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A recent study by researchers at Virginia Tech’s Fralin Biomedical Research Institute suggests that restricting menthol-flavored cigarettes could significantly reduce smoking rates and increase the use of nicotine replacement therapies, a finding that strengthens calls for policy action on menthol cigarette sales. This comes at a time when the proportion of menthol cigarette smokers is rising, even as the total number of smokers has declined across the United States. The Centers for Disease Control and Prevention (CDC) estimates that over 9 million adults, or about 32% of smokers nationwide, use menthol cigarettes. In Virginia, that number rises to 38%.
Led by Roberta Freitas-Lemos, an assistant professor at the Fralin Biomedical Research Institute’s Cancer Research Center and Center for Health Behaviors Research, the study involved an experimental marketplace that simulated real-life tobacco purchasing scenarios. Through this platform, researchers examined how participants responded to various tobacco and nicotine product policies. The findings underscore the potential benefits of restricting menthol cigarette sales alongside providing accessible nicotine replacement therapies like nicotine gum and lozenges.
“We were trying to understand how different flavor policies interact, the role of cigarette filter ventilation, and how different types of smokers would respond to those policies,” said Freitas-Lemos. “We wanted to understand the effect of restrictions on purchases.”
Published in the October 1 issue of Drug and Alcohol Dependence, the study analyzed data from 172 individuals who smoked only cigarettes and 91 who used multiple tobacco products. The participants completed a series of trial purchases in the “Experimental Tobacco Marketplace,” an online tool designed to simulate an Amazon-like shopping experience. They were asked to shop under varied conditions, such as changes in cigarette prices and restrictions on menthol flavors in both cigarettes and e-cigarettes.
The study revealed that when menthol cigarettes were unavailable, menthol-preferring smokers were less likely to buy any cigarettes and more inclined to choose nicotine replacement products. However, when both menthol cigarettes and menthol-flavored e-cigarettes were restricted, menthol smokers were less willing to substitute e-cigarettes as an alternative, indicating a preference for menthol products specifically. Smokers who preferred highly ventilated cigarettes, which are designed with filter holes to allow airflow, showed a consistently high demand for cigarettes under various conditions.
The Impact of Menthol and Filter Ventilation
Menthol, a naturally occurring compound in plants like peppermint, is often added to cigarettes to enhance flavor and make smoking smoother and more appealing. Research has shown that menthol enhances nicotine absorption, making cigarettes more addictive and increasing smoking rates. The design of tobacco products—including flavors and filter ventilation—plays a crucial role in consumer behavior, a factor the Food and Drug Administration (FDA) considers in its regulation efforts.
Freitas-Lemos highlighted the link between filter ventilation and smokers’ perception of health risks. “Cigarettes with ventilation are milder, and people think they are less harmful, but it is a false perception,” she explained. “One study showed higher rates of lung adenocarcinoma among people who smoke ventilated cigarettes.” This suggests that those who smoke ventilated cigarettes may be more responsive to flavor bans due to their perception of harm reduction.
The research team emphasized the need for additional studies to fully understand the relationship between ventilation, menthol flavoring, and smoking behaviors. Freitas-Lemos noted, “I think the most important conclusion from this study is that we can improve health outcomes by emphasizing policies that reduce sales of flavored products and increase accessibility of nicotine replacement therapies.”
Policy Implications and Future Research
The study’s results could have significant implications for public health policies surrounding tobacco. By focusing on reducing access to menthol-flavored cigarettes and increasing access to cessation aids, public health officials could help reduce smoking rates among menthol smokers. As the FDA evaluates potential menthol bans, studies like this one provide essential evidence to support targeted regulations aimed at improving health outcomes across the population.
For further reading, the full study by Roberta Freitas-Lemos and her team, “Restrictions of cigarette and e-cigarette flavor and filter ventilation on demand and substitution in the Experimental Tobacco Marketplace,” can be found in Drug and Alcohol Dependence, 2024.
