Smokers of menthol cigarettes had a significantly lower quit rate than those who smoked nonmenthol brands, according to data from a large population survey. Overall, menthol cigarettes were associated with about a 10% lower cessation rate among smokers who tried to quit, as reported online in the American Journal of Preventive Medicine. The relationship was stronger among blacks, although some Hispanic subgroups had quit rates that were more than 40% lower if they smoked menthol cigarettes.

“Despite the small associations, the present results are nontrivial,” Cristine D. Delnevo, PhD, of the University of Medicine and Dentistry of New Jersey and the Cancer Institute of New Jersey in New Brunswick, and co-authors wrote in their discussion of the findings.

“On the contrary, small but robust findings for smoking cessation are clinically meaningful because of the public health gains that accrue from stopping smoking.”

One recent study suggested that a ban on menthol cigarettes would prevent 300,000 to 600,000 tobacco-caused deaths over the next 40 years (Am J Pub Health 2011; 101: 1236-1240), they added.

Studies of smoking cessation have yielded conflicting results with respect to the impact of menthol cigarettes on quit rates. Clinical/community studies and national population surveys have produced a mix of significant associations between menthol cigarettes and lower quit rates and no evidence of a relationship.

Delnevo and colleagues undertook a study that differed from previous investigations in that former smokers who recently quit were not excluded.

Additionally, five population restrictions were incorporated into the analysis to assess the robustness of associations in specific racial/ethnic groups. Finally, separate models were developed for Hispanics by country of origin to account for variable smoking practices.

Data for the analysis came from the Tobacco Use Supplement to the Current Population Survey. The Census Bureau conducts the labor force survey monthly for the Bureau of Labor Statistics, and the Tobacco Use Supplement is compiled every three years. The analysis comprised pooled data from 2003 and 2006/2007.

The authors tested five population restrictions:

Formers smokers who quit within the past five years and all current smokers
The same two groups, limited to those who did not use other forms of tobacco
The same two groups, limited to current smokers who had ever tried to quit
The same two groups, limited to smokers who had ever tried to quit, both groups using no other type of tobacco
Past-12-month smokers who had tried to quit or who had successfully quit
The sample comprised 71,193 survey respondents: 54,662 current smokers and 16,531 former smokers.

With regard to racial/ethnic mix, whites accounted for 60,525 respondents, blacks for 5,827, and Hispanics for 4,841. The Hispanic group was further subgrouped into Mexicans (2,769) and Puerto Ricans (735).

About a fourth of the respondents reported smoking menthol cigarettes, including 27.9% of current smokers and 24.5% of former smokers. A higher proportion of women smoked menthol cigarettes (32.0% versus 22.8%), which also were associated with lower education and income and younger respondents.

Blacks overwhelmingly preferred menthol cigarettes (71.8%) as compared with whites (21.0%) and Hispanics (28.1%).

Overall, menthol smokers had an adjusted odds ratio for quitting of 0.91 as compared with smokers of nonmenthol cigarettes.

Of the four other population restrictions, three had odds ratios of 0.90 to 0.92 and were statistically significant. Only the odds ratio for past-12-month smokers did not achieve statistical significance but was in the same direction as the other analyses.

The odds decreased to 0.81 among blacks and ranged as low as 0.68 across the population restrictions.

Whites had an odds ratio of 0.93, which was statistically significant, and Hispanics an odds ratio of 0.94, which did not achieve significance.

The association between menthol cigarettes and quit rate varied among Hispanics by country of origin.

Overall, Mexicans who smoked menthol cigarettes had increased odds for quitting, ranging as high as 1.35. In contrast, Puerto Ricans who smoked menthol cigarettes had substantially lower quit rates, associated with odds ratios of 0.42 to 0.63.

“The magnitude of the relationships between menthol smoking and poorer cessation differed considerably by race/ethnicity and would have been masked in models that adjust only for race/ethnicity,” the authors wrote in the discussion of their findings.

“Historically, smoking-cessation research generally has grouped Hispanics together and contrasted them with non-Hispanic whites,” they continued. “This prevailing approach ignores the vast heterogeneity of the Hispanic population.”

Menthol cigarettes may be less harmful to smokers than regular cigarettes, according to a study by Vanderbilt University and Meharry Medical College, but all cigarette smoking is bad for you, the study’s leader pointed out. The results were released just days after a federal panel suggested that menthol cigarettes were more harmful and that limiting them could improve public health.

The Vanderbilt/Meharry study found that among people who smoke 20 or more cigarettes a day, menthol smokers are 12 times as likely to develop lung cancer as nonsmokers, while nonmenthol smokers are about 21 times as likely as nonsmokers to get the disease.
The findings were published online Wednesday in the Journal of the National Cancer Institute.

“It has been hypothesized that menthol in cigarettes influences smoking behavior, perhaps increasing dependency or adversely affecting the biology of the lung,” said Dr. William Blot, professor of medicine at the Vanderbilt-Ingram Cancer Center, who led the study.

“However, our large study found no evidence to support those theories.”

On Friday, a U.S. Food and Drug Administration advisory panel said removing menthol cigarettes from the market would benefit public health because the minty flavoring has led to an increase in smokers and makes quitting harder. However, the agency’s Tobacco Products Scientific Advisory Committee stopped short of recommending an outright ban.
The latest findings will add to the ongoing conversation on whether the FDA should ban the sale of mentholated cigarettes, Blot said.
“All cigarettes are hazardous,” he said. “The study first indicated overall that there is no higher risk. But there are some suggestions, in fact, that menthol may be less harmful.”

The study of lung cancer risk had a racially diverse group of almost 86,000 adults enrolled. Smoking prevalence was high with menthol and nonmenthol cigarette use common among the participants. The study was conducted between March 2002 and September 2009.

The National Cancer Institute provided funding for it.
The study also found that there was no significant difference between menthol and nonmenthol smokers when it came to quitting smoking.

Ban would hit Lorillard

Meanwhile, a menthol ban or other restrictions on the flavored cigarettes would fall heavily on Lorillard Inc., whose Newport brand is the top-selling menthol cigarette in the U.S., with roughly 35 percent of the market. Menthol cigarettes are one of the few growth areas in a shrinking cigarette market.

Lorillard, the country’s third-largest tobacco company, is based in Greensboro, N.C.

Lorillard CEO Murray Kessler said the advisory committee’s conclusions lack balance and he believes the panel’s report is only a first step in a “very long process” that won’t result in a ban.

“In the absence of a difference in disease, people are allowed to smoke what they prefer,” Kessler said.

The Tobacco Products Scientific Advisory Committee advises the FDA agency on scientific issues. The agency doesn’t have to follow its recommendations but often does. Many analysts believe the FDA won’t ban menthol, which about 19 million Americans smoke.

Menthol flavoring may make it easier to become addicted to cigarettes and may make smoking more alluring to young people, according to an FDA advisory panel’s preliminary report. Experts don’t expect the findings will lead to a ban on menthol, however. Reporting from Washington — Adding menthol to cigarettes may increase the likelihood of addiction and make it easier for young people to start smoking, according to preliminary findings of a Food and Drug Administration advisory panel.

The panel said the scientific evidence showed that “menthol has cooling and anesthetic effects that reduce the harshness of cigarette smoke” and this reduction “could facilitate initiation or early persistence of smoking by youth.”

The committee also said menthol was likely to make low-tar, low-nicotine cigarettes more satisfying, “and smokers who switch to low-yield cigarettes for health concerns may be more likely to continue to smoke rather than quit.”

The FDA has already banned candy, fruit and spice flavorings in cigarettes because of their potential to lure young smokers. But the 2009 law that gave the agency regulatory authority over cigarettes specified that menthol should be evaluated separately.

Menthol cigarettes make up about 30% of the cigarette market and are favored by about 80% of black smokers, who suffer from disproportionately high rates of lung cancer and other smoking-related disease.

Some civil rights groups, including the Congress of Racial Equality, have said that a ban on menthol would unfairly target black consumers. Others, such as the NAACP Legal Defense and Educational Fund, have argued that menthol should not be treated more leniently than other flavorings that make cigarettes more alluring — especially to young smokers.

The preliminary findings were contained in a draft report by the 12-member panel and were posted on the FDA’s website ahead of a meeting Wednesday.

The final report is due by March 23. Its recommendations are nonbinding and could range from no action to outlawing use of the mint-like flavoring.

The FDA usually follows the recommendations of its advisory panels. Many analysts, including some anti-smoking advocates, do not expect the agency to impose a ban on menthol.

“There are no surprises” in the report, said Michael Siegel, an expert on smoking’s public health effects and a professor at Boston University. “There is no evidence that menthol cigarettes are more harmful, so if that is your criterion, then a ban on menthol is not supported.

“However, menthol clearly masks the harshness of cigarette smoking, so if you look at this from a marketing perspective, yes, of course menthol contributes to increased cigarette sales,” Siegel said in an e-mail.

Philip Gorham, an analyst who tracks tobacco companies for the investment research firm Morningstar Inc., said the draft slightly bolsters the possibility that the panel will recommend some restrictions on menthol, such as limiting the marketing of the cigarettes.

“It feels like they’ve left the door open” to do something short of recommending a ban, Gorham said.

Gregg Perry, a spokesman for tobacco company Lorillard Inc., said the draft documents appeared to support the company’s position that “a menthol cigarette is no more dangerous than a non-menthol cigarette … as it relates to diseases caused by cigarette smoking.”

“While we don’t know what nonbinding recommendation the FDA advisory panel will ultimately reach, we believe that the evidence clearly shows there is no justification for increased regulation of menthol cigarettes,” Perry said.

Two of the largest manufacturers of mentholated cigarettes initiated a lawsuit against the FDA Friday to prevent the consideration of an upcoming FDA panel report recommending expanding the current flavored cigarette ban to include menthol varieties.

Lorillard and R.J. Reynolds — makers of the Newport and Kool cigarette brands, respectively — argue that three members of the advisory panel have “severe financial and appearance conflicts of interest and associated biases,” including receipt of funding for research or consultation work from manufacturers of smoking-cessation products.

Predictably, the president of the Campaign for Tobacco-Free Kids, Matthew Myers, dismisses the tobacco companies’ claims as “putting profits ahead of lives and health.” He further posits the view that, “They fear that the committee, having examined the evidence, will recommend effective actions that reduce or eliminate the lucrative market for menthol cigarettes.”

ACSH’s own report on mentholated cigarettes, however, found no “evidence” that mentholated cigarettes pose any greater adverse health effects than unflavored cigarettes. “Cigarettes are deadly and addictive, but menthol is not part of the problem,” says ACSH’s Dr. Elizabeth Whelan. “And even if mentholated cigarettes were banned, smokers who prefer menthol cigarettes will find a way to secure them, from unlicensed sources, or find a way to add menthol to their smokes,” she adds. Rather than promoting public health, as ACSH’s Dr. Gilbert Ross has argued in the past, banning mentholated cigarettes would likely create a black market for contraband mentholated cigarettes:

It is ludicrous to imagine that a significant fraction of menthol smokers will just quit smoking because of the absence of legitimate menthols. Moreover, since menthol smokers actually tend to smoke fewer cigarettes per day than non-menthol smokers, the net result of a menthol ban would very likely be a net increase in cigarette consumption. Some smokers will get the false impression from a menthol ban that non-menthol smokes are somehow safer…

Dr. Whelan added, “Matt Myers’ comments miss the point, intentionally I suspect: the lawsuit targets clear conflict-of-interests among certain members of the committee. Myers chooses to reiterate the evils of Big Tobacco, which while true have nothing to do with the fairness of the committee members.”

Lorillard Inc. and R.J. Reynolds Tobacco Co. last week asked a federal court to stop the Food and Drug Administration (FDA) from relying on advisory panel recommendations on issues such as menthol cigarettes, the Associated Press reports. Filed in the U.S. District Court in Washington, the suit alleges financial conflict of interest and bias by several members of the Tobacco Products Scientific Advisory Committee (TPSAC).

The TPSAC is responsible for advising the FDA on tobacco-related issues and is expected to release a report later this month on the health impact of menthol cigarettes, a key growth area for tobacco companies.

While the FDA assumed the authority to regulated tobacco in June 2009, the law doesn’t allow the agency to ban nicotine or tobacco, only to regulate what goes into the products as well as to regulate how they’re marketed. As such, it relies on advisory panels to address scientific issues. While the agency isn’t required to follow their recommendations, it usually does.

The lawsuit claims on issues regarding menthol in cigarettes and smokeless tobacco that the TPSAC fails to meet federal requirements that committee members be fairly balanced and not inappropriately influenced by special interests.

The suit alleges that three committee members have conflicts of interest because they were paid expert witnesses in anti-tobacco lawsuits and have financial ties to pharmaceutical companies that produce smoking cessation products.

“There will be no way for the defendants or the public to have confidence that the Committee’s report and recommendations with respect to menthol are the product of an unbiased assessment of the relevant science, uninfluenced by special interests and by the prospect of financial gains,” the suit reads.

Several cigarette makers had previously asked the FDA to remove members of the panel for conflicts of interest.

Under any reasonable assumptions, banning menthol cigarettes would create a substantial black market in the United States, substantially mitigating any decline in cigarette smoking and inspiring a “significant increase in organized crime activity,” and potentially increasing youth access to cigarettes, according to an independent economic analysis submitted today to a Food and Drug Administration (FDA) advisory committee.

“Following a ban, a sizable black market would likely quickly emerge to satisfy the demand for menthol cigarettes,” the report by Compass Lexecon, a Chicago-based economic consulting firm, concluded. Findings from the study, commissioned by Lorillard, Inc. (NYSE: LO), were presented today to the FDA’s Tobacco Products Scientific Advisory Committee. The authors presented preliminary findings to the Committee in November.
In the event of a ban, the quandary for U.S. policymakers “will be whether to heighten enforcement, which likely would lead to higher street prices that could reduce menthol consumption, but also would make organized crime more lucrative,” said Ronald S. Milstein, senior vice president, external affairs, for Lorillard. The study was presented by Dennis A. Carlton, a senior managing director of Compass Lexecon and a former deputy assistant attorney general in the Antitrust Division of the U.S. Department of Justice.
“Final findings of this study reinforce our belief that a ban on menthol cigarettes cannot be justified,” Milstein said. The FDA advisory committee has been mandated by Congress to examine the potential for a contraband market as part of its report and recommendation to the FDA on the use of menthol in cigarettes.
The study’s main finding:
Current menthol smokers largely would turn to the black market for menthol cigarettes and for non-menthol cigarettes.
Black market cigarettes currently exist and likely would expand quickly in response to surges in demand for these cigarettes.
Thus, a ban likely will not eliminate most of the cigarette consumption by menthol smokers in the U.S.
The ban may have the unintended consequences of increasing criminal activity and allowing greater youth access to unregulated cigarettes.

The study found that a 10 percent increase in the effective price of illegal menthol cigarettes would lead to an initial decline in overall smoking of only about one percent and black market sales would be about 87 percent of current menthol sales. Prices 25 percent higher would lead to menthol sales of about 72 percent of the current size of the current sales, and total smoking would initially fall by about two percent. The “effective price” cited in the study includes not only the money paid but the effort required and the reluctance consumers must overcome to purchase on the black market.
“These estimates imply that black market sales and lost governmental tax revenues would be measured in the billions of dollars,” Milstein said.
The final study will be made available at www.understandingmenthol.com, a website sponsored by Lorillard.
About Lorillard, Inc.
Lorillard, Inc. (NYSE: LO) is the third largest manufacturer of cigarettes in the United States. Founded in 1760, Lorillard is the oldest continuously operating tobacco company in the U.S. Newport, Lorillard’s flagship menthol-flavored premium cigarette brand, is the top selling menthol and second largest selling cigarette in the U.S. In addition to Newport, the Lorillard product line has four additional brand families marketed under the Kent, True, Maverick, and Old Gold brand names. These five brands include 43 different product offerings which vary in price, taste, flavor, length and packaging. Lorillard maintains its headquarters and manufactures all of its products in Greensboro, North Carolina.

Lorillard, Inc., the third-largest tobacco maker in the U.S., is fighting to stop the Food and Drug Administration (FDA) from banning menthol in cigarettes, The Wall Street Journal reported Jan. 5. Menthol cigarettes make up about 30 percent of industry sales. Lorillard — not the only tobacco company against a menthol ban — makes Newport, the leading brand. Newport menthols have driven an increase in the company’s market share, from 9 percent in 2001 to 13 percent in the third quarter of 2010, even as overall domestic cigarette sales declined.

Since Newport menthols make up the vast majority of Lorillard cigarette sales, the company may fear a “doomsday scenario if menthol gets banned and they can’t keep a majority of their customers,” according to Philip Gorham, an analyst with Morningstar, Inc.

The FDA was given the authority by Congress to regulate tobacco in legislation passed in 2009. Although the law specifically outlawed flavorings such as candy, spice and fruit, which might be especially appealing to youth, it left it to the FDA to assess whether menthol flavoring should remain legal.

An FDA advisory committee, the Tobacco Products Scientific Advisory Committee, will make its recommendations on menthol in March. The agency may recommend responses less stringent than a ban, such as restrictions on advertising.

The FDA is not bound by the committee’s recommendations and has no deadline to act.

Some health advocates said that menthol, which is drawn from mint plants and creates a cooling sensation in the mouth and throat, is attractive to youth because it covers up the harsh taste of cigarettes. They also say that it is appealing to African-Americans, “who have long been a target of menthol marketing campaigns,” according to The Wall Street Journal.

Federal survey data from 2009 showed that 45 percent of smokers between 12 and 17 use menthols, and about 80% of African-American smokers prefer menthols to other brands.

A 2010 report from the Centers for Disease Control and Prevention found that African-Americans suffered disproportionately from smoking-related disease, compared to other racial and ethnic groups. Further, while only 20.6 percent of all Americans smoke, 21.3 percent of black adults do.

Lorillard and other opponents of an FDA ban on menthol argue that jobs are at risk, and that a black market for menthol cigarettes would remain if menthol cigarettes were outlawed. To head off a ban, the company has moved aggressively to dominate public discourse on the topic. According to The Wall Street Journal, it has bought Internet domain names potentially critical of menthols, such as MentholKillsMinorities.com, MentholAddictsYouth.com, FDAMustBanMenthol.com, KillerMenthol, BanMenthol and MentholKills.

The company set up pro-menthol Twitter and Facebook pages as well as UnderstandingMenthol.com, where, The Wall Street Journal reported, it “frequently links to articles that include quotes or are written by groups that oppose a menthol ban and present reasoning similar to its own.”

Lorillard also hired a PR firm to gain media exposure for prominent African-Americans opposing a ban. For example, one of the firm’s consultants placed the spokesman for the Congress of Racial Equality, Niger Innis, on radio programs to discuss menthol. He objected to a possible ban because “you are taking away a legal preference and choice for African-Americans,” and because a black market could create “another vehicle of criminality in the African-American community.”

The same consultant submitted a pro-menthol editorial under the byline of Harry C. Alford, the CEO of the National Black Chamber of Commerce. Lorillard contributes $35,000 in yearly dues to the organization. Alford said the editorial “was not in any way influenced” by that relationship.

“African-Americans like their Newport cigarettes, and there is no reason why they should not be allowed to have them,” he said.

Health advocates in the black community dismissed such public relations efforts. For example, Dr. Louis Sullivan, U.S. health secretary under the first President Bush, was “very disappointed and very distressed” because African-American groups were being “used by tobacco companies.”

Lorillard would not comment on whether it had contributed financially to organizations that supported its point of view.

“Over time, the company has been a member of organizations such as trade groups, chambers of commerce and other organizations,” a spokesman for the company said. “Given what is at stake, it’s only natural that we support them in their firmly held beliefs.”

Recent studies have shown that those who smoke menthol cigarettes may have a harder time kicking the smoking habit. Racial or ethnic minority smokers who choose to smoke menthol cigarettes have a lower quit rate than those of the same bracket who smoke regular cigarettes. The distinction is greater among smokers who are younger.

Menthol cigarettes have been shown to contain higher levels of carbon monoxide, cotinine and nicotine in each cigarette, as compared to regular cigarettes. Menthol cigarettes use the menthol compound produced from mint oils to create a cooling sensation in the mouth. The result, according to Jonathan Foulds, Ph.D., professor of Public Health Sciences at Penn State College of Medicine, could be that smokers inhale more nicotine per cigarette and so become more addicted. Thus, economic pressures may mean that people smoke menthols in order to get the most nicotine from fewer cigarettes.
The results of the study were published in the journal Nicotine and Tobacco Research. The research compiled data from ten published studies on patterns of menthol smokers versus regular smokers. Not all studies found a relation between menthol and quitting, but the effects of menthol on quitting were more greatly pronounced in younger smokers, and especially African-American and Latino smokers.

People who smoke menthol cigarettes may have a harder time kicking the habit, according to a new report. Menthol cigarettes, which make up about one-quarter of the market, produce a cooling sensation and help smokers inhale more nicotine per cigarette.

And that enables smokers to become more addicted while smoking fewer cigarettes a day.

Researchers say this most likely explains the low quit rate among African Americans and younger smokers, two groups that have the highest menthol cigarette use.