Menthol Toolkit

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What is Menthol?Trends and HistoryTargeting and DisparitiesTaking ActionIn the News


What is Menthol?

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Menthol is an anesthetic that can be extracted from mint plants or produced synthetically. Its minty, cooling effect helps mask the harshness of cigarette smoke and e-cigarette aerosol, reducing airway pain and irritation. Because of this, many people believe menthol products are less harmful. Nothing could be further from the truth.

Health Risks

The menthol additive:

  • hooks new smokers by making it easier to inhale. They are popular among youth and beginner smokers.1
  • makes cigarettes more addictive, making it harder to quit smoking. Menthol smokers show greater nicotine dependence and are less likely to successfully quit smoking.2
  • allows smokers to inhale more deeply, which settles harmful particles more deeply in their lungs.1
  • may delay detection of early warning symptoms of smoking-induced respiratory problems.1

References

  1. "Menthol and Cigarettes" -- California Department of Public Health (2017)
  2. "Quit Attempts and Quit Rates Among Menthol and Nonmenthol Smokers in the United States" (2011)

Menthol Collage.jpg

Trends and History

For group-specific trends, see the Targeting and Disparities section of this toolkit.

Wisconsin Trends

  • 42.4% of Wisconsin adults smoke or formerly smoked menthol cigarettes.1
  • Over half of current Wisconsin high schoolers who smoke report that they usually smoke menthol cigarettes.2

National Trends

  • 40% of cigarette smokers aged 12 or older smoke menthols.3
  • Menthol cigarettes are slowing the reductions in overall cigarette smoking rates. From 2004 to 2014, the decline in cigarette consumption was greater for non-menthol cigarettes than menthol cigarettes.4
adult menthol use

References

  1. Behavioral Risk Factor Survey, 2017 -- WI Department of Health Services
  2. Youth Tobacco Survey 2018: High School Snapshot -- WI Department of Health Services (2019)
  3. National Survey on Drug Use and Health, 2018
  4. Menthol: Facts, stats and regulations -- Truth Initiative (2018)

Menthol was first used as a cigarette additive in the 1920s. Although menthol cigarettes started out as a specialty item, targeted marketing strategies helped them grow in popularity. Promotion began with female smokers in the 1930s, and shifted to African American smokers in the 1940s and younger and first-time smokers in the 1970s.1 Since at least the 1990s, LGBTQ communities have also been a target of menthol marketing.

Today, menthol cigarettes represent approximately one-fourth of all cigarette sales in the United States.2

In 2009, the Family Smoking Prevention and Tobacco Control Act was passed by Congress, banning artificial or natural flavorings in cigarettes. The legislation included flavors such as strawberry, clove, grape, and cherry, but menthol was excluded. Although the Food and Drug Administration has regulatory authority on tobacco products, it has not yet taken action on menthol.2

References

  1. The Marketing of Menthol Cigarettes in the United States: Population, Messages, and Channels (2004)
  2. Menthol and Cigarettes -- California Department of Public Health (2017)

Targeting and Disparities

Big Tobacco continues to target particular groups with marketing for menthol products: African Americans, LGBTQ folks, and youth and young adults. This has caused significant health disparities in these groups compared to the general population. If menthol flavoring was banned, many of these disparities could be drastically reduced.

Trends in Use

  • Menthol cigarettes are the most popular tobacco product among African Americans.2
  • Among cigarette smokers in the U.S., 70.5% of African Americans use menthol cigarettes--20 percentage points higher than Whites and Hispanics.2

Evidence of Targeting

A 2016-2018 study of Milwaukee WRAP data showed that:

  • Black neighborhoods had a 50% higher density of tobacco retailers than White neighborhoods.
  • Tobacco retailers in Black neighborhoods had almost twice as much outdoor menthol advertising as those in White neighborhoods.
  • Tobacco retailers in Black neighborhoods ran almost twice as many menthol price promotions as those in White neighborhoods.

National research confirms these findings: communities with a higher proportion of African American residents see significantly more advertising and cheaper prices for menthol cigarettes.1

Menthol advertisements are also more prevalent in African American publications such as Ebony, Jet, and Essence. These advertisements incorporate elements of African American culture, music, and messages related to racial identity.1,2 These targeted advertisements portray images of successful, happy, confident, and attractive African Americans. They also feature models with more pronounced African American features, such as darker complexions and afro hairstyles.1,3

jim crow

Above images and description: Tracy Brown, Curator for the African American Tobacco Control Leadership Council

Big Tobacco also financially supports African American organizations through sponsorships estimated at $25 million yearly.4 Once-secret internal tobacco industry documents show that this "philanthropy" has three specific business purposes:4

  1. Increase African American tobacco use
  2. Use African Americans as a frontline force to defend industry policy positions
  3. Defuse tobacco control efforts

Truth Video: "Market Priority" (0:30)

Newsy Video: Menthol Cigarettes' Link to Black Americans (2:56)

Truth Initiative: Black Lives / Black Lungs (15:13)

Disparate Outcomes

African Americans suffer the greatest burden of tobacco-related mortality of any racial or ethnic group in the United States. Each year, approximately 45,000 African Americans die from smoking-related disease, which is the number one cause of death in the African American community.5

If a menthol ban had gone into effect in 2011, researchers projected that more than 320,000 deaths could have been averted by 2050, a third of them among African Americans.6

Resources

References

  1. Tobacco Company Marketing to African Americans -- Campaign for Tobacco-Free Kids (2017)
  2. Menthol and Cigarettes -- California Department of Public Health (2017)
  3. The African Americanization of Menthol Cigarette Use in the United States (2004)
  4. African American leadership groups: smoking with the enemy -- Yerger VB, Malone RE. (2002)
  5. Marketing Menthol: The History of Tobacco Industry Targeting of African Americans -- Campaign for Tobacco-Free Kids (2019)
  6. Menthol: Facts, stats and regulations -- Truth Initiative (2014)

Trends in Use

  • 71% of LGBTQ youth smokers report smoking menthols.1
  • 36% of LBGTQ adult smokers report smoking menthols compared to 29% of straight smokers.1

Evidence of Targeting

Tobacco companies have targeted menthol marketing to traditionally safe spaces for the LGBTQ community, like gay bars and Pride festivals, through event sponsorship and coupons to purchase a pack for just $1 -- nearly 90% off the retail price.2

Additionally, LGBTQ people are more than twice as likely to be exposed to e-cigarette content on social media and internet platforms (including Facebook, Youtube, Twitter, and Tumblr) than non-LGBTQ people.3

In the 90s, a tobacco company in San Francisco created a marketing plan to target the LBGTQ community. They called it "Project SCUM."4

Big tobacco also continues to utilize rainbows and "pride" language, particularly in LGBTQ publications, to hook new customers from these communities. They depict tobacco use as a normal part of life for the LGBTQ community.

Menthol Ad Gay Publication

Ad from Out Magazine, 1994

Menthol Ad Out Magazine

Ad from Out Magazine, 2001. This ad promotes "The House of Menthol." "Houses" have long been a source of LGBTQ social support and entertainment to fill a void when families of origin are not supportive.

Disparate Outcomes

There is adequate research to confirm that LGBT people have a unique “cluster of risk factors” that would lead them to have both greater cancer incidence and later stage diagnosis.5 Those risk factors include higher rates of tobacco use, discrimination, lower likelihood of having health insurance coverage, and greater likelihood of having negative experiences with health care professionals.5,6

Resources

References

  1. National Youth Advocacy Coalition. Coming Out about Smoking: A Report from the National LGBTQ Young Adult Tobacco Project. 2010.
  2. Newport's 'Pleasure Lounge' Aims to Ignite Cigarette Sales -- The Wall Street Journal (2016)
  3. LGBTQ Tobacco Use Fact Sheet -- National LGBT Cancer Network
  4. Marketing Tobacco to LGBT Communities -- Smokefree.gov
  5. The LGBT Community's Disproportionate Cancer Burden -- National LGBT Cancer Network
  6. LGBTQ People With Cancer Fact Sheet -- American Cancer Society (2019)

Trends in Use

menthol eliquid

  • Youth smokers are the age group most likely to use menthol cigarettes.1
  • Between 2015-2019, mint and menthol went from among the least popular to among the most popular e-cigarette flavors for high school students.2
  • A 2019 study found that mint was the most popular flavor among Juul users in 10th and 12th grades.3
  • 89% of Wisconsin high school students would not use unflavored tobacco products.4

Evidence of Targeting

Flavored tobacco products are highly popular among youth and young adults: Over 80% of youth who have ever used tobacco started with a flavored product.5

Flavored and menthol tobacco product packaging is often brightly colored and placed next to candy in retail environments.6 According to the 2018 WRAP survey, more than 1 in 4 Wisconsin retailers sold tobacco products within 12 inches of youth products like toys and candy.7

Evidence from tobacco industry documents shows that the industry studied smokers’ menthol preferences and manipulated menthol levels to appeal to a variety of smokers, including adolescents and young adults.1

youth marketing

Image: Campaign for Tobacco Free Kids

Disparate Outcomes

Studies show that menthol cigarettes are more likely to increase youth initiation, hinder cessation, and promote relapse.8

Longitudinal studies show that initiation with menthol cigarettes facilitates progression to established cigarette use among young smokers.1

Resources

References

  1. Menthol: Facts, stats and regulations -- Truth Initiative (2018)
  2. e-Cigarette Use Among Youth in the United States, 2019 -- Cullen et al. (2019)
  3. Flavors of e-Cigarettes Used by Youths in the United States -- Leventhal et al. (2019)
  4. Youth Tobacco Survey 2018: High School Snapshot -- WI Department of Health Services (2019)
  5. Big Tobacco Wants You to See Grape -- Truth (2018)
  6. Bold and bright: How tobacco companies market flavored products to appeal to youth -- Truth Initiative (2018)
  7. Product Placement -- WRAP Survey (2018), Partnership for a Tobacco-Free Wisconsin
  8. Menthol and Cigarettes -- California Department of Public Health (2017)

Taking Action

The tobacco prevention and control movement can take action on menthol.

  1. Educate. Speak out about the harms and disparate targeting of menthol products.
  2. Collaborate. Engage local leaders, coalitions, and retailers to reduce menthol advertising and couponing.
  3. Follow the money. Pay attention to menthol and tobacco sponsorships, and encourage organizations and prominent individuals to reject it.
  4. Stay vigilant. While some states are working to ban e-cigarette flavors, menthol is often being exempted, just as it was with flavored cigarettes.

Local Examples

No Menthol Sundays

No Menthol Sunday 2019 Video Clip -- WAATPN

Milwaukee Pride Fest Newport Pleasure Lounge

Rejecting Menthol Promotions and Sponsorship at Milwaukee PrideFest --City of Milwaukee Tobacco-Free Alliance LGBTQ+ Work Group

In the News

Related Resources