The Threat of Menthol Cigarettes to U.S. Public Health

BackgroundFor many years, national surveys have shown a consistently disproportionately high prevalence of menthol smokers among African Americans compared with the general population. However, to our knowledge, no prior study has quantified the harm that menthol smoking has caused on that population. In this work, we estimate the public health harm that menthol cigarettes have caused to the African American community over the last four decades.MethodsUsing National Health Interview Survey data, we employed a well-established simulation model to reproduce the observed smoking trajectory over 1980–2018 in the African American population. Then, we repeat the experiment, removing the effects of menthol on the smoking initiation and cessation rates over that period, obtaining a new hypothetical smoking trajectory. Finally, we compared both scenarios to calculate the public health harm attributable to menthol cigarettes over 1980–2018.ResultsOur results show that menthol cigarettes were responsible for 1.5 million new smokers, 157 000 smoking-related premature deaths and 1.5 million life-years lost among African Americans over 1980–2018. While African Americans constitute 12% of the total US population, these figures represent, respectively, a staggering 15%, 41% and 50% of the total menthol-related harm.DiscussionOur results show that menthol cigarettes disproportionally harmed African Americans significantly over the last 38 years and are responsible for exacerbating health disparities among that population. Removing menthol cigarettes from the market would benefit the overall US population but, particularly, the African American community.

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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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Reducing the Adverse Public Health Impact of Menthol Cigarettes in Disparate Populations

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa027 ◽

2020 ◽

Vol 22 (4) ◽

pp. 456-457

Author(s):

Jessica L Barrington-Trimis

Keyword(s):

Public Health ◽

Health Impact ◽

Public Health Impact ◽

Menthol Cigarettes

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Menthol cigarettes and the public health standard: a systematic review

BMC Public Health ◽

10.1186/s12889-017-4987-z ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 49

Author(s):

Andrea C. Villanti ◽

Lauren K. Collins ◽

Raymond S. Niaura ◽

Stacey Y. Gagosian ◽

David B. Abrams

Keyword(s):

Public Health ◽

Systematic Review ◽

The Public ◽

Menthol Cigarettes ◽

Public Health Standard

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Menthol Cigarettes and Mortality: Keeping Focus on the Public Health Standard

Nicotine & Tobacco Research ◽

10.1093/ntr/nts176 ◽

2012 ◽

Vol 15 (2) ◽

pp. 617-618 ◽

Cited By ~ 5

Author(s):

A. C. Villanti ◽

G. A. Giovino ◽

D. M. Burns ◽

D. B. Abrams

Keyword(s):

Public Health ◽

The Public ◽

Menthol Cigarettes ◽

Public Health Standard

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Effect of menthol cigarette and other menthol tobacco product bans on tobacco purchases in the RTI iShoppe virtual convenience store

Tobacco Control ◽

10.1136/tobaccocontrol-2019-054997 ◽

2019 ◽

pp. tobaccocontrol-2019-054997 ◽

Cited By ~ 4

Author(s):

Jamie Guillory ◽

Annice E Kim ◽

James M Nonnemaker ◽

Brian Bradfield ◽

Nathaniel Harlan Taylor ◽

...

Keyword(s):

Public Health ◽

Health Impact ◽

Tobacco Product ◽

Experimental Conditions ◽

Menthol Cigarette ◽

Tobacco Marketing ◽

Menthol Cigarettes ◽

Product Regulation ◽

Cigarette Brand ◽

Virtual Store

ObjectiveTo test how a potential US ban of menthol products or replacement with ‘green’ products and ads could influence tobacco purchases.MethodsUS adult menthol smokers (N=1197) were recruited via an online panel and randomly assigned to complete a shopping task in one of four versions (experimental conditions) of the RTI iShoppe virtual store: (1) no ban, (2) replacement of menthol cigarettes and ads with green replacement versions, (3) menthol cigarette ban and (4) all menthol tobacco product ban. Logistic regressions assessed the effect of condition on tobacco purchases.ResultsParticipants in the menthol cigarette ban (OR=0.67, 95% CI 0.48 to 0.92) and all menthol product ban conditions (OR=0.60, 95% CI 0.43 to 0.83) were less likely to purchase cigarettes of any type than participants in the no ban condition. Participants in the green replacement (OR=1.74, 95% CI 1.13 to 2.70), menthol cigarette ban (OR=3.40, 95% CI 2.14 to 5.41) and all menthol product ban conditions (OR=3.14, 95% CI 1.97 to 5.01) were more likely to purchase a cigarette brand different from their usual brand than participants in the no ban condition.ConclusionsOur findings suggest that menthol bans could have great public health impact by reducing cigarette purchases. However, tobacco marketing strategies, such as creating green (or other replacement) versions of menthol cigarettes, may undermine public health benefits of a menthol ban by prompting purchases of non-menthol cigarettes. Our findings highlight the importance of taking tobacco marketing tactics into consideration in tobacco product regulation.

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Evaluating the effect of switching to non-menthol cigarettes among current menthol smokers: an empirical study of a potential ban of characterising menthol flavour in cigarettes

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055154 ◽

2019 ◽

pp. tobaccocontrol-2019-055154 ◽

Cited By ~ 2

Author(s):

Krysten W Bold ◽

Peter Jatlow ◽

Lisa M Fucito ◽

Tore Eid ◽

Suchitra Krishnan-Sarin ◽

...

Keyword(s):

Public Health ◽

Repeated Measures ◽

Public Health Problem ◽

Smoking Behaviour ◽

Menthol Cigarette ◽

Regulatory Policies ◽

Urine Cotinine ◽

Menthol Cigarettes ◽

Black Smokers ◽

Additional Support

IntroductionMenthol cigarette use remains a serious public health problem, prompting the consideration of tobacco regulatory efforts to ban menthol cigarettes. The current study uses a novel empirical design to model the potential effects of a ban of menthol cigarettes on smoking behaviour among current menthol smokers.Methods29 non-treatment-seeking adults who smoked menthol cigarettes were recruited in Connecticut in 2017–2018 (n=15 female; n=17 Black, n=10 White, n=5 Hispanic). Repeated-measures analyses examined within-person changes in smoking behaviour when participants were switched from smoking their usual brand menthol cigarettes to a matched-brand non-menthol cigarette for 2 weeks to model a potential ban of menthol cigarettes.ResultsParticipants smoked significantly fewer non-menthol (vs menthol) cigarettes per day (mean decrease=2.2 cigarettes, SD=3.2, p<0.001), confirmed by significant reductions in urine cotinine levels (p=0.013). After switching to non-menthol cigarettes, participants had significantly lower nicotine dependence scores (reduced by >18%, p<0.001) and greater increases in quitting motivation and confidence (rated 1–10) (motivation: mean increase=2.1, SD=2.8, p<0.001; confidence: mean increase=1.3, SD=3.3, p=0.04). Exploratory analyses indicated significant interactions by race (p=0.004); Black smokers had greater reductions in cigarettes per day (mean decrease=3.5 cigarettes, SD=2.8) versus non-Black smokers (mean decrease=0.2, SD=2.6).ConclusionsBanning menthol as a characterising flavour in cigarettes may decrease smoking and reduce the addictive potential of cigarettes among current smokers. Results provide additional support for tobacco regulatory policies banning menthol flavour in an effort to improve public health.Trial registrationNCT03075839.

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