In 2010, the US Food and Drug Administration's (FDA's) Tobacco Products Scientific Advisory Committee (TPSAC) delivered its report on menthol in cigarettes,1 and in 2013, the FDA issued its independent evaluation of the impact of menthol on public health.2 ,3 The reports are consistent in their main conclusions that (1) menthol in cigarettes increases experimentation and progression to regular smoking, and (2) that menthol in cigarettes makes it harder for smokers to quit, especially African–American smokers. A recent analysis of the National Survey on Drug Use and Health by Giovino et al documented the strong preference for menthol cigarettes among youth and echoed a 2011 report from the Substance Abuse and Mental Health Services Administration4 showing that menthol cigarette use remained stable from 2004 to 2010 in youth (aged 12–17 years) and adults (aged 26 years and older), and actually increased in young adults (aged 18–25 years), despite significant decreases in non-menthol cigarette use in all three age groups.5 Additionally, a 2012 report by Morgan Stanley showed menthol a gaining market share in total cigarette volume from 2005 to 2012, and also noted that menthol cigarettes had a higher share among 12–25-year-olds6 in the face of decreases in youth and young adult smoking.7

While previous research has highlighted menthol use among specific population groups, as well as market share of menthol, we could find no reports on overall menthol consumption. As such, we estimated menthol and non-menthol cigarette consumption from 2000 to 2011 by multiplying annual menthol market share, obtained from the Maxwell Reports,8 by annual cigarette consumption data as reported by the Alcohol and Tobacco Tax and Trade Bureau.9 As shown in figure 1, the decline in cigarette consumption is greater among non-menthol cigarettes (37%; 323.2 billion sticks in 2000 to 202.9 billion sticks in 2011) than for menthol cigarettes (20%; 112.4 billion sticks in 2000 to 89.9 billion sticks in 2011), and 89% of the total decline in cigarette consumption is attributed to non-menthol cigarettes. Possible explanations for these trends include higher rates of initiation for menthol versus non-menthol cigarettes, lower cessation among menthol smokers, increased consumption among current menthol smokers, switching from non-menthol to menthol, or a combination of any of these.

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Figure 1

Menthol and non-menthol cigarette consumption in the USA, 2000–2011.

This letter presents the third dataset showing an increased menthol market share in the USA, despite declining cigarette consumption over the past decade. Moreover, the decline in cigarette consumption is overwhelmingly attributed to decreases in non-menthol cigarette use. While these ecological data cannot tell us who is smoking menthol cigarettes, the trend is consistent with population data showing stable or increased menthol cigarette use in youth, young adults and adults concurrent with significant decreases in non-menthol cigarette use.4 ,5 While the FDA evaluation concluded that menthol did not differ from non-menthol with regards to toxicity, these ecological data point to the fact that menthol cigarettes are different from non-menthol cigarettes, and bolster TPSAC's conclusion that menthol in cigarettes increases regular smoking and results in lower likelihood of smoking cessation.