WASHINGTON - A special supplemental issue to the journal Addiction was released today focusing on menthol flavored cigarettes ("menthols") and the significant harm associated with them. This Menthol Special Journal Issue, funded by the National Cancer Institute (NCI), includes 11 new studies focusing on the prevalence of menthol flavored cigarette use, cessation success rates among menthol cigarette users and factors that might influence smoking and quitting menthols. Key findings from the special supplement include data confirming disproportionately higher rates of menthol cigarette smoking among African Americans and young adults; and menthol smokers, particularly African Americans, are also less successful when they try to quit.[1,2] Young adult non-daily smokers who smoke menthols demonstrate greater signs of nicotine dependence than those who smoke non-menthols.
This special issue in Addiction -- an extensive collection of manuscripts dedicated solely to addressing research on menthol tobacco products in the past decade – provides new scientific insights, especially as they relate to African Americans and other racial/ethnic groups. The U.S. Food and Drug Administration (FDA) Tobacco Products Scientific Advisory Committee (TPSAC) is currently reviewing evidence to evaluate the impact of the use of menthols on the public's health – including the impact on young people and racial/ethnic groups and will submit its report to FDA in March 2012 on menthol flavored cigarettes. All other flavorings including chocolate, strawberry, pineapple, and grape, were banned from cigarettes in September 2009 as part of the 2009 Family Smoking Prevention and Tobacco Control Act, but menthol, the most widely used flavor in tobacco, was not included in this ban. This special issue is being released only a few days before TPSAC's next meeting on the topic of menthol cigarettes on November 18.
"These manuscripts, along with those in the prior literature, show that menthol cigarette smoking disproportionately impacts populations at risk of initiating smoking, young people, and tobacco-related health disparities," said Kola Okuyemi, MD, MPH, senior editor of the supplement. "These papers add to the body of evidence that informs future research and policy directions regarding mentholated cigarettes." The findings support the statement made to the FDA by Gardiner and Clark that "Given the overwhelming disease and death caused by smoking, menthol has no redeeming value other than it makes the poison go down more easily."
Prior research shows disproportionate marketing to and use of menthol products in youth and African American populations. Taken together, the research from today's special journal issue confirms that vulnerable populations in the United States, including African Americans, women, young people, the unemployed and those with lower levels of education are at higher risk for smoking menthol cigarettes. Among African American smokers, young adults (age 18-24) are four times more likely to smoke menthol cigarettes compared to African American smokers aged 65 and older.
While several studies in the special journal issue also confirm past research showing there are lower successful quit rates among menthol smokers, new findings show that race is associated with how menthol cigarettes affect one's quit attempt. Among African Americans, menthol cigarette smoking is associated with decreased likelihood of smoking cessation. One study specifically noted that African American and Hispanic menthol smokers are more likely to be seriously considering quitting smoking and have positive estimations of their future quitting success, but are less successful in long-term quitting smoking compared to non-menthol smokers.
"The tobacco industry has a long history of promoting menthol cigarettes to minorities and it shows," said Cheryl G. Healton, DrPH, president and CEO of Legacy. "The menthol smoking rates among minority communities are disproportionately high, and to add insult to injury, once they do decide to quit, it is often more challenging for them to do so successfully. We believe that the comprehensive findings of this special issue along with past research provide the FDA with the necessary information to ban menthol," she added.
Lorillard Tobacco Company states on its website, Understanding Menthol, that "a menthol cigarette is just another cigarette — and should be treated no differently." But, the research suggests that menthol cigarettes could be more harmful than non-menthol cigarettes. One study included in the special issue found an increased level of nicotine addiction among daily menthol smokers who only smoke a few cigarettes daily in comparison with those non-menthol smokers who smoke similar low numbers of cigarettes. Another found that young adult non-daily smokers who smoke menthol cigarettes were significantly more dependent than those who smoke non-menthol cigarettes. And while menthol smokers smoke fewer cigarettes each day compared to non-menthol smokers, current menthol and non-menthol smokers have similar health outcomes..
One study in today's special issue examined smoke-free policies among employed persons and reports that menthol smokers were nearly 70 percent less likely to be covered by smoke-free policies at both work and home compared to non-menthol smokers. Furthermore, evidence from tobacco control research suggests that if you raise the price of cigarettes, you can reduce smoking consumption rates. One study found that if you increase the price of menthol cigarettes by 10 percent only 2.3 percent of menthol smokers would switch to non-menthols. This study also suggests that menthol and non-menthol cigarettes are not close substitutes; that is, menthol smokers are committed to smoking menthols. If menthol were banned then strong preference for mentholated cigarettes may serve as a lever to reduce smoking prevalence when combined with increased access to effective cessation treatments.
Legacy has remained a committed member of the public health community in urging a ban on menthol cigarettes. Menthol cigarettes are the only flavor in cigarettes that have not been banned by the FDA since the agency acquired regulatory authority over tobacco products in 2009. In October 2010, Legacy joined the NAACP Legal Defense and Educational Fund, Inc., National African American Tobacco Prevention Network (NAATPN) and the African American Tobacco Control Leadership Council (AATCLC) in a collective call to ban menthol as an additive in all tobacco products.
Legacy is dedicated to building a world where young people reject tobacco and anyone can quit. Located in Washington, D.C., the national public health organization helps American live longer, healthier lives. Legacy develops programs that address the health effects of tobacco use, especially among vulnerable populations disproportionately affected by the toll of tobacco, through grants, technical assistance and training, partnerships, youth activism, and counter-marketing and grassroots marketing campaigns. The foundation's programs include truth®, a national youth smoking prevention campaign that has been cited as having contributed to significant declines in youth smoking; EX®, an innovative public health program designed to speak to smokers in their own language and change the way they approach quitting; and research initiatives exploring the causes, consequences and approaches to reducing tobacco use. The American Legacy Foundation was created as a result of the November 1998 Master Settlement Agreement (MSA) reached between attorneys general from 46 states, five U.S. territories and the tobacco industry.