Menthol cigarette bans are effective at getting people to quit smoking, new research finds.
The US Food and Drug Administration has said that a menthol ban is a “top priority,” but public health advocates have accused the Biden administration of dragging its feet, and the ban has gotten caught up in election-year politics despite research showing clear health benefits.
The new research, published Wednesday in the journal Nicotine & Tobacco Research, looked at studies that have examined the effects of bans in more than 170 US localities, two states, several countries and the European Union.
The researchers did a deep search of English-language studies on tobacco use that were published through November 2022.
The pooled results show that about a quarter of menthol smokers quit within a year or two when the substance is banned from cigarettes.
They found that of the menthol smokers who did not quit after bans were put into place, about half switched to non-menthol cigarettes, 12% switched to other flavored tobacco products, and another quarter found a way to continue smoking menthols.
National bans seemed to be most effective, the studies showed. Menthol cigarette smoking rates were lower in settings with national bans and highest when there were only local or statewide bans.
The tobacco industry has argued that a nationwide ban could make it dangerous for menthol smokers who would seek out illegal cigarettes, leading to violent encounters with police. However, the research did not turn up any evidence that bans created surges of people who turned to a black market for menthol cigarettes.
“Contrary to claims by the tobacco industry, we did not see an increase in the use of illicit products,” study co-author Dr. Sarah Mills said.
“This review provides compelling evidence that the US Food and Drug Administration should move forward with banning the sale of menthol cigarettes,” said Mills, an assistant professor in the Department of Health Behavior at the Gillings School of Public Health.
Smoking is the No. 1 cause of preventable death in the US. Even if just a quarter of menthol smokers quit, it could improve the health of thousands of people.
Although the number of people who smoke cigarettes in the US has fallen to one of the lowest levels in history, the proportion of those who smoke menthols has been increasing, according to the US Centers for Disease Control and Prevention. And the numbers of quitters among some demographics, including among older people, have fallen flat.
A ban would be of particular help to the health of communities of color and the LGBTQ+ community, both of which have been targeted by industry advertising for decades. A 2020 study showed that although 43% of all adult smokers smoked menthols, more than 83% of Black smokers did. And a CDC study found that while 29% of heterosexual people smoked menthols, 36% of LGBT smokers did.
Menthol-flavored cigarettes are particularly appealing to children, studies show, so a ban could also stop new smokers from ever starting.
More than half of kids who smoke choose menthol cigarettes, according to the CDC. Studies have found that children who smoked menthols were more likely to become regular smokers than occasional smokers.
Menthol itself isn’t addictive, but menthol cigarettes are more attractive to new smokers, studies show, because the flavoring masks the harsh taste and smell that may put some new smokers off. Menthol also anesthetizes the throat, making it easier to deeply inhale the dangerous smoke.
“When added to cigarettes, menthol sweetens the poison of nicotine, which makes it easier to start smoking and also much harder to quit,” Mills said.
Previous tobacco control restrictions have also been highly effective at helping people quit, Mills said.
“Tobacco control is seen as a public health success story. We’ve been able to reduce smoking rates markedly in the total population over the past several decades to get to a relatively low smoking rates overall right now,” she said.
But disparities in smoking rates and in smoking-related disease though have to be addressed, Mills said.
Black adults die at significantly higher rates than White adults from smoking-related illnesses including stroke, heart disease and lung cancer. Black people make up 12% of the population in the US, but the community accounts for 41% of smoking-related premature deaths and 50% of the life-years lost associated with menthol tobacco product use between 1980 and 2018, one study found.
If menthols were banned, the gap between Black and White lung cancer deaths would close within five years, a Council on Foreign Relations study found.
Dr. Rafael Meza, an expert in tobacco epidemiology and control, said the new research comes at a pivotal time as the US considers a menthol ban.
“It adds to the already very compelling evidence that banning menthol would result in fewer people smoking cigarettes and provide higher public health benefits, especially for populations that have pretty high rates of use, particularly Black Americans,” said Meza, a distinguished senior scientist at BC Cancer Research Institute in Canada who was not involved with the new research.
Meza said he would love for the literature to show that bans encouraged everyone to stop smoking. But the new findings may not completely capture all those who quit, he said, because people who switch to non-menthols just might find it easier to quit down the road.
“There’s just more and more evidence every day that it would be a good idea to do a ban,” Meza said. “Everyone in tobacco control work is eagerly awaiting this.”
