More details on how menthol helps Big Tobacco keep kids hooked

Keeping menthol in cigarettes (and other tobacco products) has been a priority for the tobacco companies ever since they got it exempted from the characterizing flavor ban in the 2009 Family Smoking Prevention and Tobacco Control Act that gave the FDA jurisdiction over tobacco products.

The already-strong case for banning menthol just got stronger with publication of “Cigarette smoking frequency, quantity, dependence, and quit intentions during adolescence: Comparison of menthol and non-menthol smokers (National Youth Tobacco Survey 2017-2020)” by Dale Mantey and colleagues in Addictive Behaviors. Using the CDC’s National Youth Tobacco Survey, they found that

  • Youth menthol cigarette smokers smoked more days per month and more cigarettes per day
  • Fewer young menthol cigarette smokers intended to quit smoking than non-menthol smokers and were more addicted

In other words, menthol reinforces sustained cigarette smoking among youth.

This is bad news for the kids and public health but great for tobacco companies. It also adds to our understanding of why the companies fought so hard to exempt menthol from the 2009 FDA law and why they continue to fight so hard against FDA regulation and, more important, local and state laws banning the sale of flavored tobacco products, including menthol.

This study also adds to the case for passing laws and regulations prohibiting menthol (and its analogs) as ingredients not just as “characterizing flavors.”

They also highlight that the tobacco companies target certain racial/ethnic groups with menthol products, which raises issues of health equity:

Findings must be put in context of tobacco related health disparities among racial/ethnic minorities in the US. The tobacco industry has disproportionately marketed menthol cigarettes to communities of color, resulting in disproportionately higher rates of menthol cigarette smoking among African Americans and Hispanic/Latinos, relative to non-Hispanic Whites. As such, the elevated risk for heavier and more frequent cigarette smoking as well as lower quit initiations among menthol cigarette smokers found in this study raises serious concerns for long-term health disparities. [cites deleted]

While this paper deals with cigarettes, the results almost certainly apply to e-cigarettes and other tobacco products. As Mantey and colleagues point out, “menthol additives interact at the receptor level with the actions of nicotine, increasing nicotine bioavailability as well as risk for nicotine dependence.

President Biden has permitted the FDA to start working on getting rid of menthol in cigarettes and other tobacco products exempted in the 2009 law. And FDA outlined a strong rationale for a ban in its letter granting the Citizen’s Petition urging it to issue a ban. Turning this into reality, however, requires a regulation which is a long, involved process. In addition, an FDA rule eliminating menthol will almost certainly trigger litigation from the industry which means that final FDA action on menthol in cigarettes is likely years away.

The situation is different for new products, including e-cigarettes, heated tobacco products, dissolubles and all the other devices industry is cooking up to get and keep kids (and everyone else) addicted. FDA could ban menthol in those products today by ending its “enforcement discretion” that allows them to continue to be on the market and not authorizing the sale of any new menthol products through the PMTA process which is now under way.

The fact that FDA has approved menthol versions of Philip Morris’ heated tobacco product IQOS on the assumptionthat menthol smokers might not switch to IQOS without menthol IQOS raises concerns that FDA will also approve a menthol Juul e-cigarette, which would be a disaster.

That’s another reason why it is important for localities and states to continue enacting and implementing comprehensive flavor bans that include all tobacco products and all flavors, including menthol.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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