Teens & Tobacco

Cigarette smoking has been on the decline for years. But menthol cigarettes are one segment of the tobacco market that has remained strong.

The Food and Drug Administration (FDA) proposed new rules today to prohibit these products and flavored cigars. These proposed rules are in response to public health concerns about the dangers of menthol cigarettes and their huge popularity among young people and Black, Hispanic and Asian American smokers.

We spoke with Jennifer Cofer, director of the EndTobacco® Program at MD Anderson, about the harms posed by menthol cigarettes and why the FDA's decision matters.

What is menthol, and why do manufacturers add it to cigarettes?

Menthol is a flavor additive with a minty taste and smell. In addition to tasting good, it has a cooling and painkilling effect. Cigarette manufacturers add it to cigarette filters to cover up the unpleasant taste of tobacco and make cigarettes more appealing.

What does the FDA decision on menthol cigarettes mean?

The FDA has the authority to regulate ingredients, marketing and new products. It banned flavored cigarettes in 2009, but made an exception for menthols. The FDA is essentially catching up by including menthol as a banned flavor now. Last year, the FDA announced that a plan was in the works to catch up, essentially, by including menthol as a banned flavor.

Now, the public will have the opportunity to comment on the proposed rules this summer before the product standards are finalized. It could be several months before menthols and cigars disappear from shelves.

Who smokes menthol cigarettes?

About 18.5 million people in the United States are regular menthol smokers. That’s 37% of the cigarette market. Here’s a breakdown of their use by race in the United States:

• 85% of Black smokers smoke menthols
• 46% of Hispanic smokers smoke menthols
• 39% of Asian American smokers smoke menthols

Why is race important? Because people who smoke menthols tend to inhale more deeply and have a harder time quitting smoking. That means that the health effects of smoking have a disproportionate impact on those communities with a higher rate of menthol use. 

Menthols and mint are also extremely popular among teenage smokers. More than half of cigarette smokers ages 12 to 17 use menthol cigarettes.

The hope is that, once finalized, the rules will help reduce the number of new, young adult nonsmokers and improve the health of people who currently use menthol cigarettes.

What does the research say about the dangers of menthol cigarettes?

Because menthol flavoring masks the harsh taste of cigarette smoke, menthol smokers engage in more intense smoking behaviors than smokers of regular cigarettes. As a result, they suffer greater damage to their health. Here are three reasons menthols are so dangerous:

• People who smoke menthols smoke more. The minty coolness of the menthol covers up the harshness of the cigarette, so smoking is easier to tolerate. As a result, menthol smokers inhale more deeply and they smoke more cigarettes. That means over their smoking lifetime, they take in more of toxic chemicals and tar from cigarettes.
• Menthols are harder to quit. Research by both the FDA and the Tobacco Products Scientific Advisory Committee shows that those who smoke menthol cigarettes are more likely to be dependent and have more trouble quitting. So, while Black smokers are more likely to try to quit smoking than white smokers, they’re less likely to be successful. That’s because of a higher nicotine dependence related to smoking menthol cigarettes. One result: Black men and women have a higher rate of lung cancer than any other race.
• Menthols appeal to young smokers. Studies show that young people who start smoking menthol cigarettes are more likely to become addicted and become long-term daily smokers.

What are the health risks of flavored cigars?

Flavored cigars, or cigarillos, come in flavors like cherry, grape and vanilla. They are typically available at convenience stores and gas stations for a very low price.

Like menthol cigarettes, flavored cigars were not covered by the 2009 flavor ban. Cigars are not regulated in the same way as cigarettes.

Removing these products would be an important step in reducing the overall impact of tobacco on public health, especially in communities where they are popular.

Is there anything else should we know about menthol cigarettes?

There is no safe tobacco product. If you are a smoker or vaper, one of the best things you can do to protect your health and reduce your risk of cancer is to quit. The best way to do that is through a comprehensive program that includes a combination of medications and counseling. MD Anderson offers free research studies for adults in Texas at any stage of smoking cessation. Learn more at SmokeFreeStudy.org.

Youth and young adults who want to quit using tobacco products can text VAPEFREETX to 88709. Parents can text QUIT to 202-899-7550 to get tips and advice for helping their teens and young adults quit using tobacco or vape products.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.