Menthol Cigarettes and Smoking Cessation Behavior: A White Paper

Publicly available internal tobacco industry documents were analyzed to explore questions regarding menthol cigarettes and cessation behavior, using the following as initial questions: 1) Compared to non-menthol smokers, do menthol smokers have a harder time quitting, report more or fewer quit attempts, and/or have higher or lower quit rates? 2) Compared to non-menthol smokers, are menthol smokers more or less likely to relapse or delay quitting, and/or to experience different odds of maintaining abstinence long-term? Tobacco companies largely considered reviews of the academic literature on these questions; therefore, documentary evidence was employed to refine research questions. More than 500 relevant documents were identified on 1) perceived sensory and taste rewards of menthol and potential relation to quitting; 2) motivation or desire to quit among menthol users; and 3) socio-demographic correlates of both menthol usage and cessation patterns. Menthol’s cooling and anesthetic effects mask the short-term negatives of smoking such as throat pain, burning, and cough. This may provide superficial physical relief as well as psychological assurance against concerns about health that would otherwise motivate smokers to quit. Menthol smokers, particularly women, also perceive the minty aroma of menthol cigarettes to be more socially acceptable than non-menthol cigarettes, a perception that lessens the impact of smoking denormalization on quitting motivation. Relative to the overall smoking market, menthol smokers tend to be younger, female, and non-white; this description also fits those smokers who have a harder time of quitting and staying quit. Document analysis suggests that menthol in cigarettes may encourage experimenters who find non-mentholated cigarettes too harsh, including young or inexperienced users, to progress to regular smoking rather than quitting, and may inhibit the desire to quit among established menthol smokers who have become accustomed to the taste and sensation of menthol cigarettes.