Bans on Flavored Cigarettes Should Be Universally Embraced — And Include Menthol

Tobacco companies have long tried to attract young people to use their products, and adding flavors is a favored tactic. Including flavors (like menthol or clove) in cigarettes masks the harshness of combusted tobacco smoke, making smoking more palatable to novice smokers.

The strategy has been successful in many places. In the early 2000s, the use of flavored cigarettes was nearly three times higher in 17-year-old smokers in the U.S. compared with smokers over 25, and research shows young people in other parts of the world have a similar preference for flavored cigarettes (see, for example, evidence from Mexico, Chile and the UK .

In an effort to curb youth smoking, at least 11 countries and the European Union have banned the sale of some or all flavored cigarettes. For example, in 2009 the U.S. Food and Drug Administration (FDA) enacted the Family Smoking Prevention and Tobacco Control Act, which effectively banned added flavors, herbs, and spices (such as clove) in cigarettes sold in the U.S. According to one analysis, the ban resulted in a 17% drop in the likelihood that an adolescent would become a cigarette smoker.

The caveat with the US policy? The ban didn’t include menthol, which dampened the effectiveness of the policy because menthol was by far the most common flavored cigarette sold in the US. While smoking went down overall, that same analysis found use of menthol cigarettes crept up, as smokers preferring flavored cigarettes switched to the last remaining flavor available. The policy also exempted cigars, and flavored little cigars popped up overnight sold by the same companies who previously sold flavored cigarettes, targeting youth and others who would have purchased flavored cigarettes.

Menthol cigarettes are particularly popular in the U.S., more so than in other countries, accounting for roughly a third of cigarettes sold. Euromonitor International finds that only Singapore, Dominican Republic, Cameroon, and Thailand have markets with larger menthol shares. The map below shows the share of sales in 78 countries, of which only 7 have higher flavored cigarette sales shares than the US. The exclusion of menthol from the flavored cigarette ban likely yielded higher rates of youth smoking and exacerbated tobacco-related health disparities in groups who are more likely to prefer menthol cigarettes such as (in the U.S.) African-Americans.

In places where menthol has been included in flavor bans, tobacco companies have exploited loopholes to get around the harshest effects of the policies on their sales. For example, after the European Union announced its ban on flavored cigarettes, tobacco companies started producing peppermint-scented cardboard strips to place inside a pack of cigarettes or bag of rolling tobacco to mimic the experience smokers had with menthol cigarettes. Others began wrapping their menthol cigarettes in tobacco leaves instead of paper so that they could be sold as cigarillos, a type of small cigar that were not included in the flavored cigarette ban. In Ireland, Philip Morris and Japan Tobacco removed most menthol flavoring from their cigarettes,  but left a legally dubious “hint” of flavor behind.

This didn’t just happen in the EU. After menthol flavored cigarettes were banned in some Canadian provinces in 2015 (and nationwide in 2017), some manufacturers repackaged cigarettes to remove the word “menthol” from the packaging, but kept the same design, color, and language promising a “smooth taste” to give the impression the cigarettes were a menthol substitute. And all over the world, flavored drops (including menthol) designed to be applied directly to unflavored tobacco products are currently being sold online, allowing smokers to create their own flavored products despite the bans in place.

To address these issues, countries should enact broad, coordinated policies at the national level to ban flavored combustible tobacco that extend to all flavors (including menthol), as well as all combustible tobacco products, such as cigars, cigarillos, pipe tobacco, roll-your-own tobacco, and waterpipe. Policymakers could also consider measures to address the online sales of flavored combustible tobacco products and do-it-yourself additives like scented strips, flavored drops, or capsules.

Banning flavored cigarettes has the potential for substantial public health benefits including reducing youth smoking and racial disparities in smoking and smoking-related diseases. Importantly, closing the loopholes described here is essential to ensure bans are as effective as possible at realizing these outcomes.

By Melissa Maitin-Shepard and Robyn Correll-Carlyle

Cover Image Credit: Quit Victoria, 2018