Menthol cigarettes linked to 10 million extra smokers, hundreds of thousands of premature deaths

The research shows that about 10 million smokers were attributable to menthol cigarettes, which researchers estimate accounted for about 3 million life years lost.

“Our results indicate that mentholated tobacco products have had a significant impact on public health and could continue to pose a substantial health risk,” said David Mendez, senior author of the study and an associate professor in the Department of Health Management and Policy at the U-M School of Public Health.

“We hope these data will help the Food and Drug Administration evaluate the potential regulatory actions for mentholated tobacco products.”

The study, published in Tobacco Control, indicates that the most important drivers of the relative impact of menthol cigarettes were the effects that menthol has in smoking initiation and cessation, said first author Thuy Le of the Department of Health Management and Policy at U-M’s School of Public Health.

“Previous studies have shown that menthol experimentation is positively associated with progression to established smoking,” Le said. “In addition, menthol smokers are less likely to quit smoking than nonmenthol smokers. These observations were incorporated in the model and are the key factors in determining the outcomes of our study.”

For their study, the researchers calibrated a well-established model developed by Mendez and colleague Ken Warner, dean emeritus of the U-M School of Public Health. Le and Mendez used the model in conjunction with National Health Interview Survey data and other public data sources to reproduce the overall U.S. adult smoking prevalence between 1980 and 2018 and associated mortality.

They then used the model again with adjusted parameters to reflect a scenario in which menthol cigarettes were assumed not to be present in the market over the same period. Finally, they compared both scenarios to quantify the public health harm attributable to menthol over the 1980-2018 period.

Mendez said they hope the FDA will look at this and other data as it evaluates potential regulatory actions for mentholated tobacco products.

Menthol cigarettes were created in 1925 and became widely spread in the 1950s and ’60s. In 2009, the Family Smoking Prevention and Tobacco Control Act gave the FDA authority to regulate the manufacture, distribution and marketing of tobacco products. The FDA banned flavors such as candy, spice and fruit, but menthol was not banned.

In 2011, the Tobacco Products Scientific Advisory Committee submitted a report to the FDA concluding that the removal of menthol cigarettes from the market would benefit public health. To date, the FDA has not taken any regulatory action on mentholated cigarettes.

According to the Population Assessment of Tobacco and Health Study, 81% of youth and 86% of young adults who ever used tobacco—even once or twice in their lifetimes—reported that the first tobacco product they used was flavored. The FDA says 86% of African American smokers, 46% of Hispanic smokers, 39% of Asian smokers and 29% of white smokers use menthol cigarettes.

Both Le and Mendez are researchers at U-M’s Center for the Assessment of Tobacco Regulation, supported with funding from the NIH and FDA.

More information: 

• Study: An estimation of the harm of menthol cigarettes in the United States from 1980 to 2018