Earlier this year, the Food and Drug Administration (FDA) proposed a new rule that would prohibit the sale of menthol cigarettes. This action is in response to several reports that cited more than 18.5 million current menthol cigarette smokers ages 12 and older in the United States, and the alarming rate of menthol flavored products used by youth, young adults and racial and ethnic minority groups, especially Black Americans. However, FDA finally took action in response to a lawsuit by several public health, medical and health justice organizations seeking FDA action on menthol.
The Allure of Menthol
Menthol is flavoring added to cigarettes which produces a minty taste and cooling sensation when inhaled. These flavor and sensory effects reduce the harshness of smoking, making menthol products more appealing to new and young users to experiment with cigarettes and progress to regular use. In addition, it has long been known that most daily, long-term smokers begin before the age of 25, and menthols offer an easier option to begin smoking. According to the Centers for Disease Control (CDC), in 2021, close to 40% of current middle school and high school who smoked reported using menthols, and that almost 8 in 10 youth who used tobacco products used flavored products.1
How Menthol Makes Cigarettes More Addictive
This is particularly disheartening because additional research shows that menthol flavoring contributes to greater nicotine dependence, meaning that those who begin smoking menthol cigarettes have a much harder time quitting. In fact, studies have mapped the brain to show how menthol cigarette users have higher levels of nicotinic receptors in their brain. This is because, in addition to nicotine binding to brain receptors, menthol increases the number of these receptors, making the brain even more dependent on the continued use of not just tobacco, but menthol specifically.2 According to a report shared by Guillaume Poirier, PhD, instructor in psychiatry and co-author of one study the National Institute of Drug Abuse, “Our findings support the notion that beyond flavor, mentholated tobacco may have psychoactive effects that impact nicotine addiction and withdrawal. Adding menthol to nicotine increased the communication between a brain area in the reward pathway and one involved in memory already known to be involved in nicotine addiction and withdrawal.”3
Menthol and Racial Disparities
Even though tobacco use has declined over the last few decades, there are still large disparities across groups defined by race, ethnicity, educational level and socioeconomic status. Menthol cigarettes not only contribute to these numbers but frequently are the most popular tobacco product. In fact, studies show that Black Americans, individuals who identify as LGBTQ+, and individuals with behavioral health disorders are more likely to report smoking menthol cigarettes than other population groups. This largely has to do with the tobacco industry targeting certain populations through advertising. For instance, Big Tobacco has been known to market menthols as a “smoother” or “healthier” cigarette, and they have used popular musicians or actors to push the message to their target audience.
Why the FDA Should End the Sale of Menthols
Prohibiting the sale of menthol cigarettes would reduce the ease of experimenting with cigarettes, particularly to younger users, and encourage people who smoke menthol cigarettes to quit, which could reduce overall use of tobacco products. In fact, modeling studies have estimated a 15.1% decrease in smoking prevalence within 40 years, leading to an estimated 324,000 to 654,000 lives saved, if menthol is taken off the market. These models suggest that the health benefits would be particularly pronounced among the populations most impacted by tobacco use but are conservative estimates since they do not factor in the lives saved when youth users never begin smoking.
These models were made based on the success of the Tobacco Control Act of 2009, which initially prohibited every other flavored cigarette but failed to include menthol. In its implementation of the Tobacco Control Act, the FDA partnered with several other government agencies, including the National Institutes of Health (NIH), to understand the effects of menthol. This included close study and careful consideration of the scientific evidence and complex policy issues related to menthol cigarettes. After mounting scientific evidence and decades of research, the FDA has proposed ending the sale of menthol cigarettes to protect public health.
The FDA is currently reviewing comments on their proposal to end the sale of menthol cigarettes. The American Lung Association calls on FDA to issue a final rule ending the sale of menthol cigarettes as well as a separate final rule ending the sale of flavored cigars that was proposed at the same time by the end of the year.
To learn more about menthol, visit Lung.org/menthol. For more information about quitting tobacco use, visit the American Lung Association website at Lung.org/ffs or call the free Lung HelpLine at 1-800-LUNGUSA (1-800-586-4872).
- Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021 | MMWR (cdc.gov)
- Alsharari, S.D., J.R. King, J.C. Nordman, et al. “Effects of Menthol on Nicotine Pharmacokinetic, Pharmacology and Dependence in Mice.” PLoS ONE, 10(9):e0137070, 2015. Available at https://doi.org/10.1371/journal.pone.0137070.
- Brain imaging study finds link between menthol tobacco, nicotine addiction (umassmed.edu)
Blog last updated: August 23, 2023