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      Menthol cigarettes and the public health standard: a systematic review

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          Although menthol was not banned under the Tobacco Control Act, the law made it clear that this did not prevent the Food and Drug Administration from issuing a product standard to ban menthol to protect public health. The purpose of this review was to update the evidence synthesis regarding the role of menthol in initiation, dependence and cessation.


          A systematic review of the peer-reviewed literature on menthol cigarettes via a PubMed search through May 9, 2017. The National Cancer Institute’s Bibliography of Literature on Menthol and Tobacco and the FDA’s 2011 report and 2013 addendum were reviewed for additional publications. Included articles addressing initiation, dependence, and cessation were synthesized based on study design and quality, consistency of evidence across populations and over time, coherence of findings across studies, and plausibility of the findings.


          Eighty-two studies on menthol cigarette initiation ( n = 46), dependence ( n = 14), and cessation ( n = 34) were included. Large, representative studies show an association between menthol and youth smoking that is consistent in magnitude and direction. One longitudinal and eight cross-sectional studies demonstrate that menthol smokers report increased nicotine dependence compared to non-menthol smokers. Ten studies support the temporal relationship between menthol and reduced smoking cessation, as they measure cessation success at follow-up.


          The strength and consistency of the associations in these studies support that the removal of menthol from cigarettes is likely to reduce youth smoking initiation, improve smoking cessation outcomes in adult smokers, and in turn, benefit public health.

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          The online version of this article (10.1186/s12889-017-4987-z) contains supplementary material, which is available to authorized users.

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          Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013–2014)

          The 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors other than menthol in cigarettes but did not restrict their use in other forms of tobacco (e.g., smokeless, cigars, hookah, e-cigarettes).
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            Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents

            Objective To examine tobacco industry marketing of menthol cigarettes and to determine what the tobacco industry knew about consumer perceptions of menthol. Methods A snowball sampling design was used to systematically search the Legacy Tobacco Documents Library (LTDL) (http://legacy.library.ucsf.edu) between 28 February and 27 April 2010. Of the approximately 11 million documents available in the LTDL, the iterative searches returned tens of thousands of results from the major US tobacco companies and affiliated organisations. A collection of 953 documents from the 1930s to the first decade of the 21st century relevant to 1 or more of the research questions were qualitatively analysed, as follows: (1) are/were menthol cigarettes marketed with health reassurance messages? (2) What other messages come from menthol cigarette advertising? (3) How do smokers view menthol cigarettes? (4) Were menthol cigarettes marketed to specific populations? Results Menthol cigarettes were marketed as, and are perceived by consumers to be, healthier than non-menthol cigarettes. Menthol cigarettes are also marketed to specific social and demographic groups, including African–Americans, young people and women, and are perceived by consumers to signal social group belonging. Conclusions The tobacco industry knew consumers perceived menthol as healthier than non-menthol cigarettes, and this was the intent behind marketing. Marketing emphasising menthol attracts consumers who may not otherwise progress to regular smoking, including young, inexperienced users and those who find ‘regular’ cigarettes undesirable. Such marketing may also appeal to health-concerned smokers who might otherwise quit.
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              Quit attempts and intention to quit cigarette smoking among young adults in the United States.

              We investigated variables associated with quitting behaviors among current, daily, and nondaily young adult smokers in the United States. Data from the national 2003 Tobacco Use Special Cessation Supplement to the Current Population Survey were analyzed to identify factors associated with quit attempts and serious intention to quit among young adult smokers aged 18 to 30 years (n=7912). Daily smokers who smoked 20 or more cigarettes per day, had their first cigarette within 30 minutes of waking, and smoked no usual type were less likely than were their comparison groups to have 1 more or quit attempts. Nondaily smokers who were male, Hispanic, and smoked no usual type of cigarette were also less likely than were their comparison groups to report 1 or more quit attempts. Although unemployed nondaily smokers were more likely than were the employed to report intention to quit, nondaily smokers with an annual family income of $25,000 to $49,000 were less likely than were higher-income families to report intention to quit. Nicotine dependence measures were significantly associated with quitting and intention to quit among daily smokers, but sociodemographics were associated with quitting and intention to quit among nondaily smokers.

                Author and article information

                802 656 1187 , andrea.villanti@uvm.edu
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                29 December 2017
                29 December 2017
                : 17
                [1 ]The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
                [2 ]ISNI 0000 0004 1936 7689, GRID grid.59062.38, Vermont Center on Behavior and Health, Department of Psychiatry, , University of Vermont, ; Burlington, VT USA
                [3 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Health, Behavior and Society, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA
                [4 ]Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
                [5 ]ISNI 0000 0000 8944 3799, GRID grid.417962.f, Public Policy, Truth Initiative, ; Washington, DC, USA
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: Truth Initiative
                Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: P50DA036114
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100000057, National Institute of General Medical Sciences;
                Award ID: P20GM103644
                Award Recipient :
                Research Article
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                © The Author(s) 2017

                Public health

                public health, cessation, dependence, policy, youth tobacco use


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