Do Menthol Bans Actually Drop Smoking Rates? What Does Science Show Us?

While research has shown that menthol cigarettes pose a problem as they make it easier to smoke, studies have shown that menthol bans are not that effective.

In recent years, a lot has been said about menthol cigarettes’ bans and how they could potentially decrease smoking rates. Research suggests that menthol flavouring in cigarettes masks the harshness of tobacco with its cooling sensation, dulling the throat irritation caused by smoking. Naturally this makes smoking easier, leading to deeper inhalation and increased nicotine consumption

Additionally, menthol cigarettes have raised concerns due to findings indicating that menthol facilitates nicotine absorption, leading to higher dependence, with smokers of menthol cigarettes facing increased difficulty in quitting compared to non-menthol smokers. Moreover, menthols are often marketed as being smoother, lighter and more refreshing, further perpetuating their appeal.

Understanding the role of menthol in cigarette smoking is crucial for implementing effective tobacco control measures and reducing smoking-related harm. Recent studies have looked into the effectivity of menthol bans by analysing smoking rates in places where such measures have been set.

Following menthol bans, most smokers transitioned to non-menthol variants
A recent paper published in Nicotine & Tobacco Research, affiliated with Oxford University Press, explored the impact of menthol bans on smoking rates. Globally, the prevalence of menthol cigarette use among smokers varies greatly. In 2020, 7.4% menthol users were recorded in Europe, in contrast with 43.4% adult smokers in the United States.

Menthol cigarettes are disproportionately used by young people, racial/ethnic minorities, and lower-income smokers, with 81% of non-Hispanic Black smokers in the US opting for menthols, compared to 34% of White smokers. Several jurisdictions, including over 170 US cities, two states, several countries such as Canada and Ethiopia, and the European Union, have implemented bans on menthol cigarette sales.

The current study examined the impact of these bans by systematically reviewing studies published in English up to November 2022. Researchers conducted a comprehensive search across databases, including PubMed/Medline, CINAHL, PsycINFO, Web of Science, and Embase, analysing 78 prior studies, primarily from Canada, the EU, and the US.

The findings revealed that following bans, 50% of menthol smokers switched to non-menthol cigarettes, while 24% quit smoking altogether. On the other hand, 12% transitioned to other flavoured tobacco products, while 24% continued smoking menthols. Notably, national menthol bans demonstrated higher effectiveness compared to local or state bans, with higher quit rates in areas with country-wide bans.

These results suggest that implementing menthol bans could lead to a slight reduction in smoking rates. Most smokers just transitioned to different products, hence the study underscored the importance of considering comprehensive measures whilst taking into account their potential impact on various demographic groups and tobacco product preferences.

Bans are not always a quick fix
On the other hand, a recent study aiming to analyse trends in smoking menthol cigarettes among adults in Great Britain (GB) after the ban on menthol cigarettes in May 2020, reported complex findings.

Data were collected from a monthly cross-sectional survey from October 2020 to March 2023. Researchers assessed the prevalence of menthol cigarette smoking among all adults and specifically among 18–24-year-olds, as well as differences between England, Scotland, and Wales. They also examined the sources from where individuals purchased menthol versus non-flavoured cigarettes.

The findings revealed that in the first quarter, 16.2% of adults smoking cigarettes reported menthol cigarette use, and this prevalence remained relatively stable throughout the study period. However, among 18–24-year-olds, there was a decline in menthol cigarette smoking. Specifically, the prevalence of menthol cigarette use decreased by two-thirds in Wales but remained relatively stable in England and Scotland. Despite the ban, roughly one million adults in GB continued to smoke menthols.

Regarding purchasing sources, the majority (93.9%) reported obtaining menthol cigarettes from legal sources, while 14.8% obtained them from illicit sources, and 11.5% purchased them cross-border. This suggests either that many smokers use additives to add a menthol flavour to regular cigarettes, or that they buy brands which are menthol flavoured even if they are not labelled that way.

Importantly, there were no significant differences in purchasing sources between individuals smoking menthol versus non-flavoured cigarettes. Overall, the study concluded that there were no noteworthy changes in the prevalence of menthol cigarette smoking among adults in GB post-ban, except for a decline observed among young people and in Wales. Additionally, the persistence of menthol smoking was not primarily driven by illicit purchases, as the majority of individuals obtained menthol cigarettes from legal sources.

These findings indicate the complexity of the situation emphasizing the need for continued monitoring and potentially adding measures to reduce access to menthols.