Smokers of menthol cigarettes have a harder time quitting, large new study finds

By Claudia López Lloreda

A new study published Tuesday finds that smoking menthol cigarettes versus unflavored cigarettes is associated with reduced success in quitting among people who smoke nearly every day.

In recent years, the FDA has moved to ban almost all flavored cigarettes and cigars, but menthol has remained the lone holdout. Even so, the agency proposed such a ban in April, and researchers say the new findings support this ban.

In the study published in Tobacco Control, a BMJ journal, researchers at the University of California, San Diego found that menthol-cigarette smokers — who made up nearly 40% of those in the study — had a significantly harder time quitting than non-menthol smokers. Use of menthol cigarettes prior to attempting to quit decreased the probability of a smoker being able to abstain for more than one month by 28%, and for more than one year by 53%, compared to those who didn’t smoke menthol cigarettes.

“This [current study] is the best data we have so far from an observational study,” said Eric Leas, an assistant professor at the University of California, San Diego and first author of the study. “It’s confirming [the FDA’s] choice” to ban menthol.

Cigarette makers began adding menthol — known for its cooling and numbing properties — to cigarettes in the 1920s as a way to reduce the irritation caused by cigarette smoke. For years, menthol use has worried public health experts who say it makes it easier for young people to start smoking and leads smokers to potentially consume more tobacco and nicotine, increasing the risk of addiction.

Health experts have also been concerned about the disproportionate impact on certain minority groups. For instance, 85% of Black smokers use menthol cigarettes compared to 30% of white smokers. Black smokers also tend to have lower quitting rates, which is one of the reasons the researchers behind the new study decided to explore the link between menthol use and smoking cessation in vulnerable populations, said Leas. “It’s a clear signal in the data.”

Previous studies had examined the effect of menthol in cigarettes and similarly found that menthol makes it harder for smokers who quit to stay off smoking, but these were largely conducted in smaller groups. This new study, however, looked at this relationship in one of the largest cohorts — roughly 46,000 individuals — studied for tobacco use.

The scientists used data from an FDA-funded nationwide survey called Population Assessment of Tobacco and Health to examine the probability of people abstaining from smoking for 30 days and 12 months. The people in the nationally representative sample — 17% of whom were Black Americans — were surveyed four times between 2013 and 2018, allowing researchers to track smoking habits in specific individuals. This design also allowed the researchers to identify transitions between menthol and non-menthol use and the factors that might have contributed to the continued use of cigarettes.

The researchers found that individuals who switched from menthol cigarettes to unflavored cigarettes had a higher likelihood of quitting than those who maintained menthol use. Participants were considered to have attempted to quit if they reported doing so by trying to gradually scale back the number of cigarettes smoked, or by trying to quit entirely.

The study also found that the association between menthol use and difficulty quitting was more pronounced in non-Hispanic Black smokers. This finding “indicates the continued threat that menthol poses for the health of Black Americans,” said Geoffrey Fong, chief principal investigator of the International Tobacco Control Policy Evaluation Project and a professor at University of Waterloo in Canada.

The new study “would be another reason why the FDA should go ahead with their plan in the next year and go through regulations to ban menthol cigarettes,” said Fong, who was not involved with the study but was part of the group that conceived the PATH survey.

Such bans have shown success elsewhere. Canada, for instance, enacted a similar ban on menthol-flavored tobacco products in 2017, and followup studies have validated the effectiveness of the ban, showing that more smokers quit.

R.J. Reynolds Tobacco Co., the maker of Newport cigarettes, the best-selling menthol brand in the U.S., did not immediately respond to a request for comment.

The study’s authors say that they next plan to assess whether menthol use could also impact other aspects of smoking, such as initiation, which would be critical for young smokers. “The scientific evidence is very clear about the benefits of a ban and the continued greater devastation among those who are smoking menthol,” said Fong. “Menthol is not a good thing to have in cigarettes.”

July 6, 2021

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