The Family Smoking Prevention and Tobacco Control Act (TCA) of 2009 outlawed the manufacture, distribution, and sale of cigarettes with “characterizing flavors,” assuming that these candy and fruit flavors disproportionately appeal to minors, facilitating smoking initiation and dependence. As a result of the TCA, regulating tobacco products was, for the first time, put under the purview of the Food and Drug Administration (FDA).
Partly the result of an extraordinary alliance between Philip Morris and the Campaign for Tobacco-Free Kids, the TCA erected enormous regulatory barriers to the introduction of new tobacco products. Banning the flavors sold by Philip Morris’ competitors and exempting menthol cigarettes mainly appeased Philip Morris, which was the only tobacco company in favor of the bill.
Tobacco control activists viewed the exemption of menthol as a missed opportunity and have long sought to convince the FDA to ban menthol cigarettes outright. Section 907 of the TCA authorizes the FDA to establish a product standard requiring tobacco manufacturers to eliminate menthol from their products if it is “appropriate for the protection of public health.” To meet this criteria, the FDA must consider:
- the risks and benefits to the population as a whole, including users and non-users of tobacco products;
- the increased or decreased likelihood that existing users of tobacco products will stop using such products; and
- the increased or decreased likelihood that those who do not use tobacco products will start using such products.
To answer these considerations, the Tobacco Products Scientific Advisory Committee (TPSAC) was charged with reviewing the scientific evidence regarding menthol and recommending future regulation to the FDA.
In 2011, the TPSAC published its review of menthol cigarettes, concluding they have a negative effect on public health. A separate review by the FDA published in 2013 found: “Menthol in cigarettes is likely associated with increased initiation and progression to regular use of cigarette smoking.” These principal claims against menthol, as opposed to non-menthol, cigarettes constitute why they are considered a unique threat to public health. On November 15, 2018, the FDA announced it would pursue a ban on the sale of menthol cigarettes.
While the share of the cigarette market occupied by menthol has grown over time, total cigarette smoking has dropped sharply in both the adult and youth populations, for both regular and menthol cigarettes. In particular, youth menthol smoking has declined to a point of being less popular than non-menthol smoking. If current trends continue, the total percentage of youth smoking menthol cigarettes will be at or near zero within the next few years.
Nevertheless, allegations made against menthol should be considered and reviewed to see if critics’ claims are borne out in the real world. If the strength of the association between menthol cigarettes and increased youth initiation is as strong as tobacco control activists suggest, there should be signs of it in the national data.
Employing National Survey on Drug Use and Health (NSDUH) data from the Substance Abuse and Mental Health Services Administration (SAMHSA) and industry distribution figures provided by R.J. Reynolds, Reason Foundation examined whether there was a strong positive relationship between the distribution of menthol cigarettes and youth cigarette smoking. The data covered all 50 states and Washington, D.C. for years 2008-2018.
The resulting analysis found:
- States with more menthol cigarette consumption relative to all cigarettes have lower rates of child smoking.
- States with higher cigarette distribution levels per capita of all types have higher rates of both adult and child smoking.
- In general, the metric analyses show consistent nonpredictive relationships between relative menthol cigarette consumption rates and use of any age group.
- The only predictive relationship is between adult and child smoking rates, and since we do not expect children to cause their parents to smoke, we conclude states with higher rates of adult use cause higher rates of youth use.
The data demonstrate that menthol cigarette distribution does not increase youth smoking initiation any more than regular cigarette distribution. This study concludes that menthol cigarette availability does not pose a greater threat to public health than regular cigarette availability.
From these findings, we can infer, in concurrence with the public health literature, that the best way to lower the youth smoking rate is to lower the adult smoking rate.
Any consideration of menthol prohibition should be made in the context of rapidly falling youth cigarette use, the lack of association between menthol use rates in states and youth smoking, and the costs of prohibition.