The U.S. Food and Drug Administration (FDA) is moving forward with plans to ban menthol cigarettes and all flavored cigars—policies that agency officials say could help prevent some of the roughly 500,000 U.S. deaths linked to tobacco each year.
“The actions we are proposing can help significantly reduce youth initiation and increase the chances that current smokers quit,” FDA Commissioner Dr. Robert Califf said in a statement. “It is clear that these efforts will help save lives.”
However, it remains to be determined if the proposed ban on menthol will actually work.
This policy has been supported by influential health groups. Menthol is a flavor that adds minty taste to cigarettes and provides a cooling sensation, masking the harshness. According to public health experts, menthol cigarettes may be less appealing for new smokers than they are for existing smokers. This makes them more difficult to quit. A new study has raised questions about whether menthols can be harder to quit than regular cigarettes.
Black Americans are more likely than other Americans to use menthols due to the decades-long targeted marketing by tobacco companies. While supporters, such as the NAACP argue that a ban on the use of menthols would be beneficial for Black Americans’ health, critics claim it could cause discriminatory policing and criminalize a product that is used more frequently by those of color. In a joint letter sent to the U.S. Department of Health and Human Services secretary last year, the ACLU and other signatories wrote that a menthol ban would “prioritize criminalization over public health and harm reduction” and could create an illicit market for menthol products. The FDA stated that it will impose penalties on retailers and manufacturers who violate the ban. It did not say if this would be against individuals.
Others who don’t support the ban argue that it will simply push menthol smokers to use unflavored tobacco products.
One small 2020 study showed that vaping was less popular among young people after San Francisco banned all flavors of tobacco, including menthols. While other societal factors may explain that shift—including an outbreak of vaping-related lung disease beginning months after San Francisco’s policy went into full effect—the authors concluded that flavor bans could lead to more traditional cigarette smoking.
However, there are a few real-world studies that show that bans on menthol can have positive impacts on the public’s health.
An article published in JAMA Network Open The regulation’s impact on teenage menthol-smoking was examined using surveys that were conducted prior to and following its implementation. About 12% of U.K. teenage smokers admitted to using menthol-flavored products before the policy was implemented. After it took effect, that number dropped to 3%—a clear sign that the ban led to a drop in youth menthol use, the authors write. Some of the 3% that said they continued using menthols might have been unable to obtain them legally or used filters and sprays with minty flavors.
Although the finding was intuitive, it could be used to support menthol bans. This is because public-health experts, such as the U.S. Centers for Disease Control and Prevention (CDC), believe that young people can become addicted by using flavored tobacco products. The problem is that the JAMA Network Open study didn’t look into whether former teen menthol users quit smoking altogether or simply switched to another type of tobacco product.
“The ban in England seems to have worked in reducing [teenage] menthol smoking, so by extension we would hope it would work in the U.S., although there are obviously big market differences,” says co-author Katherine East, an academic fellow at King’s College London’s Institute of Psychiatry, Psychology, and Neuroscience. According to federal statistics, only 2% of U.S. high school students smoke cigarettes regularly. However, among this small number, menthols are very common. About 38% of American teenagers smoke menthols, as opposed to 12% before the ban.
Geoffrey Fong is the principal investigator for the International Tobacco Control Policy Evaluation Project. In Canada, provinces banned menthol cigarettes starting in 2015. A national ban was implemented in 2017. In a paper published in April, Fong and his colleagues found that Canada’s regulations did, indeed, prompt many menthol users to quit smoking altogether.
They compared national surveys of tobacco use from before and after the ban to find that only 22% of Canadians who had used menthols quit. This compares to 15% for non-menthol users. This means that almost 80% of all menthol smokers are affected. hadn’t To quit smoking, I had to either switch to another type of tobacco or find a way for me to keep consuming menthols. For example, by buying them on a First Nations reservation that is exempted under the ban. The U.S. also has many exemptions from federal tobacco regulations. But Fong calls the seven-percentage-point difference in quit rates between menthol and non-menthol smokers “huge,” especially considering how difficult it is to kick a nicotine addiction of any kind.
Prior to the ban, relatively few Canadians had ever smoked menthols. Fong and co-authors were interested in how similar policies could affect the health of Americans who use these products more frequently. Based on their Canadian research, Fong and his co-authors estimated that more Americans would quit smoking if menthol was banned. This includes more than 380,000 Black smokers.
“There’s extremely strong public-health benefits from this,” Fong says. “From our research, we can expect significant positive effects, and greater proportional benefits for the public health of the Black community.”
In 2020, another research review found that nearly 30% of U.S. smokers who smoked menthol would be open to switching to ecigarettes if the drug was banned. While e-cigarettes aren’t harmless, experts widely consider them to be less dangerous than traditional cigarettes—so even without total nicotine cessation, most experts would consider that a net positive for public health.
Ultimately, though, researchers won’t know what effect a menthol ban could have on U.S. smokers until years after one is implemented. Since the rule faces a long bureaucratic road and likely won’t take effect until at least 2024, that means solid conclusions are a ways off.
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