Smoking Cessation Community

On March 23rd, the Tobacco Products Scientific Advisory Committee (TPSAC) will publish its report and recommendations to FDA on how menthol should be regulated in cigarettes. TPSAC has been considering all the evidence on the effects of menthol in cigarettes on public health. Drafts of some of the chapters of its report are on the FDA website.

TPSAC has to address a number of questions, including whether availability of menthol cigarettes increases the number of kids who become regular smokers, and whether smokers of menthol cigarettes are less likely to quit. Some have interpreted the initial draft chapters on the direct health effects of mentholated cigarettes as signaling that FDA will not take steps to restrict sales of menthol cigarettes, causing the value of stock in Lorillard tobacco company to rise last week. For example, draft chapter 6 concluded that "the evidence is insufficient to conclude that smokers of menthol cigarettes face a different risk of tobacco-caused diseases than smokers of non-menthol cigarettes." However, the evidence is strong that young people who start smoking menthol cigarettes become more addicted to them, and that African American adults who smoke menthol cigarettes are less able to quit than African Americans who smoke regular cigarettes. Some colleagues and I recently published a review of this issue which concluded "recent studies have consistently found that racial/ethnic minority smokers of menthol cigarettes have a lower quit rate than comparable smokers of regular cigarettes, particularly among younger smokers." About half of the studies we reviewed found effects of menthol on quitting and half did not. But it seemed as though the more recent studies (since 1999) were more consistently finding a menthol effect and we hypothesized that this possibly related to increased price of cigarettes and menthol helping poor smokers to inhale more per cigarette and become more addicted. Since that time some additional studies have been completed, and one in particular is very convincing. Dr Cristine Delnevo and colleagues at the University of Medicine and Dentistry of New Jersey analyzed two very large surveys of the U.S. population carried out in 2003 and 2006/7. The sample included over seventy thousand current or former smokers, giving sufficient numbers to examine the effects in racial and ethnic subgroups, and to exclude people who stated that they had not even tried to quit in the past 5 years or who had switched to another tobacco product. The authors analyzed the data in 5 different ways, but the results were broadly consistent. Overall, people who have smoked menthol cigarettes, made a quit attempt in the previous 5 years, and had not switched to another tobacco product, were significantly less likely to have succeeded in becoming an ex smoker, than people who had smoked regular cigarettes. This finding was particularly strong and consistent for African American smokers?and consistent with other recent studies.

I believe that this study deserves particular attention, because of its size, its representativeness of the U.S. population, and the consistency of its findings when analyzed in different ways. When added to the findings of other studies carried out since 1999 it makes it clear that African Americans who smoke menthol cigarettes are less likely to be able to quit smoking than African Americans who smoke non-menthol cigarettes, even when one controls for numerous other factors (e.g. age, sex, education etc etc). Given that over 70% of African American smokers smoke menthols, this effect on ability to quit results in a sizeable health impact. The TPSAC has a duty to recommend policy change if the evidence suggests it is more likely than not, that the policy will lead to an improvement in public health. Ending the process whereby large segments of the population become more addicted to cigarettes than they would otherwise be, appears to meet that criterion?.by a large margin.