Banning menthol leads a quarter of menthol smokers to quit

The two justifications for the FDA’s proposed product standard prohibiting menthol cigarettes and cigars are (1) it will reduce youth initiation, and (2) it will help menthol smokers to quit. Now Sarah Mills and colleagues have published a review and meta-analysis of the effects of menthol bans around the world, The Impact of Menthol Cigarette Bans: A Systematic Review and Meta-Analysis, that shows that the benefits of a national ban would be even bigger than the FDA estimated. In particular, they found that 24% of menthol cigarette smokers quit smoking after menthol was banned.

This is a huge effect, which explains why the tobacco companies are spending a fortune trying to block efforts the end menthol.

They also debunks the arguments that the tobacco companies and the network of surrogates they finance among Black groups and police are raising against FDA action and against menthol bans everywhere:

Critics of menthol bans, however, report that such policies [menthol band] will have little benefit because menthol smokers will not quit after a ban and instead switch to non-menthol cigarettes and OTPs [other tobacco products, including e-cigarettes]. Concern about an increase in illicit trade of cigarettes is another argument against a ban. In contrast, findings from this review suggest that menthol cigarette smokers quit smoking at relatively high rates after a menthol ban. Research from Canada found no increase in the number of illicit cigarettes seized after the ban. [citations dropped; emphasis added]

While 24% of menthol smokers quit, some continued to smoke: 50% switched to non-menthol cigarettes, 12% switched to other flavored tobacco products, and 24% continued smoking menthol cigarettes, which they obtained from places where menthol wasn’t banned (graph below). The fact that some menthol smokers didn’t quit, however, does not detract from the huge benefit for those who did.

(The paper didn’t address preventing kids from starting to smoke.)

The authors also concluded that national bans were more effective than regional bans because it was harder to get menthol cigarettes elsewhere. State and local bans were, however, still effective, just not as effective as national bans.

This strong study adds to the evidence supporting FDA action to prohibit manufacturing and import of menthol cigarettes and cigars. The evidence summarized in this paper also shows the high stakes in terms of benefits to improving the health of Black smokers that hopefully will lead the White House to stop blocking the FDA.

In addition, this summary of the evidence supports comprehensive state and local bans on the sale of menthol and other flavored tobacco products. This state and local activity should continue regardless of what the White House lets the FDA do because the tobacco companies will likely delay FDA implementation with frivolous lawsuits.

Here is the abstract:

Introduction: This review investigates the impacts of banning the sale of menthol cigarettes at stores.

Methods: A systematic search of studies published in English up to November 2022 was conducted. The following databases were searched: PubMed/Medline, CINAHL, PsycINFO, Web of Science, and Embase, as well as a non-indexed journal. Studies evaluating either the impact of real-world or hypothesized menthol cigarette bans were included. Primary outcomes include tobacco use behaviors. Secondary outcomes include cigarette sales, retailer compliance, and the tobacco industry’s response to a menthol ban. Data on tobacco use behavior after a menthol ban were pooled using random-effects models. Two pairs of reviewers independently extracted data and assessed study quality.

Results: Of the 964 articles that were identified during the initial search, 78 were included in the review and 16 were included in the meta-analysis. Cessation rates among menthol cigarette smokers were high after a menthol ban. Pooled results show that 24% (95% confidence interval [95% CI]: 20%, 28%) of menthol cigarette smokers quit smoking after a menthol ban, 50% (95% CI: 31%, 68%) switched to non-menthol cigarettes, 12% (95% CI: 3%, 20%) switched to other flavored tobacco products, and 24% (95% CI: 17%, 31%) continued smoking menthol cigarettes. Hypothesized quitting and switching rates were fairly close to real-world rates. Studies found the tobacco industry attempts to undermine menthol bans. National menthol bans appear more effective than local or state menthol bans.

Conclusions: Menthol cigarette bans promote smoking cessation suggesting their potential to improve public health.

Implications: Findings from this review suggest that menthol cigarette bans promote smoking cessation among menthol cigarette smokers and have the potential to improve public health.

CNN published an excellent story summarizing the study and its implications.

The full citation is: Mills SD, Peddireddy S, Kurtzman R, Hill F, Catalan V, Bissram JS, Ribisl KM. The Impact of Menthol Cigarette Bans: A Systematic Review and Meta-Analysis. Nicotine Tob Res. 2024 Feb 21:ntae011. doi: 10.1093/ntr/ntae011. Epub ahead of print. PMID: 38379278. It is available here.