Smoking may be under siege, but it is still the world's second-biggest cause of preventable death. Tobacco kills nearly 6 million people every year, approximately 10 percent of all deaths. Smoking also results in hundreds of billions of dollars in economic costs from increased health care expenditure and lost productivity.
In the West, anti-smoking campaigns seem to have stalled. About one in five U.S. adults smokes, about the same as 10 years ago. Now those who seek to further reduce the harm from smoking have proposed a new measure: a ban on menthol in cigarettes.
Earlier this month, after months of intense debate, the European Parliament voted for a ban on menthol cigarettes, which will come into force in 2022. Similar moves are afoot in the United States, again surrounded by intense debate.
Menthol cigarettes were invented in the 1920s by Lloyd "Spud" Hughes of Mingo Junction, Ohio, who reportedly stored his cigarettes in a tin with menthol crystals that he used to treat a persistent cold. The tobacco absorbed the mint flavor and made the cigarettes easier to smoke. Hughes began selling mentholated cigarettes, and by 1932 his Spud brand was the fifth–best-selling cigarette in the country.
Today about a quarter of cigarettes sold in the United States are menthol; 30 percent of adult smokers and more than 40 percent of youth smokers report smoking them.
In 2009 the United States passed a law that for the first time gave the Food and Drug Administration the authority to regulate tobacco products. Among other things, the agency now has the power to regulate the levels of "harmful components" they contain.
The FDA quickly acted to ban flavorings such as chocolate and vanilla, which are thought to be particularly attractive to children and teenagers. But it stopped short of banning menthol—the most popular additive—pending further studies.
Menthol is not simply a flavor additive: It can also have druglike effects. In addition to its fresh taste and aroma, it can produce cooling, soothing sensations, which is why it is an ingredient in a number of medicinal products, such as throat lozenges. Menthol produces these effects by binding to receptors on sensory neurons that mediate signals related to pain, temperature, and irritation. Low doses of menthol in cigarette smoke can therefore reduce the painful and irritating effects on the lining of the nose, mouth, and airways, thereby allowing smokers to inhale more easily.
An analysis of internal tobacco industry documents from 1965 to 2000 identifies two types of menthol smoker. The first are people for whom menthol primarily serves to reduce the harsh effects of smoke. These people tend to be occasional smokers or young smokers. The second are people for whom it provides a stronger flavor and physical sensation. In the United States, they tend to be African-American men.
Data from numerous surveys and research projects confirm these findings. Adolescents aged between 12 and 17, for example, smoke menthol cigarettes at a higher rate than older age groups. The same is true for young adults aged 18 to 24.
The fact that menthol cigarettes are favored by adolescents and young smokers leads to the suspicion that their availability encourages people to smoke, and this, too, is supported by research. In 2011 a report from the FDA's Tobacco Products Scientific Advisory Committee concluded that "there is strong evidence indicating that adolescent menthol cigarette smokers are more dependent on nicotine than adolescent non-menthol cigarette smokers."
The increased use of menthol cigarettes among African-Americans, meanwhile, suggests that their availability results in disproportionate harm to that section of society.
In July the FDA said it was "likely" that menthol cigarettes posed a greater health risk than normal cigarettes, because they encourage young people to take up smoking, make it more difficult to quit, and increase addiction. The agency opened a public consultation period, due to end Nov. 22, with a view to an eventual ban.
The primary counterargument put forward by the tobacco industry is that a ban would create a black market for menthol cigarettes. However, the evidence for this is weak. One study directly asked smokers of menthol cigarettes how they would respond if the product were no longer sold. Thirty-nine percent said they would quit, and 36 percent said they would switch to non-menthol cigarettes.
In another study that included the response "seek out illicit products," only 25 percent indicated that they might consider purchasing black-market products. These findings do not suggest that there would be an explosion of illicit activity if menthol cigarettes were banned.
In light of the tremendous threat that tobacco use poses to health and the minimal risk that would be expected from banning menthol cigarettes, the risk/benefit calculation appears to favor a ban. This opinion is shared by several leading health organizations, including the American Cancer Society, American Heart Association, American Lung Association, American Academy of Pediatrics, African American Tobacco Control Leadership Council, and American Public Health Association. These organizations recently submitted a petition to the commissioner of the FDA to request the prohibition of the use of menthol.
We will know how a ban on menthol cigarettes will pan out only when we actually test it outside the laboratory. There is a growing consensus that the science is telling us it is time to conduct the experiment.
This article originally appeared in New Scientist.