Young smokers recruited with menthol, study finds

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Internal industry documents, independent lab tests, and survey data reveal strategy

Menthol cigarette brands have been rising in popularity with adolescents, and the highest use has been among younger, newer smokers. Researchers at Harvard School of Public Health (HSPH) explored tobacco industry manipulation of menthol levels in specific brands and found a deliberate strategy to recruit and addict young smokers by adjusting menthol to create a milder experience for the firsttime smoker. Menthol masks the harshness and irritation of cigarettes, allowing delivery of an effective dose of nicotine, the addictive chemical in cigarettes. These milder products were then marketed to the youngest potential consumers.

The paper, “Tobacco Industry Control of Menthol in Cigarettes and Targeting of Adolescents and Young Adults,” appears in the online First Look section of the American Journal of Public Health in advance of publication in the September issue.

“For decades, the tobacco industry has carefully manipulated menthol content not only to lure youth but also to lock in lifelong adult customers,” said Howard Koh, professor and associate dean for public health practice at HSPH and a co-author of the paper.

Lead author Jennifer M. Kreslake, a research analyst, and colleagues from the Tobacco Control Research Program at HSPH reviewed internal tobacco industry documents on menthol product development, conducted laboratory tests to measure menthol content in U.S. brands, examined market research reports, and drew data from the 2006 National Survey on Drug Use and Health, an annual nationally representative survey among U.S. residents aged 12 years and older. The industry documents revealed that tobacco companies researched how controlling menthol levels could increase brand sales among specific groups. The companies determined that products with higher menthol levels and stronger perceived menthol sensation suited long-term smokers of menthol cigarettes while milder brands with lower menthol levels appealed to younger smokers.

The companies then positioned and marketed milder menthol products to appeal primarily to new menthol smokers and also introduced new, milder brands. For example, in 2000 Marlboro introduced Marlboro Milds, which have a lower menthol concentration, while raising the menthol content in Marlboro Menthol, favored by older smokers. Menthol brands with the greatest market-share growth among young adults had the lowest menthol levels (Marlboro Milds and Newport) among the brands tested by HSPH.

The 2006 national survey showed that a significantly greater proportion of adolescent and young adult smokers used menthol brands compared with older smokers. In 2006, 43.8 percent of current smokers aged 12 to 17 years reported that they used menthol cigarettes as did 35.6 percent of current smokers aged 18 to 24 years. By contrast, 30.6 percent of smokers older than 35 years reported menthol use.

The researchers noted that race was also a factor in use and brand choice, with African Americans as a whole more likely to use menthol brands. African-American adolescent and young adult smokers used menthol as frequently as did older African-American smokers, but they were more likely to choose a lower-menthol variety. Earlier HSPH research described industry efforts to target African Americans with menthol brands.

A bill before Congress would for the first time give the FDA the authority to regulate additives such as menthol. At present, no regulatory agency has the authority to address the issue of menthol in cigarettes.

The HSPH researchers suggest in their paper that the rapid introduction of new milder menthol brands in the past decade is a violation of a provision in the Master Settlement Agreement of 1998 between tobacco companies and state governments that prohibits the companies from directly or indirectly targeting youths. The authors recommend that “to protect the public health, tobacco products should be federally regulated, and additives such as menthol should be included in that regulation.”

“This is another example of the cynical behavior of the tobacco industry to hook teens and African Americans to a deadly addiction. This is after the industry told the American public it had changed its marketing practices. The FDA bill provides the vehicle to end the hypocrisy and save the lives of the young and a targeted minority group,” said Gregory N. Connolly, professor of the practice of public health and a co-author of the American Journal of Public Health paper. Connolly is director of the Tobacco Control Research Program at HSPH.

Tobacco use is the largest preventable cause of death globally. According to the National Cancer Institute, smoking-related illnesses in the United States account for an estimated 438,000 deaths each year.

An estimated 25.9 million men (23.9 percent) and 20.7 million women (18.1 percent) in the United States are smokers, according to the American Heart Association.

This research was funded by The American Legacy Foundation and the National Cancer Institute.