Menthol Use is Associated With Greater Smoking Frequency Among US Youth

Menthol is added to nicotine products to make them less aversive. While sweet and fruity cigarette and vape flavors were banned in 2009, menthol was not. This study used data from the Population Assessment of Tobacco and Health Study (N=1096 youth who smoke cigarettes, aged 12–14 at baseline) to assess associations between menthol flavored products, frequency of use, and nicotine dependence.*

• Among youth who smoked, those with menthol product use smoked an average of 3.1 additional days per month, were more likely to smoke frequently (adjusted rate ratio [aRR], 1.59), and had higher nicotine dependence scores, compared with peers who smoked non-menthol products.
• Compared with youth who continued menthol product use, those who switched to non-menthol products smoked 3.6 fewer days per month, had a 47% lower risk of frequent smoking (aRR, 0.68), and had 3% lower nicotine dependence scores.

* Assessed via the Wisconsin Inventory of Smoking Dependence Motives framework.

Comments: In addition to a minty taste and smell, menthol has cooling and painkilling effects, which may facilitate deeper inhalation. Menthol also slows nicotine metabolism, resulting in greater nicotine exposure. All of these factors combine to increase the risk of nicotine use disorder among people with menthol product use. The tobacco industry aggressively lobbied to prevent the FDA from banning menthol flavored products in 2009. In April 2021, the Biden administration proposed a federal menthol ban; this is now open for public commentary.

Sharon Levy, MD

Reference: Leas EC, Benmarhnia T, Strong DR, Pierce JP. Use of menthol cigarettes, smoking frequency, and nicotine dependence among US youth. JAMA Netw Open. 2022 Jun 1;5(6):e2217144.