US: Menthol Ban Would Save 650,000 Lives by 2060

Banning menthol in cigarettes and cigars in the United States could save tens of thousands of lives each year and lead to significant health gains, according to a new University of Michigan study that underscores the urgency of final approval and implementation of the ban by the Food and Drug Administration (FDA) in April 2021.[1].

The study, published in the journal Tobacco Control[2], notes that additional measures such as tax increases and an effective ban on the sale of tobacco products to those under 21 could further reduce initiation, smoking prevalence and associated deaths.

Menthol cigarette consumption remains high in the United States

While the prevalence of smoking in the United States has declined significantly over the past decade, menthol cigarette use has remained constant. Menthol cigarettes now account for 35% of cigarette sales and are consumed primarily by adolescents, young adults, women, and African Americans due to targeted and aggressive marketing by the tobacco industry.[3]. Menthol cigarettes have been associated with increased smoking initiation and reduced smoking cessation. The authors suggest that the lack of a ban on menthol in cigarettes and cigars will be responsible for continued smoking initiation even as overall smoking prevalence declines.

Banning menthol would save more than 16,000 lives a year

For this study, the researchers developed a scenario with a menthol ban starting in 2021 and estimated the public health impact in terms of smoking-attributable deaths and years of life lost. They considered different options: the current scenario, without a menthol ban, and the one with the ban in effect between 2021 and 2060. With a ban on menthol tobacco products, combined consumption of menthol and non-menthol cigarettes would decrease by 15 % by 2026. It is estimated that smoking-attributable deaths would fall by about 5 % and the number of years of life lost by 8.8 %, or 16,250 deaths per year avoided and more than 11 million years of life gained (nearly 300,000 per year) over a 40-year period. Extended to a period of 60 years, the years of life gained would increase from 11.3 to 14.7 million.

These figures are for the entire US population on average, without taking into account the particular impact on certain categories of the population. Experts have suggested greater consequences for the African-American population. In the context of a menthol ban, it is estimated that 48% of African-Americans would be dissuaded from starting smoking because of the measure, compared to 39% on average for the entire population.

Taking into account the switch to electronic cigarettes in the estimates

A small body of research has examined the potential impacts of banning menthol in cigarettes. One simulation model had previously predicted that a menthol ban would have major effects on smoking prevalence and smoking-attributable deaths. However, this model simulated a ban from 2010 and did not account for potential shifts in consumption to other nicotine products, including vaping devices.[4]A relatively large percentage of menthol smokers, particularly young smokers, would switch to vaping products if banned.

Keywords: Menthol, United States, vaping, mortality

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[1] Tobacco Free Generation, US Bans Menthol Cigarettes, April 29, 2021, accessed September 7, 2021

[2] Levy DT, Meza R, Yuan Z, et al Public health impact of a US ban on menthol in cigarettes and cigars: a simulation study, Tobacco Control Published Online First: 02 September 2021. doi: 10.1136/tobaccocontrol-2021-056604

[3] Tobacco Free Generation, At the heart of the cigarette manufacturers' strategy: menthol, May 20, 2020, accessed September 7, 2021

[4] Tobacco Free Generation, Menthol: 10 million additional smokers in the United States, March 1, 2021, accessed September 7, 2021