FDA Case for Menthol Ban Undermined by New Study

Menthols aren’t harder to quit than other cigarettes.

Just in time for the Food and Drug Administration's expected announcement of a formal rule to ban menthol cigarettes, a new study undermines one of the agency's central arguments for prohibition.

The FDA claims that menthol cigarette brands (which contain high amounts of mint flavoring unlike typical cigarettes) are easier to start smoking, more appealing to youth, and more addictive than their non-menthol counterparts. But that's hard to square with the existing data. According to the 2021 National Youth Tobacco Survey, more than 60 percent of middle and high school students who smoke use non-menthol cigarettes. It's widely known in the public health community that menthol smokers typically start later in life and smoke fewer cigarettes per day. A Reason Foundation study found that states with the highest menthol consumption also had the lowest youth smoking rates.

But there is another argument in the FDA's dwindling arsenal. FDA and its allies claim menthol cigarettes are harder to quit, particularly for African Americans. Because around 85 percent of African American smokers use menthols compared to around 30 percent of white smokers, the Biden administration believes prohibition would "promote health equity" and reduce health disparities. It should be noted that according to the American Cancer Society, disparities are already narrowing because African American youth are less likely to start smoking than their peers of other races. Furthermore, African American adults do not smoke at significantly higher rates than whites.    

A new study conducted by researchers from Vanderbilt University Medical Center, published in the Journal of the National Cancer Institute, finds no statistically significant difference in quit rates between menthol and non-menthol smokers. Using data from participants in the Southern Community Cohort Study, the average annual quit rate was 4.3 percent for menthol smokers and 4.5 percent for non-menthol smokers. There was also no difference in quit rates between African American and white smokers.

"In this large-scale follow-up study, we could not confirm the FDA's report that menthols are harder to quit, at least in the population we followed," said the study's corresponding author, William Blot.

Blot also highlighted a potential unintended consequence of menthol prohibition: "If the existing epidemiologic data showing lower risk of lung cancer among menthol than non-menthol smokers hold generally, then in the long-term if high percentages of menthol smokers switch to non-menthols, the ban could have the unintended consequence of a net increase rather than decrease in risk, at least for lung cancer." Blot is referring to scientific literature, including research he has authored, showing menthol smokers typically contract lung cancer at lower rates than non-menthol users. While the mechanisms for these findings are not well understood, as menthols are just as deadly as non-menthol cigarettes, it could result from menthol smokers starting later in life and smoking less.

Where they've been implemented, like in the European Union and Canada, menthol cigarette bans have been a disappointment to their supporters. Most menthol smokers switch to regular cigarettes, buy illicit menthol, or use devices to adulterate legal cigarettes to give them a minty taste. But the U.S. is uniquely vulnerable to the dangers of prohibition. Its menthol market is larger by comparison, at around a third of cigarette sales, and there are significant racial disparities in use patterns.

Law enforcement groups, civil rights organizations, and think tanks are pleading with the Biden administration to embrace a strategy of harm reduction instead of criminalization to reduce smoking rates. But in the name of equity, Biden's FDA appears committed to banning a product disproportionately used by African Americans while leaving the favored cigarette of white smokers free and clear. If prohibition is a necessary and proper solution to menthol smoking, which is unpopular among a majority of youth and adult smokers, why wouldn't the same logic apply to non-menthol cigarettes, which are responsible for the majority of smoking-related diseases?

It's hard to answer this question without coming to the conclusion that the administration believes singling out a minority of a minority is an easier prospect than trying to ban all cigarettes at once. And if one can do so under the guise of promoting racial equity, so much the better.