Menthol smokers find it harder to kick the habit

New research shows that people who smoke menthol-flavored cigarettes are 9% less likely to quit successfully than people who smoke regular cigarettes, giving ammunition to the push for the Food and Drug Administration to ban menthol additives.

Black and Puerto Rican smokers of menthol cigarettes had an even harder time quitting, said a study released Aug. 15 by the American Journal of Preventive Medicine. Blacks who smoked menthols were 19% less likely to quit than blacks who smoked unflavored cigarettes. Puerto Rican menthol smokers had a 43% lower quit rate than their nonmenthol-smoking counterparts. The quit rates of other surveyed ethnic groups were about the same as the overall rate.

The findings are based on monthly U.S. Census Bureau surveys of more than 56,000 households between 2003 and 2007. Researchers examined responses of current and former smokers of regular and menthol cigarettes and looked at how many quit successfully, controlling for differences in education, socioeconomic status and other factors.

Although the overall differences in quit rates between menthol and nonmenthol cigarette smokers were not large, they were statistically significant and "suggest there is a robust menthol effect on cessation at the population level," the study said.

Previous research on the effect of menthol cigarettes on quit rates has been mixed, because studies looked at smaller slices of the population, such as patients at smoking-cessation clinics, said Cristine D. Delnevo, PhD, MPH, lead author of the new study. She said physicians should take note of the findings in helping patients who are trying to quit.

"If physicians are talking to patients about their smoking and advising them to quit, they should ask them whether or not they smoke menthols and be aware that those patients may need extra help in their quit attempts," said Delnevo, associate professor at the University of Medicine & Dentistry of New Jersey School of Public Health and a member of the Cancer Institute of New Jersey, both in New Brunswick, N.J.

The findings are "not surprising, considering that menthol smokers inhale more deeply and tend to smoke more cigarettes than nonmenthol smokers," said Cecil B. Wilson, MD, a Winter Park, Fla., internist and immediate past president of the American Medical Association. "The AMA has encouraged the FDA to take steps to ban the use and marketing of menthol in cigarettes; this study further illustrates that menthol is a harmful additive."

Banning menthol additives probably would cut the number of smokers, said Michael Siegel, MD, MPH, a professor in the Dept. of Community Health Sciences at the Boston University School of Public Health.

"When you ban people's favorite brand, at least some of them are going to use that as an opportunity to quit," he said.

A ban on menthols would prevent at least 300,000 deaths attributable to smoking by 2050, estimated the authors of a study published in July's American Journal of Public Health. About a third of cigarettes sold in the U.S. are menthols, and three-quarters of black smokers choose these cigarettes, according to the Centers for Disease Control and Prevention.

Flavored cigarettes were banned in the Family Smoking Prevention and Tobacco Control Act, enacted in 2009, but an exception was made for menthols pending a report from the FDA's Tobacco Products Scientific Advisory Committee. In March, the committee reported that the "removal of menthol cigarettes from the marketplace would benefit the public health."

Several advocacy groups criticized the committee for including experts who work for pharmaceutical companies that make smoking-cessation products. An external panel is examining the matter. The FDA said in June that it will make the results of the review available for public comment in the Federal Register, though the agency has not said when that might happen and did not respond to an American Medical News request for more information by this article's deadline.

First Amendment fight

Lorillard Inc., which makes the top-selling menthol cigarette brand, Newport, called the FDA tobacco committee's report "unsubstantiated." A spokesman said the company was still reviewing the American Journal of Preventive Medicine study at this article's deadline and would not comment on its findings.

The company has touted a January 2010 report by an economic consulting firm predicting that a menthol-additive ban would lead to a booming illegal market and make it easier for underage people to buy cigarettes. Lorillard introduced a nonmenthol version of Newport in November 2010.

In August, Lorillard joined three other tobacco companies in filing a federal lawsuit to stop the FDA from requiring graphic warnings covering half of cigarette packages starting in September 2012.

"The regulations violate the First Amendment," said Floyd Abrams, a lawyer who has argued many First Amendment cases and is representing the tobacco companies. "The notion that the government can require those who manufacture a lawful product to emblazon half of its package with pictures and words admittedly drafted to persuade the public not to purchase that product cannot withstand constitutional scrutiny. The government can engage in as much anti-smoking advocacy as it chooses in whatever language and with whatever pictures it chooses; it cannot force those who lawfully sell tobacco to the public to carry that message, those words and those pictures."

R.J. Reynolds Tobacco Co., Commonwealth Brands Inc. and Liggett Group LLC are co-plaintiffs in the suit, which was filed in the U.S. District Court for the District of Columbia. The FDA declined to comment on the lawsuit, as it does with all pending litigation.