Research Topics: Menthol and Tobacco

1. What is menthol?

• Menthol is an organic compound naturally found in mint plants such as peppermint and spearmint.
• Menthol is a monocyclic terpene alcohol that is clear or white in color and solid at room temperature.
• Menthol acts as a coolant, stimulates cold receptors, and is frequently used to relieve minor pain, irritation and to prevent infection.[1]

2. What types of tobacco products contain menthol?

• Menthol was first added to cigarettes in the 1920s.[2]
• Today, approximately 90% of cigarettes marketed in the United States contain menthol.[3]
• Cigarettes can contain natural and synthetic forms of menthol.[4]
• Cigarettes advertised as "menthol" cigarettes contain amounts of menthol that are 0.1-0.45% of the cigarette tobacco weight.[4]
• Many "non-mentholated" cigarettes contain amounts of menthol that are 0.01%-0.03% of the cigarette tobacco weight.[4]
• Menthol is also found in cigars, little cigars, smokeless tobacco products, and tobacco rolling paper.
• Some new tobacco products allow the user to adjust the intensity of menthol flavor through devices that contain concentrated amounts of menthol.

3. Are menthol cigarettes harmful?

• All cigarettes are harmful.
• There is no evidence that menthol cigarettes are safer than any other cigarette.
• Like other cigarettes, menthol cigarettes harm nearly every organ in the body and cause diseases including cancer, cardiovascular, respiratory diseases, and multiple adverse reproductive outcomes.[5]
• The former Surgeon General, Dr. Richard Carmona, clearly states that no level of cigarette smoke exposure is safe.[6]
• Second-hand smoke exposure from any cigarette, including menthol cigarettes, can also cause diseases such as cancer and heart disease.[6]

4. How has tobacco industry marketed menthol cigarettes?

• Menthol is a cigarette additive actively marketed to consumers based on its physiological effects as an anti-irritant and cooling agent.[4, 7]
• Data from the 2009 Federal Trade Commission Report indicates that menthol cigarettes contribute to 20% of the tobacco industry’s cigarette sales market.[8]
• Research studies and evidence from the tobacco industry documents indicate the tobacco industry has a history of marketing menthol cigarettes to women, youth, and minority racial/ethnic groups including African Americans/Blacks, Latinos/Hispanics, and Asian Americans.[9, 10, 11, 12, 13, 14, 15, 16]
• Target marketing practices promoting the use of menthol cigarettes among women began in the 1930’s with the first menthol cigarette brand called "Spud." One of the ads for Spud read as follows, "To read the advertisements these days, a fellow'd think the pretty girls do all the smoking."[17]
• The introduction of the menthol-flavored Salem cigarette in the 1950’s further captivated a growing population of female smokers.[9]
• Research indicates the tobacco industry has targeted youth and young adults for the use of menthol cigarettes.[9, 10, 11, 18]
• Research suggests that target marketing specifically to African Americans/Blacks began in the 1940’s,[12] and African Americans/Blacks may be the most directly targeted group of menthol smokers.[9, 12, 13, 14, 15, 16]

5. Who smokes menthol cigarettes?

• Data from the Tobacco Use Supplement to the Current Population Survey[19] provides recent national estimates of smoking rates and menthol cigarette use among adults ages 18+ years in the United States (see Table 1). Nearly 27% of U.S. current smokers report their usual cigarette type as menthol. Menthol cigarette use varies by gender, age, race/ethnicity, and socioeconomic status including income, education, occupation, and employment status (see Table 2).
• Studies also show that menthol cigarettes may be associated with smoking uptake among youth.[11, 18] Research on tobacco industry documents reveals how tobacco companies manipulated menthol content and other sensory characteristics of cigarettes to facilitate initiation and dependence among young people.[11]
• Data from the 2006 National Survey on Drug Use or Health show that 43.8% of adolescents ages 12-17 years smoke menthol cigarettes compared to 35.6% of youth ages 18 to 24 years and 30.6% of adults ages 35+ years.[10]
• Some researchers and advocates have hypothesized that high rates of menthol cigarette use might partially explain the disproportionate tobacco-related cancer burden among African Americans , and may explain difficulty in quitting among African Americans.[20, 21, 22, 23, 24, 25]

6. Where can I find more information on menthol cigarettes?

If you are interested in learning more about menthol cigarettes and other menthol tobacco products, please refer to the resources on this website. The resources include meetings, publications, a bibliography, national and state-level surveys that include questions on menthol, information regarding the 2009 Family Smoking Prevention and Tobacco Control Act, and resources to help you quit smoking and use of other tobacco products.

Meetings
The First Conference on Menthol Cigarettes: Setting the Research Agenda was held March 21-22, 2002 in Atlanta, GA. The purpose of the meeting was to evaluate the present state of the science concerning the health implications of adding menthol to cigarettes, and to set the priorities for future studies on the health effects of menthol cigarettes. Sponsors of this meeting included the Centers for Disease Control and Prevention, the National Cancer Institute, the American Legacy Foundation, Battelle, The Centers for Public Health Research and Evaluation, the National African American Tobacco Prevention Network, the Robert Wood Johnson Foundation, the Onyx Group, and the California Tobacco Related Disease Research Program. An Executive Summary and special issue provide additional information about the meeting, research recommendations, and research publications on menthol cigarettes.

• Executive Summary of the meeting cancercontrol.cancer.gov/tcrb/MentholExecSumRprt4_10-16.pdf - 09-25-2006



• Menthol Cigarettes—Setting the Research Agenda (2004). Special issue published by Nicotine and Tobacco Research (vol. 6, suppl 1)
  http://www.informaworld.com/smpp/title~content=g713942500~db=all

Publications

Government Reports

• U.S. Department of Health and Human Services, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006. Available at: www.surgeongeneral.gov/library/secondhandsmoke/



• U.S. Department of Health and Human Services, The Health Consequences of Smoking: A Report of the Surgeon General, 2004. Available at: http://www.surgeongeneral.gov/library/smokingconsequences/index.html



• U.S. Department of Health and Human Services, Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General, 1998. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/1998/index.htm.



• Centers for Disease Control and Prevention, Cigarette Brand Preference Among Middle and High School Students Who Are Established Smokers — United States, 2004 and 2006, February 2009. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5805a3.htm

Other

• American Legacy Foundation, Cigarette Preferences among Youth – Results from the 2006 Legacy Media Tracking Online Survey, 2007. Available at: http://www.americanlegacy.org/705.aspx



• American Legacy Foundation, Cigarette Smoking among Youth – Results from the 2002 National Youth Tobacco Survey, 2004. Available at: http://www.americanlegacy.org/711.aspx

Bibliography
The National Cancer Institute has prepared an online bibliography that includes 343 peer-reviewed research articles related to menthol cigarette smoking. Sources for identifying the research articles included PubMed, SCOPUS, and Web of Science. To view the bibliography, please access the following link: http://cancercontrol.cancer.gov/tcrb/documents/menthol_bibliography_508.pdf.

To identify the latest menthol papers and stay abreast of the most recent published research, please access the Centers for Disease Control and Prevention searchable database, Smoking and Health Resource Library: http://apps.nccd.cdc.gov/shrl/QuickSearch.aspx

National and State Surveys That Include Questions on Menthol, Brand Preferences, and Use of Mentholated Tobacco

Tobacco Use Supplement to the Current Population Survey (TUS-CPS)
http://riskfactor.cancer.gov/studies/tus-cps/info.html

• Survey years for questions on menthol: 2003, 2006/7
• Ages: 15+ years

National Health and Nutrition Examination Survey (NHANES)
http://www.cdc.gov/nchs/nhanes.htm

• Survey years for questions on menthol: 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008
• Ages: 12+ years

National Survey on Drug Use or Health (NSDUH formerly known as the NHSDA)
http://www.oas.samhsa.gov/nsduh.htm

• Surveys years for questions on menthol: 2000, 2001, 2002, 2004, 2005, 2006, 2007, 2008
• Ages: 12+ years
• Data available: http://www.icpsr.umich.edu/

National Health Interview Survey (NHIS)
http://www.cdc.gov/nchs/nhis.htm

• Survey years for questions on menthol: 1978, 1979, 1980, 1987 CC, 2005 CC
• Ages: 18+ years

Teenage Attitudes and Practices Survey (TAPS)
http://wonder.cdc.gov/wonder/sci_data/surveys/nhis/type_txt/tapsii.asp

• Survey year for questions on menthol: 1993
• Ages: 10-22 years
• Data available: http://www.icpsr.umich.edu/

National Youth Tobacco Survey (NYTS)
http://www.cdc.gov/tobacco/data_statistics/surveys/nyts/index.htm

• Survey years for questions on menthol: 1999, 2000, 2004, 2006
• Ages: Middle and high school students (grades 6-12)

Youth Tobacco Survey (YTS)
http://www.cdc.gov/tobacco/data_statistics/surveys/yts/index.htm

• Survey years for questions on menthol: 2000, 2001/2002, 2006
• Ages: Middle and high school students (grades 6-12)

Massachusetts Tobacco Survey (MTS)
http://www.csr.umb.edu/projects_tobacco.htm

• Survey year for questions on menthol: 2001
• Ages: Youth ages 12-17 years and adults 18+ years
• Contact the Massachusetts Department of Public Health for data

The Family Smoking Prevention and Tobacco Control Act 2009
On Monday, June 22, 2009 President Barack Obama signed into law H.R. 1256, the Family Smoking Prevention and Tobacco Control Act. This legislation gives the Food and Drug Administration the authority to regulate tobacco products. As stated in Section 3 of the legislation, the purposes are:

1. to provide authority to the Food and Drug Administration to regulate tobacco products under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), by recognizing it as the primary Federal regulatory authority with respect to the manufacture, marketing, and distribution of tobacco products as provided for in this division;



2. to ensure that the Food and Drug Administration has the authority to address issues of particular concern to public health officials, especially the use of tobacco by young people and dependence on tobacco;



3. to authorize the Food and Drug Administration to set national standards controlling the manufacture of tobacco products and the identity, public disclosure, and amount of ingredients used in such products;



4. to provide new and flexible enforcement authority to ensure that there is effective oversight of the tobacco industry’s efforts to develop, introduce, and promote less harmful tobacco products;



5. to vest the Food and Drug Administration with the authority to regulate the levels of tar, nicotine, and other harmful components of tobacco products;



6. in order to ensure that consumers are better informed, require tobacco product manufacturers to disclose research which has not previously been made available, as well as research generated in the future, relating to the health and dependency effects or safety of tobacco products;



7. to continue to permit the sale of tobacco products to adults in conjunction with measures to ensure that they are not sold or accessible to underage purchasers;



8. to impose appropriate regulatory controls on the tobacco industry;



9. to promote cessation to reduce disease risk and the social costs associated with tobacco-related disease; and



10. to strengthen legislation against illicit trade in tobacco products.

Section 907 of the legislation (Tobacco Product Standards) bans the use of specific flavored constituents and additives in cigarettes or any cigarette components. Menthol flavor is currently excluded from this ban. Specifically, the legislation states,

"Beginning 3 months after the date of enactment of the Family Smoking Prevention and Tobacco Control Act, a cigarette or any of its component parts (including the tobacco, filter, or paper) shall not contain, as a constituent (including a smoke constituent) or additive, an artificial or natural flavor (other than tobacco or menthol) or an herb or spice, including strawberry, grape, orange, clove, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee, that is a characterizing flavor of the tobacco product or tobacco smoke. Nothing in this subparagraph shall be construed to limit the Secretary’s authority to take action under this section or other sections of this Act applicable to menthol or any artificial or natural flavor, herb, or spice not specified in this subparagraph."

For additional information on the Family Smoking Prevention and Tobacco Control Act, please visit the FDA's Tobacco Products webpage: http://www.fda.gov/TobaccoProducts/default.htm. To download a copy of the Family Smoking Prevention and Tobacco Control Act, please refer to the "Resources for You" section on the following webpage: http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/default.htm.

Quitting Smoking and Use of Tobacco Products

• You can quit smoking menthol cigarettes or any other cigarette.
• Quitting smoking will reduce your risk of cancer, heart disease and other deadly diseases.
• Quitting smoking will also reduce the level of secondhand smoke exposure among others thereby reducing others’ risk of cancer and other deadly diseases.
• For additional information and help quitting smoking and using tobacco products including menthol products, call 1-800-QUITNOW, or login to: www.smokefree.gov or www.women.smokefree.gov

References

1. McCurdy, C. R. and S. S. Scully (2005). "Analgesic substances derived from natural products (natureceuticals)." Life Sci 78(5): 476-484.



2. Reid, J. R. (1993). "A history of mentholated cigarettes: This Spud’s for you." Recent Advances in Tobacco Sciences 19: 71-84.



3. Giovino, G. A., S. Sidney, et al. (2004). "Epidemiology of menthol cigarette use." Nicotine Tob Res 6 Suppl 1: S67-81.



4. Ferris Wayne, G. and G. N. Connolly (2004). "Application, function, and effects of menthol in cigarettes: a survey of tobacco industry documents." Nicotine Tob Res 6 Suppl 1: S43-54.



5. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health: Atlanta, GA 2004. Available at: http://www.surgeongeneral.gov/library/smokingconsequences/index.html



6. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health: Atlanta, GA 2006. Available at: http://www.surgeongeneral.gov/library/secondhandsmoke/



7. Kreslake, J. M., G. F. Wayne, et al. (2008). "The menthol smoker: tobacco industry research on consumer sensory perception of menthol cigarettes and its role in smoking behavior." Nicotine Tob Res 10(4): 705-15.



8. Federal Trade Commission Cigarette Report for 2006. Washington, DC: 2009. Available at: http://www.ftc.gov/opa/2009/08/tobacco.shtm.



9. Sutton, C. D. and R. G. Robinson (2004). "The marketing of menthol cigarettes in the United States: populations, messages, and channels." Nicotine Tob Res 6 Suppl 1: S83-91.



10. Kaufman, N. J., B. C. Castrucci, et al. (2004). "Changes in adolescent cigarette-brand preference, 1989 to 1996." Am J Health Behav 28(1): 54-62.



11. Kreslake, J. M., G. F. Wayne, et al. (2008). "Tobacco industry control of menthol in cigarettes and targeting of adolescents and young adults." Am J Public Health 98(9): 1685-92.



12. U.S. Department of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1998. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/1998/index.htm



13. Gardiner, P. S. (2004). "The African Americanization of menthol cigarette use in the United States." Nicotine Tob Res 6 Suppl 1: S55-65.



14. Landrine, H., E. A. Klonoff, et al. (2005). "Cigarette advertising in Black, Latino, and White magazines, 1998-2002: an exploratory investigation." Ethn Dis 15(1): 63-7.



15. Cummings, K. M., G. Giovino, et al. (1987). "Cigarette advertising and black-white differences in brand preference." Public Health Rep 102(6): 698-701.



16. Yerger, V. B., J. Przewoznik, et al. (2007). "Racialized geography, corporate activity, and health disparities: tobacco industry targeting of inner cities." J Health Care Poor Underserved 18(4 Suppl): 10-38.



17. U.S. Department of Health and Human Services. (2001). Women and Smoking: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of Smoking and Health. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/2001/index.htm



18. Hersey, J. C., S. W. Ng, et al. (2006). "Are menthol cigarettes a starter product for youth?" Nicotine Tob Res 8(3): 403-13.



19. U.S. Department of Commerce, Census Bureau (2008). National Cancer Institute and Centers for Disease Control and Prevention Co-sponsored Tobacco Use Supplement to the Current Population Survey (2006-07): http://riskfactor.cancer.gov/studies/tus-cps/. Data files (AND/OR) technical documentation website: http://riskfactor.cancer.gov/studies/tus-cps/info.html.



20. Abidoye, O., M.K. Ferguson, and R. Salgia (2007). Lung carcinoma in African Americans. Nat Clin Pract Oncol 4(2): p. 118-129.



21. Hebert, J.R. (2003). Invited commentary: Menthol cigarettes and risk of lung cancer. American Journal of Epidemiology 158(7): p. 617-620.



22. Gandhi, K.K., et al. (2009). Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic. Int J Clin Pract 63(3): p. 360-7.



23. Okuyemi, K.S., et al. (2007). Relationship between menthol cigarettes and smoking cessation among African American light smokers. Addiction 102(12): p. 1979-86.



24. Okuyemi, K.S., et al. (2004). African-American menthol and nonmenthol smokers: differences in smoking and cessation experiences. J Natl Med Assoc 96(9): p. 1208-11.



25. Okuyemi, K.S., et al. (2003). Does menthol attenuate the effect of bupropion among African American smokers? Addiction 98(10): p. 1387-93.