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An estimation of the harm of menthol cigarettes in the United States from 1980 to 2018
  1. Thuy TT Le,
  2. David Mendez
  1. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  1. Correspondence to Thuy TT Le, Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA; thuyttle{at}


Background Menthol cigarettes are thought to encourage smoking initiation among youths and young adults and make it more difficult for smokers to quit, thus increasing cigarette harm. However, no study to date has quantified the damage that menthol cigarettes have caused the US population.

Objective To estimate the excess smoking prevalence, smoking initiation, and mortality in the US from 1980 through 2018 that can be attributed to menthol cigarettes.

Methods Using a well-established simulation model of smoking prevalence and health effects and data from the National Health Interview Survey (NHIS), we first reproduced the overall US adult smoking prevalence between 1980 and 2018 (pseudo-R2=0.98) and associated mortality. Then we re-ran the model, assuming that menthol cigarettes were not present in the market over the same period. Finally, we compared both scenarios to quantify the public health harm attributable to menthol over the 1980–2018 period.

Results From 1980 to 2018, we found that menthol cigarettes were responsible for slowing down the decline in smoking prevalence by 2.6 percentage points (13.7% vs 11.1% in 2018). Our results also show that menthol cigarettes were responsible for 10.1 million extra smokers, 3 million life years lost and 378 000 premature deaths during that period.

Conclusions With millions of excess smoking initiators and thousands of smoking-related deaths due to mentholated cigarettes from 1980 through 2018, our results indicate that these products have had a significant detrimental impact on the public’s health and could continue to pose a substantial health risk. Our findings can assist the Food and Drug Administration in evaluating potential regulatory actions for mentholated tobacco products.

  • harm reduction
  • public policy
  • prevention

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  • Contributors TTTL and DM conceptualised the project. TTTL calibrated the model, performed the simulations. DM developed the original model and supervised the work. Both authors contributed to writing of the manuscript.

  • Funding Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health and Food and Drug Administration Centre for Tobacco Products (award number U54CA229974).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. This study was carried out based on publicly available data sources.