Abstract
BackgroundAlthough menthol was not banned under the Tobacco Control Act, the law made it clear that this did not prevent the Food and Drug Administration from issuing a product standard to ban menthol to protect public health. The purpose of this review was to update the evidence synthesis regarding the role of menthol in initiation, dependence and cessation.MethodsA systematic review of the peer-reviewed literature on menthol cigarettes via a PubMed search through May 9, 2017. The National Cancer Institute’s Bibliography of Literature on Menthol and Tobacco and the FDA’s 2011 report and 2013 addendum were reviewed for additional publications. Included articles addressing initiation, dependence, and cessation were synthesized based on study design and quality, consistency of evidence across populations and over time, coherence of findings across studies, and plausibility of the findings.ResultsEighty-two studies on menthol cigarette initiation (n = 46), dependence (n = 14), and cessation (n = 34) were included. Large, representative studies show an association between menthol and youth smoking that is consistent in magnitude and direction. One longitudinal and eight cross-sectional studies demonstrate that menthol smokers report increased nicotine dependence compared to non-menthol smokers. Ten studies support the temporal relationship between menthol and reduced smoking cessation, as they measure cessation success at follow-up.ConclusionsThe strength and consistency of the associations in these studies support that the removal of menthol from cigarettes is likely to reduce youth smoking initiation, improve smoking cessation outcomes in adult smokers, and in turn, benefit public health.
Highlights
Menthol was not banned under the Tobacco Control Act, the law made it clear that this did not prevent the Food and Drug Administration from issuing a product standard to ban menthol to protect public health
Of the 131 empirical articles on menthol cigarettes included in the full review, 82 were relevant to initiation (n = 46; Additional file 1: Table S1), dependence (n = 14; Additional file 2: Table S2), and cessation (n = 34; Additional file 3: Table S3)
Initiation The prevalence of menthol cigarette use is higher in youth than young adults and adults A 2015 study using 2004–2010 data from the National Survey on Drug Use and Health (NSDUH), adjusted for misclassification of menthol brand, showed that from 2008 to 10, 56.7% of youth smokers
Summary
Menthol was not banned under the Tobacco Control Act, the law made it clear that this did not prevent the Food and Drug Administration from issuing a product standard to ban menthol to protect public health. The law did not include menthol in that ban, nor did it address flavors in non-cigarette tobacco products [6]. The Act makes clear that the Food and Drug Administration (FDA) has the authority to issue a product standard to ban menthol in cigarettes, or any other tobacco product, to protect public health. The Act required the Tobacco Product Scientific Advisory Committee (TPSAC), as its first order of business, to review the state of the science on menthol and make a recommendation to the FDA based on the public health standard [7]. This report concluded that it is “likely that menthol cigarettes pose a public health risk above that seen with non-menthol cigarettes” [9]
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