February 21, 2024

Researchers in the Department of Health Behavior at the UNC Gillings School of Global Public Health have published a new paper today in Nicotine & Tobacco Research which finds that banning the sale of menthol cigarettes could lead to a meaningful reduction in smoking rates.

Menthol cigarettes are a strong public health concern because studies show the cooling effects of menthol mask the harshness of cigarettes, making it easier for young people to start smoking. Prior research has also found that menthol in cigarettes makes it easier for smokers to absorb nicotine, leading to greater dependence. Menthol smokers also find it harder to quit smoking compared to those who smoke non-menthol cigarettes.

The rates of menthol cigarette use among smokers vary globally. Around 7.4% of smokers in Europe use menthol cigarettes, while in the United States, around 43.4% of adult smokers used menthol cigarettes in 2020. Menthol cigarettes see disproportionate use by young people, people from marginalized groups and lower-income smokers. About 81% of non-Hispanic Black smokers in the U.S. use menthol cigarettes, as compared to 34% of white smokers.

More than 170 U.S. cities and two states, several countries (including Canada and Ethiopia), and the European Union have banned the sale of menthol cigarettes.

Dr. Sarah Mills

Dr. Sarah Mills

The study team, led by Sarah Mills, PhD, assistant professor of health behavior, examined the effects of these bans. The investigators conducted a systematic search of studies published in English up to November 2022 to discover how menthol bans change smoking behavior. The researchers looked at 78 prior studies, mostly from Canada, the EU and the U.S.

The study found that the effects of menthol cigarette bans are substantial. The results show that while 50% of menthol smokers switched to smoking non-menthol cigarettes, almost a quarter (24%) of menthol cigarette smokers quit smoking altogether after a menthol ban. Around 12% switched to other flavored tobacco products, and 24% continued smoking menthols. The study also found that national menthol bans appear more effective than local or state menthol bans, as quit rates were higher in places with country-wide bans.

“This review provides compelling evidence for the U.S. Food and Drug Administration’s proposed ban on menthol cigarettes,” Mills said. “The White House postponed banning menthol cigarettes in December 2023. Our review of the evidence suggests this delay is causing harm to the health of the public, especially among Black communities. Contrary to industry claims, studies find no increase in the use of illicit products. A menthol cigarette ban would provide the greatest benefits to Black individuals who smoke. As a result of targeted marketing by the tobacco industry, today every 4 in 5 Black individuals who smoke use menthol cigarettes.”

Currently, Mills and colleagues Kristen Hassmiller Lich, PhD, and Kurt Ribisl, PhD, are incorporating estimates from the review into a simulation model that will estimate the impact of a national menthol cigarette ban on tobacco-related disease.

Read the full study online.

Additional co-authors on the paper include Snigdha Peddireddy, MPH, Rachel Kurtzman, PhD, Frantasia Hill, MPH, Victor Catalan and Kurt Ribisl, PhD, from the Gillings School and Jennifer S.  Bissram, MSIS, from the UNC Health Sciences Library.

Research reported in this publication was supported by the National Cancer Institute and FDA Center for Tobacco Products. COI: One of the authors of the paper (Dr. Ribisl) has served as a paid expert consultant representing plaintiffs in litigation against e-cigarette and tobacco companies.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

Media release courtesy of Oxford University Press. For a copy of the publication, contact Daniel Luzer at daniel.luzer@oup.com

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