

Michael O Chaiton ◽

Ioana Nicolau ◽

Robert Schwartz ◽

Joanna E Cohen ◽

Eric Soule ◽

...

Keyword(s):

Cohort Study ◽

Relative Rate ◽

Baseline Survey ◽

Tobacco Products ◽

Menthol Cigarette ◽

Quit Attempt ◽

Population Cohort ◽

Menthol Cigarettes ◽

Population Cohort Study

ObjectivesThe province of Ontario, Canada, banned the use of menthol-flavoured tobacco products as of 1 January 2017. The long-term impact of a menthol ban on smoking behaviour has not been previously evaluated.MethodsPopulation cohort study with baseline survey conducted September–December 2016 and follow-up January–August 2018 among residents of Ontario, Canada, 16 years old and over who reported current smoking (past 30 days) at baseline survey and completed follow-up (n=913) including 187 reporting smoking menthol cigarettes daily, 420 reported smoking menthol cigarettes occasionally, and 306 were non-menthol cigarette smokers. Relative rates of making a quit attempt and being a non-smoker at follow-up were estimated with Poisson regression controlling for smoking and demographic characteristics at baseline.ResultsAt follow-up, 63% of daily menthol smokers reported making a quit attempt since the ban compared with 62% of occasional menthol smokers and 43% of non-menthol smokers (adjusted relative rate (ARR) for daily menthol smokers compared with non-menthol smokers: 1.25; 95% CI 1.03 to 1.50). At follow-up, 24% of daily menthol smokers reported making a quit since the ban compared with 20% of occasional menthol smokers and 14% of non-menthol smokers (ARR for daily menthol smokers compared with non-menthol smokers: 1.62; 95% CI 1.08 to 2.42).ConclusionsThe study found higher rates of quitting among daily and occasional menthol smokers in Ontario 1 year after the implementation of a menthol ban compared with non-menthol smokers. Our findings suggest that restrictions on menthol may lead to substantial improvements in public health.

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A Longitudinal Examination of Behavioral Transitions among Young Adult Menthol and Non-Menthol Cigarette Smokers Using a Three-State Markov Model

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa240 ◽

2020 ◽

Author(s):

Dale S Mantey ◽

Melissa B Harrell ◽

Baojiang Chen ◽

Steven H Kelder ◽

Cheryl L Perry ◽

...

Keyword(s):

Young Adults ◽

Young Adult ◽

Cigarette Smoking ◽

Markov Model ◽

Cigarette Smokers ◽

Menthol Cigarette ◽

Menthol Cigarettes ◽

Increased Risk ◽

Smoking Behaviors ◽

Hispanic Latinos

Abstract Introduction Young adult cigarette smoking behaviors are complex and dynamic. Emerging research suggests a growing rate of switching from non-menthol to menthol cigarettes. Transitions across cigarette smoking states are not well understood. This research longitudinally explores transitions in cigarette smoking behaviors among 18-29 year olds. Methods We applied a Markov model to data collected biannually for 1,542 initially 18-29-year old young adults (mean age: 20.9 years; SD=2.6) in Texas, who provided 7,021 total observations from Fall 2014 – Spring 2017. All participants were past 30-day menthol or non-menthol cigarette smokers at first observation. We examined transitions across three states of cigarette smoking (menthol, non-menthol, and nonsmoking) and compared predictors of each transition, during young adulthood. Results Descriptively, 22.2% of menthol and 14.3% of non-menthol smokers switched products while 25.6% of menthol and 26.0% of non-menthol smokers quit smoking. Among quitters, 20.0% relapsed via menthol and 28.2% relapsed via non-menthol cigarettes. Results from Markov model indicated that Hispanic/Latinos (Hazard Ratio [HR]: 3.69) and Asians (HR: 2.85) were significantly more likely to switch from non-menthol to menthol cigarettes, relative to non-Hispanic whites. Among recent quitters, use of non-cigarette products was associated with increased risk of relapse via menthol (HR: 1.54) and non-menthol (HR: 1.85) cigarettes. Conclusion A substantial proportion of young adult cigarette smokers transitioned across cigarette smoking states over the course of 2.5-years. Other tobacco use and nicotine dependence were impediments to becoming and remaining a non-smoker. Hispanic/Latinos and Asians, relative to non-Hispanic Whites, had greater odds of transitioning from non-menthol smoking to both non-smoking and to menthol smoking. Findings suggest racial/ethnic differences in cigarette smoking transitions during young adulthood. Implications This paper examined multidirectional transitions across cigarette smoking, including switching between menthol and non-menthol cigarettes, among young adults. Results indicate that Hispanic/Latino and Asian young adults are at increased risk to transition to menthol cigarette smoking compared with non-Hispanic white young adults. Findings highlight need for further study of Hispanic/Latino and Asian young adult smoking behaviors.

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The profile of menthol cigarette smokers in the months following the removal of these products from the market in England

10.21203/rs.3.rs-578480/v1 ◽

2021 ◽

Author(s):

Loren Kock ◽

Lion Shahab ◽

Ilze Bogdanovica ◽

Jamie Brown

Keyword(s):

Cigarette Smoking ◽

Age Groups ◽

Transitional Period ◽

Cross Sectional ◽

Cigarette Smokers ◽

Menthol Cigarette ◽

Menthol Cigarettes ◽

Chi Squared ◽

Cigarette Dependence ◽

The Impact

Abstract Introduction: In May 2020 the EU Tobacco Products Directive (TPD) ban on the sale of menthol cigarettes was implemented after a four-year transitional period. This study examined the prevalence of menthol cigarette smoking in the months following the ban, and according to sociodemographic and smoking characteristics.Methods: Cross-sectional data came from a representative survey of current smokers (18+) in England (unweighted n=1,577) during seven months (July-January) in 2020/2021. The weighted prevalence of menthol cigarette smoking as a proportion of total cigarette smoking was calculated, and chi-squared statistics assessed the relationship between menthol smoking, sociodemographic and smoking characteristics. Sources of purchase of menthol cigarettes were also explored.Results: The proportion of current smokers who smoked menthol cigarettes was similar in July to October 2020 (17.5%, 95% CI 15.3%-20.1%) compared with November 2020 to January 2021 (16.3%, 95% CI 13.9%-19.2%) (χ2(1)=0.38, P=0.56)). Menthol cigarette smoking was more common among younger age groups (16-24 = 29.0%; 25-34 = 23.3%) and women (21.1%). Menthol cigarette smokers showed lower cigarette dependence compared with other cigarette smokers. Purchases of menthol cigarettes from any illicit source in the past six months declined from 34.5% in July-October 2020 to 19.0% in November 2020–January 2021.Conclusions: A substantial proportion (just under a fifth) of current smokers in England reported menthol cigarette smoking between July-January 2020/2021 despite the ban. There was no decline in this proportion across the period, suggesting that smokers mitigated the impact of the ban by a variety of means, such as with legal menthol accessories.

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Menthol cigarette use in substance use disorder treatment before and after implementation of a county-wide flavoured tobacco ban

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056000 ◽

2020 ◽

pp. tobaccocontrol-2020-056000

Author(s):

Joseph R Guydish ◽

Elana R Straus ◽

Thao Le ◽

Noah Gubner ◽

Kevin L Delucchi

Keyword(s):

Substance Use ◽

San Francisco ◽

Substance Use Disorder ◽

Smoking Status ◽

Smoking Behaviour ◽

Cross Sectional ◽

Menthol Cigarette ◽

Menthol Cigarettes ◽

Readiness To Quit ◽

The Impact

IntroductionThis study examined the impact of a San Francisco City and County ban on all flavoured tobacco products, including menthol cigarettes, among clients in residential substance use disorder (SUD) treatment.MethodsWe conducted cross-sectional surveys of clients at two residential SUD programmes before the County began enforcing the ban (n=160) and twice after enforcement began (n=102, n=120). The samples were compared on demographic characteristics, smoking status, smoking behaviours and the proportion reporting menthol as their usual cigarette. Menthol smokers were asked whether they smoked only menthol cigarettes, mostly menthol, both menthol and non-menthol or mostly non-menthol. Post-ban samples were asked about awareness of the ban and access to menthol cigarettes.ResultsIn multivariate analyses, we found no evidence that the ban was associated with decreased number of cigarettes per day or increased readiness to quit among current smokers. However, odds were lower post-ban for reporting menthol as the usual cigarette (OR=0.80, 95% CI 0.72 to 0.90), and for smoking only menthol cigarettes (OR=0.19, 95% CI 0.18 to 0.19). Perhaps most importantly, and with the ability to influence all other findings, 50% of self-identified menthol smokers reported purchasing menthol cigarettes in San Francisco nearly 1 year after the ban was implemented.ConclusionIn subgroups where smoking has remained elevated, like those receiving SUD treatment, local menthol bans may have only modest impacts on smoking behaviour. Broader regional, state or national bans, that effectively restrict access to menthol products, may be needed to show stronger effects on smoking behaviour.

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