Why menthol bans matter for public health
This diagram maps the public health motivations for implementing a ban on menthol cigarettes, focusing on preventing smoking initiation, especially among youth, and lowering smoking-attributable disease. It demonstrates how menthol provides a cooling sensation, easing early initiation, reinforcing nicotine dependence, and suppressing quitting. By understanding these relationships, stakeholders can emphasize the health risks of menthol cigarettes in communities to increase public support for menthol bans and prevent youth smoking initiation.
Cited references
Higher nicotine dependence scores were associated with a reduced odds of intention to discontinue cigarillos.
Smokers who did not make a quit attempt before bans were less likely than those who made a pre-ban quit attempt to make a quit attempt at follow-up
Smokers who did not make a quit attempt before bans were less likely than those who made a pre-ban quit attempt to make a quit attempt at follow-up
Smokers with no plans to quit before bans were also less likely than those with plans to quit before bans to make a quit attempt at follow-up.
Compared with smokers with lower nicotine dependence, those with higher nicotine dependence were less likely to be short-term quitters
Residents who smoked within 30 min of waking (OR 0.48, 95% CI 0.23 to 0.98) and daily smokers (OR 0.42, 95% CI 0.21 to 0.84) were less likely to say they would quit if menthol-flavoured products were no longer sold.
daily smokers (OR 0.42, 95% CI 0.21 to 0.84) were less likely to say they would quit if menthol-flavoured products were no longer sold.
Menthol smokers who said they would quit smoking if menthol were banned smoked an average of 3.8 fewer cigarettes per day compared to those who said they would continue smoking (t = 3.6, p
Menthol smokers who said they would quit in the event of a ban were more likely to have attempted to quit in the previous 12 months than those who said they would not
Menthol smokers who said they would quit in the event of a ban were more likely to have attempted to quit in the previous 12 months than those who said they would not
In Canada, menthol or capsule smoking was more common among participants who reported being a little or very addicted to cigarettes than those who reported not being addicted (3.1% vs 1.3%; AOR, 1.02; 95% CI, 1.00-1.03; P = .01) (Table 2)
In England, there was little evidence for any associations between cigarette consumption or dependence and menthol or capsule smoking (Table 2).
In the US, menthol or capsule smoking was more common among those who smoked on at least 20 of the past 30 days vs otherwise (38.1% vs 32.7%; AOR, 1.07; 95% CI, 1.01-1.13; P = .03)
In the US, menthol or capsule smoking was more common among those ... who smoked 2 to 5 (37.9%) or more than 5 (38.5%) cigarettes per day than those who smoked 1 or fewer (29.8%) (2-5 vs 1 cigarettes per day, AOR, 1.09; 95% CI, 1.02-1.15; P = .006; >5 vs 1 cigarettes per day, AOR, 1.10; 95% CI, 1.03-1.18; P = .007) [C1] United States [/C1]
In the US, menthol or capsule smoking was more common among those ... who reported urges to smoke every or most days vs less often (38.0% vs 30.3%; AOR, 1.08; 95% CI, 1.02-1.14; P = .006) (Table 2) [C1] United States [/C1]
Any menthol or capsule smoking in the past 30 days was also associated with a greater number of consumption and dependence indicators in all 3 countries than the usual brand measure (Table 2).
Any menthol or capsule smoking in the past 30 days was also associated with a greater number of consumption and dependence indicators in all 3 countries than the usual brand measure (Table 2).
Any menthol or capsule smoking in the past 30 days was also associated with a greater number of consumption and dependence indicators in all 3 countries than the usual brand measure (Table 2).
Any menthol or capsule smoking in the past 30 days was also associated with a greater number of consumption and dependence indicators in all 3 countries than the usual brand measure (Table 2).
Menthol smokers were less likely to support a ban on menthol (aOR = 0.18, 95% CI: 0.08–0.43)
Menthol smokers were less likely to support a ban on menthol (aOR = 0.18, 95% CI: 0.08–0.43) and on all additives (aOR = 0.24, 0.12–0.49)
Those who reported that additive-free cigarettes are less harmful were more likely to support a ban on additives (aOR = 1.72, 1.18–2.50).
In terms of experimental cigarettes, the LMM analysis indicated that a main effect of the presence of menthol emerged, such that menthol cigarettes were smoked significantly more than non-menthol cigarettes, regardless of nicotine content (see Figure 1, panel B, and Supplementary Table 2)
Using EC on a greater number of days during the past week (aRRR=1.51, 95% CI=1.11–2.07), intentions to quit EC use (aRRR=6.08, 95% CI=1.51– 24.46), and greater FTND scores (aRRR=1.42, 95% CI=1.03–1.97) were associated with increased likelihoods of quitting versus maintaining CC use (Supplementary Table 2b2).
Conversely, using CC on a greater number of days during the past week was associated with a decreased likelihood of quitting versus maintaining CC use
. Menthol smokers were more likely than otherwise similar nonmenthol smokers to disagree with a menthol ban (50.5% vs 31.2%; P
Menthol smokers with at least 1 recent quit attempt had twice the AOR as otherwise similar smokers who had not recently tried to quit of reporting they would rather quit than switch to a nonmenthol brand.
Menthol smokers with at least 1 recent quit attempt had twice the AOR as otherwise similar smokers who had not recently tried to quit of reporting they would rather quit than switch to a nonmenthol brand.
Nearly 13% of menthol smokers would switch to a nonmenthol cigarette if menthol were banned. None of the demographic characteristics assessed predicted membership in this group, although we observed an inverse relationship with age that was marginally statistically significant in multivariable analysis. The AOR that these smokers were nicotine dependent was 5.6 times as high as the AOR among other menthol smokers
Those who smoked sooner after waking had lower odds of endorsing quitting smoking.
menthol in cigarettes increases initiation
This study found that menthol bans likely have direct and indirect positive effects on smoking cessation among menthol smokers. Menthol bans may have the greatest impact on smoking cessation among those who are already motivated to quit before the implementation of a menthol ban.
These were reasons not only for preferring menthol cigarettes currently, but were also important when initiating smoking: “For me at least when I started smoking, they were easier to smoke, almost. Because it’s like you don’t even feel like you’re inhaling smoke. It’s like ice in your mouth, and I just like that.” (general YA group, male, age 19)
These were reasons not only for preferring menthol cigarettes currently, but were also important when initiating smoking: “For me at least when I started smoking, they were easier to smoke, almost. Because it’s like you don’t even feel like you’re inhaling smoke. It’s like ice in your mouth, and I just like that.” (general YA group, male, age 19)
“males, older adults, Blacks and Hispanics, those with higher levels of educational attainment, those with lower levels of household income, those with a shorter history of smoking, those who used nonmenthol cigarettes or nonflavored cigars, those who smoked less than daily, those who had moderate or high levels of dependence on smoking, and those who did not obtain cigarettes or cigars solely from local retailers were all more likely to be supportive of both bans compared with their counterparts.”
Non-daily smokers would be more likely than daily smokers to quit all tobacco-nicotine use (OR=3.57, 95% CI 2.97 to 4.28).
Across the surveyed countries, menthol cigarette smokers tended to be younger, more likely to be female, better educated, living with a higher household income, and smoking fewer cigarettes.
All groups were predominantly supportive of a smoking ban in restaurants, with highest support reported by menthol smokers (73.5%), and lowest by other flavoured cigarette smokers (63.3%). Almost half of all smokers supported the ban on smoking in bars and pubs, with the support varying significantly by the type of cigarette smoked (56.1% among menthol, 45.4% among other flavoured cigarette smokers).
The most divisive issue between menthol smokers and other smokers was that of banning additives, including flavourings, in cigarettes, with only 25.1% of menthol smokers supporting such a law, compared to 49.9% of other flavoured cigarette smokers.
