Addressing the use of menthol tobacco products is an important part of treating tobacco use. Menthol makes tobacco products more addictive, harder to quit, and it is disproportionately affecting the health of communities of color and youth.
by Rachael Joyner, Rachael Joyner, DNP, FNP-BC, APRN
Menthol is a flavoring derived from mint plants—or made synthetically in a lab—that is added to cigarettes, cigars, and vapes to make the smoke less harsh and more tolerable. Most cigarettes sold in the US contain some degree of menthol, and those marketed specifically as menthol products contain much more. According to the Centers for Disease Control and Prevention (CDC), about 37% of all cigarettes sold in 2021 were menthol-flavored.
The evidence of menthol’s harmful effects is clear. Here are a few harsh facts:
Menthol enhances the effects of nicotine on the brain, increasing the addictiveness of tobacco products.
Tobacco products with menthol are more appealing to youth and lead to youth initiation of smoking.
Individuals who smoke menthol cigarettes or use other menthol tobacco products are less likely to be successful in quitting.
Tobacco companies have aggressively marketed menthol products to certain groups, particularly Black people; 80% of Black Americans who smoke use menthol products.
Certain groups are more likely to smoke menthol cigarettes, including youth, racial and ethnic minorities, women, individuals with mental health issues, members of the LGBTQ+ community, and people with lower socioeconomic status.
This year marks the 10th anniversary of No Menthol Sunday, held his year on May 19th. Started by the Center for Black Health and Equity, this annual day of advocacy is aimed to engage faith communities on the harms of menthol and tobacco addiction, raising awareness for this important issue impacting Black health. Visit nomentholsunday.org for a toolkit and other resources to get involved.
Between 1980 and 2018, menthol cigarettes resulted in 3 million years of potential life lost, according to estimates from the CDC. Groups such as The Center for Black Health and Equity (CBHE) have been advocating for a menthol ban for over a decade, since the Food and Drug Administration (FDA) banned other flavors in 2009. Though the FDA announced a proposal to ban menthol in cigarettes and cigars back in 2021, no federal ban has been enacted as of the writing of this post.
What can we do in the meantime as healthcare providers and public health advocates in addressing menthol tobacco product use?
"Share the facts on the harms of menthol and support people in making healthier decisions," explains Bolu Abe-Lathan, a physician assistant with the Duke Smoking Cessation Program, who works with many patients using menthol tobacco products.
She will direct patients to purchase products that don’t have menthol, so they can experience the difference. “I have had many patients come back and not enjoy smoking non-menthol cigarettes. They couldn’t believe how horrible the experience was, and they are SO thankful.”
“I tell my patients, ‘It’s time to break up with menthol.’ I spend time explaining how it changes smoking, how it changes the smoker behaviorally. The tobacco industry knows it makes the addiction stronger.” –Bolu Abe-Lathan, PA-C
When speaking with younger patients or those using flavored e-cigarettes, she highlights that many products may not be labeled as menthol but they still contain menthol. “They are not understanding that these e-cigarette flavors with ‘ice’ in the name are actually menthol. It’s not grape ice; it’s grape menthol.”
Bolu’s 3 Tips for Treating People Using Menthol Tobacco Products
1. Educate on menthol. Discuss how it affects them, its addictiveness, and how it makes it harder to quit. The more information they have, the better choices they can make. All communities use menthol tobacco products. African Americans are a huge portion of menthol smokers, but you don’t want to miss those others groups as well. It’s always important to ask everyone about menthol use.
2. Provide meaningful support. Make sure they have resources for quitting—access to medications and behavioral support. Help them understand why it’s important to use a medication, because menthol is harder to quit.
3. Encourage them to keep going. I have a lot of patients who are so concerned when they get a scary diagnosis like cancer. They feel guilty that the first thing they should do is quit but they haven’t. Normalize that stress and scary moments can be linked to increased tobacco use. Try, try, try again. Normalize that it can take several attempts before someone will quit for good. I tell patients all the time, ‘You have to keep going, because you have to save your life.’
To learn more about ways to address menthol tobacco use and treatment considerations for diverse communities, sign up here for our summer Comprehensive TTS Training July 15 - 23. To learn more about addressing youth tobacco use, don’t miss our half-day virtual training Tobacco Treatment in Adolescent and Young Adult Populations on August 7. Visit https://www.dukeunctts.com/youth to learn more or register.
About the Author
Rachael Joyner, DNP, FNP-BC, APRN, is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.
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