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.
Pike Moore, S., Osborn, C., Koopman Gonzalez, S., Quisenberry, A., Klein, E. G., Kaur, M., Suratkal, J., & Trapl, E. (2022). Flavour loyalty may predict cessation or substitution following a cigarillo flavour ban among young adults in the USA. Tobacco Control, 31(Suppl 3), s206–s213. https://doi.org/10.1136/tc-2022-057487
Compared with smokers with lower nicotine dependence, those with higher nicotine dependence were less likely to be short-term quitters
Chung-Hall, J., Fong, G. T., Meng, G., Cummings, K. M., Hyland, A., O’Connor, R. J., Quah, A. C. K., & Craig, L. V. (2022). Evaluating the impact of menthol cigarette bans on cessation and smoking behaviours in Canada: longitudinal findings from the Canadian arm of the 2016–2018 ITC Four Country Smoking and Vaping Surveys. Tobacco Control, 31(4), 556–563. https://doi.org/10.1136/tobaccocontrol-2020-056259
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.
Dearfield, C. T., Horn, K., Crandell, I., & Bernat, D. H. (2022). Behavioural intentions in response to a potential menthol cigarette sales ban: a survey examining smokers in Washington, DC public housing. BMJ Open, 12(7), e059821. https://doi.org/10.1136/bmjopen-2021-059821
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.
Dearfield, C. T., Horn, K., Crandell, I., & Bernat, D. H. (2022). Behavioural intentions in response to a potential menthol cigarette sales ban: a survey examining smokers in Washington, DC public housing. BMJ Open, 12(7), e059821. https://doi.org/10.1136/bmjopen-2021-059821
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
D’Silva, J., Amato, M. S., & Boyle, R. G. (2015). Quitting and Switching: Menthol Smokers’ Responses to a Menthol Ban. Tobacco Regulatory Science, 1(1), 54–60. https://doi.org/10.18001/TRS.1.1.6
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
D’Silva, J., Amato, M. S., & Boyle, R. G. (2015). Quitting and Switching: Menthol Smokers’ Responses to a Menthol Ban. Tobacco Regulatory Science, 1(1), 54–60. https://doi.org/10.18001/TRS.1.1.6
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)
Oncken, C., Litt, M. D., Thurlow, S., Mead-Morse, E. L., Wang, L., & Hatsukami, D. K. (2023). Manipulation of Menthol and Nicotine Content in Cigarettes: Effects on Smoking Behavior and Toxicant Exposure in Women Menthol Smokers. Nicotine & Tobacco Research, 25(4), 665–673. https://doi.org/10.1093/ntr/ntac225
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).
Pacek, L. R., Oliver, J. A., Sweitzer, M. M., & McClernon, F. J. (2019). Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to a nicotine reduction policy and menthol ban in combusted cigarettes. Drug and Alcohol Dependence, 194, 40–44. https://doi.org/10.1016/j.drugalcdep.2018.10.005
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
Pacek, L. R., Oliver, J. A., Sweitzer, M. M., & McClernon, F. J. (2019). Young adult dual combusted cigarette and e-cigarette users’ anticipated responses to a nicotine reduction policy and menthol ban in combusted cigarettes. Drug and Alcohol Dependence, 194, 40–44. https://doi.org/10.1016/j.drugalcdep.2018.10.005
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.
Pearson, J. L., Abrams, D. B., Niaura, R. S., Richardson, A., & Vallone, D. M. (2012). A Ban on Menthol Cigarettes: Impact on Public Opinion and Smokers’ Intention to Quit. American Journal of Public Health, 102(11), e107–e114. https://doi.org/10.2105/AJPH.2012.300804
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
Pearson, J. L., Abrams, D. B., Niaura, R. S., Richardson, A., & Vallone, D. M. (2012). A Ban on Menthol Cigarettes: Impact on Public Opinion and Smokers’ Intention to Quit. American Journal of Public Health, 102(11), e107–e114. https://doi.org/10.2105/AJPH.2012.300804
Those who smoked sooner after waking had lower odds of endorsing quitting smoking.
Rose, S. W., Ganz, O., Zhou, Y., Carnegie, B. E., Villanti, A. C., Rath, J., & Hair, E. C. (2019). Longitudinal Response to Restrictions on Menthol Cigarettes Among Young Adult US Menthol Smokers, 2011–2016. American Journal of Public Health, 109(10), 1400–1403. https://doi.org/10.2105/AJPH.2019.305207
menthol in cigarettes increases initiation
Schroth, K. R. J., Villanti, A. C., Kurti, M., & Delnevo, C. D. (2019). Why an FDA Ban on Menthol Is Likely to Survive a Tobacco Industry Lawsuit. Public Health Reports®, 134(3), 300–306. https://doi.org/10.1177/0033354919841011
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)
Wackowski, O. A., Evans, K. R., Harrell, M. B., Loukas, A., Lewis, M. J., Delnevo, C. D., & Perry, C. L. (2018). In Their Own Words: Young Adults’ Menthol Cigarette Initiation, Perceptions, Experiences and Regulation Perspectives. Nicotine & Tobacco Research, 20(9), 1076–1084. https://doi.org/10.1093/ntr/ntx048
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)
Wackowski, O. A., Evans, K. R., Harrell, M. B., Loukas, A., Lewis, M. J., Delnevo, C. D., & Perry, C. L. (2018). In Their Own Words: Young Adults’ Menthol Cigarette Initiation, Perceptions, Experiences and Regulation Perspectives. Nicotine & Tobacco Research, 20(9), 1076–1084. https://doi.org/10.1093/ntr/ntx048
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).
Yang, Y., Lindblom, E. N., Ward, K. D., & Salloum, R. G. (2024a). Should menthol e-cigarettes be banned? Reaction of adult smokers and users of e-cigarettes to hypothetical bans. Tobacco Control, 33(e1), e125–e127. https://doi.org/10.1136/tc-2022-057439
