Why Menthol Cigarettes Are More Dangerous

by Eli Hendel, M.D. Medical Reviewer

Many smokers, especially beginners, mistakenly believe that menthol cigarettes are less dangerous to their health. That’s because people associate menthol cigarettes with pain relief.

Part of the blame for the misinformation can be placed on the tobacco industry, which in the past marketed menthol-containing cigarettes as being safer. Ads emphasized the cool and refreshing taste these cigarettes offered. But research suggests that cigarettes containing menthol, which was first added in the 1920s, may be more addictive than nonmenthol cigarettes.

How much menthol is in cigarettes?

In 2011 menthol cigarettes made up about one-third of the cigarette market in the United States. At that point there had been little effort to see just how much menthol was actually in the most popular cigarettes on the market.

A study published in 2016 found that of the 45 cigarettes it sampled, menthol content varied widely, from 2.9 milligrams to 19.6 mg per cigarette. (The amound of menthol added to tobacco filler determines its flavoring effect: 1 to 2 mg provides a weak effect, while higher levels provide more pronounced flavoring effects.)

Products sampled in the study that contained the most menthol included Natural American Spirit Light Green, Camel Crush, and Camel Menthol. The study also found that small amounts of menthol were in cigarettes that didn’t claim to contain menthol on the label.

Why menthol is dangerous

A study published in 2011 reviewed the health effects of menthol. Researchers found that:

  • Menthol is biologically active and actually interacts with nicotine and other tobacco elements, which can contribute to cell damage or death.

  • Menthol reduces the feeling of respiratory discomfort, which means it may make smoking more tolerable.

  • Menthol cigarettes may be harder on your cardiovascular system than nonmenthol cigarettes.

In 2013, U.S. regulators identified menthol cigarettes as more harmful than traditional cigarettes.

In August 2016 researchers for the Truth Initiative studied cigarette use patterns in order to create smoking cessation programs targeted at people living with HIV. The project was specifically interested in looking at the impact of menthol cigarettes.

Findings suggested that young adults who smoke menthol cigarettes were more likely to be female, African American or Hispanic, or identify as lesbian, bisexual, and transgender compared with nonmenthol smokers.

A similar pattern was found with other flavored tobacco products, little cigars, hookah use, and smokeless tobacco.

It’s important to note that some flavored cigarettes have already been banned under the 2009 Family Smoking Prevention and Tobacco Control Act, but the ban does not cover menthol cigarettes.

Movement to ban menthol

Another addictive ingredient in cigarettes is nicotine, which poses several health hazards.

In July of 2017 the U.S. Food and Drug Administration announced plans to cut cigarette nicotine levels. Scott Gottlieb, M.D., the FDA’s commissioner, has been at the helm of a focused examination of nicotine and says he is committed to “reducing the harm that it causes to society.”

Now a group of Senate Democrats is urging Gottlieb to ban menthol cigarettes, pointing to their health risks.

The letter to Gottlieb highlighting the need for the FDA to ban menthol cigarettes was signed by eight senators, including Sen. Richard Blumenthal (D-Conn.), Sen. Elizabeth Warren (D-Mass.), and Sen. Jack Reed (D-RI). The senators asked the FDA to act on “substantial scientific data” regarding menthol’s impact on public health.

The senators make it clear that it’s time for action. As a pulmonologist I see the daily health implications of a smoking habit. The science surely suggests that menthol cigarettes are luring certain populations to start smoking or to continue smoking. The studies also suggest the heightened negative health implications associated with a menthol smoking habit.

Let’s also remember that the population who chooses not to smoke is exposed to secondhand and third-hand smoke. It’s time for the FDA to finally act and remove menthol cigarettes from the marketplace.

Eli Hendel, M.D.
Meet Our Writer
Eli Hendel, M.D.

Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music.