Study casts doubt on impact of menthol-flavored tobacco ban

A ban on the sale of menthol-flavored cigarettes that the U.S. Food and Drug Administration (FDA) is on track to implement may have unintended consequences, according to a study by researchers from Vanderbilt University Medical Center published April 21 in the Journal of the National Cancer Institute.

The ban is intended to address a health disparity since a significantly larger percentage of African Americans than whites smoke menthol cigarettes and African American men have higher lung cancer incidence and death rates from the disease. The FDA plans to issue proposed rules this spring that would prohibit menthol cigarettes, according to a Jan. 27 news release from the agency. Mitch Zeller, the FDA's director of the Center for Tobacco Products, noted in the release that nearly 85% of all non-Hispanic Black smokers smoke menthol cigarettes, compared to 30% of non-Hispanic white smokers. He also stated that menthol-flavored cigarettes can be more addictive than non-menthol cigarettes and harder to quit.

However, the study by the Vanderbilt researchers revealed similar quit rates among menthol and non-menthol smokers overall and no statistically significant difference between white and African American participants. The data came from surveys of participants in the Southern Community Cohort Study, with two-thirds of participants being African American. The study has tracked 16,425 smokers who entered the study between 2002 and 2009 and completed a follow-up survey between 2008-2012, 2012-2015 and 2015-2017. The average annual quit rate from those surveys was 4.3% for menthol smokers and 4.5% for non-menthol smokers.

Prior research by this Vanderbilt research group has shown that non-menthol smokers are at higher risk for lung cancer. They also noted a study conducted in Canada, which has banned menthol-flavored cigarettes, that revealed that most menthol smokers tend to switch to non-menthol brands rather than quit.

"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," the researchers stated in the study.

More than 9,000 African American menthol smokers were included in the analyses by the Vanderbilt researchers.

"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. This finding, when combined with the possibility that menthols may be associated with lower lung cancer risk and with the potential social consequences of banning a product preferentially used by Blacks, suggests caution in the implementation of a ban," said the study's corresponding author, William Blot, Ph.D., emeritus research professor of Medicine with the Division of Epidemiology at VUMC.