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In April 2021, the US Food and Drug Administration announced its intention to issue regulations banning menthol as a characterising flavour in cigarettes within a year.1 This proposal stemmed from decades of research highlighting the role of menthol cigarettes in promoting initiation, facilitating nicotine dependence and reducing cessation success, particularly in non-white people who smoke cigarettes.2 3 Prior studies have documented the growth of menthol’s market share in the context of dramatic reductions in cigarette consumption.4 5
A recent product feature in menthol cigarettes is the flavour capsule which allows consumers to crush a liquid-filled capsule in the filter, creating a unique menthol sensory experience.6 Sales of cigarettes with flavour capsules are growing in the USA and globally, and have high appeal among young people.6 Indeed, tobacco industry documents indicate that the target audience for ‘Camel Crush’—the first menthol flavour capsule cigarette brand in the US market—were millennials.7 This study updates previous estimates of menthol and non-menthol cigarette consumption,4 5 identifies significant inflection points and examines the role of menthol flavour capsules which were introduced in 2008.7
Cigarette consumption data from the US Tobacco Tax and Trade Bureau were multiplied by the menthol market share, which was averaged from two sources: the Federal Trade Commission Cigarette Report and Euromonitor data. Additional analyses using only Euromonitor data distinguished traditional menthol cigarettes from those with a menthol flavour capsule. Trends were assessed using Joinpoint V.4.9.0 (National Cancer Institute), a segmented regression analysis application, for average annual percentage changes (AAPCs). We present the best model fit with each segment described by its short-term trend (annual percentage changes).
Overall, cigarette consumption decreased from 346.4 billion in 2008 to 228.6 in 2020 (AAPC: −3.27% (95% CI: −4.02% to −2.51%)). Non-menthol cigarette consumption decreased from 253.4 to 146.3 billion cigarettes (AAPC: −4.58% (95% CI: −5.56% to −3.59%)), while menthol consumption decreased from 93.0 to 82.3 billion cigarettes over the same time period (AAPC: −1.29% (95% CI: −1.70% to −0.88%)). The decrease in non-menthol cigarette consumption was greater from 2008 to 2010 at which point the declines slowed from 2010 to 2020 (figure 1A). Figure 1B highlights differences within menthol cigarette style. Menthol capsule cigarette consumption increased rapidly since their market introduction in 2008–2010 and continued to grow, although at a slower pace, from 2010 to 2014; growth plateaued from 2014 to 2020. Conversely, traditional menthol cigarette consumption declined steadily across the entire time period.
Between 2008 and 2020, cigarette consumption declined in the USA, with significantly greater reductions for non-menthol cigarettes. The minimal declines for menthol cigarettes were likely due in part to the introduction of menthol capsule cigarettes to the market, which saw rapid increases from 2008 to 2014. After excluding menthol capsule products, menthol and non-menthol cigarette consumption declined at similar rates from 2010 to 2020, suggesting menthol capsules slowed the downward trajectory in cigarette consumption.
This study has limitations. First, we relied on estimates of menthol market share from two sources. Second, this is an ecological analysis, and we were not able to account for potential drivers of menthol and non-menthol cigarette consumption, such as local flavour bans. Third, consumption data cannot characterise the epidemiology of menthol smoking. However, the findings are consistent with population data from the National Survey on Drug Use and Health (NSDUH) showing increased menthol smoking prevalence among those who smoked in the past 30 days from 34% in 20088 to 43.1% in 2020.9
The ecological data underscore that menthol in cigarettes continues to stall progress in reducing cigarette smoking, and menthol capsules have likely played a role in overall usage trends. Given its documented public health harms and high rates of use among marginalised populations,10 eliminating menthol as a characterising flavour from the cigarette market remains a priority. Moreover, menthol bans must also address innovative delivery methods, such as flavour capsules.
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Twitter @crisdelnevo, @dannygiovenco
Contributors CDD conceptualised the work, compiled the data and conducted the analyses. CDD, DPG and ACV interpreted the data, drafted the manuscript and provided critical revisions of the manuscript.
Funding CDD, ACV and DPG were supported by Tobacco Centres of Regulatory Science (award U54CA229973) from the National Cancer Institute (NCI) and Food and Drug Administration (FDA). DPG was also supported by the Office of the Director at the National Institutes of Health (DP5OD023064).
Disclaimer The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the US FDA. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.