A new paper in Nicotine & Tobacco Research, published by Oxford University Press, finds that banning the sale of menthol cigarettes would likely lead to a meaningful reduction in smoking rates.
Menthol cigarettes are of particular public health concern because studies have found that the cooling effects of menthol mask the harshness of cigarettes, making it easier for young people to start smoking. Prior research has also found that menthol in cigarettes makes it easier for smokers to absorb nicotine, which results in greater dependence. Menthol smokers also find it harder to quit smoking compared to those who smoke non-menthol cigarettes.
Prevalence rates of menthol cigarette use among cigarette smokers vary globally. Some 7.4% of smokers in Europe use menthol cigarettes. In the United States, however, some 43.4% of adult smokers used menthol cigarettes in 2020. Menthol cigarettes are disproportionately used by young people, racial/ethnic minorities, and lower-income smokers. About 81% of non-Hispanic Black smokers in the US use menthol cigarettes, as compared to 34% of White smokers. More than 170 US cites and two states, several countries (e.g., Canada, Ethiopia), and the European Union ban the sale of menthol cigarettes.
Researchers here measured the effects of these policies. The investigators conducted a systematic search of studies published in English up to November 2022 (using PubMed/Medline, CINAHL, PsycINFO, Web of Science, and Embase), to discover how menthol bans change smoking behavior. The researchers involved in this study looked at 78 prior studies, mostly from Canada, the European Union, and the United States.
The study finds that the effect of menthol cigarette bans are substantial. The results show that while 50% of menthol smokers switched to smoking non-menthol cigarettes, almost a quarter (24%) of menthol cigarette smokers quit smoking altogether after a menthol ban. Some 12% switched to other flavored tobacco products, and 24% continued smoking menthol cigarettes. The study also finds that national menthol bans appear more effective than local or state menthol bans, as quit rates were higher in places with country-wide bans.
"This review provides compelling evidence for the US Food and Drug Administration's proposed ban on menthol cigarettes," said the paper's lead author, Sarah Mills. "In December 2023 the White House postponed banning menthol cigarettes. Our review of the evidence suggests this delay is causing harm to the health of the public, especially among Black communities. Contrary to industry claims, studies find no increase in the use of illicit products. A menthol cigarette ban would provide the greatest benefits to Black people who smoke. As a result of targeted marketing by the tobacco industry, today every 4 in 5 Black smokers use menthol cigarettes."
The paper, "The Impact of Menthol Cigarette Bans: A Systematic Review and Meta-analysis," is available (at midnight on February 21th) at: https://doi.org/10.1093/ntr/ntae011.
Direct correspondence to:
Sarah D. Mills,
Assistant Professor, Department of Health Behavior
Gillings School of Global Public Health
University of North Carolina, Chapel Hill
