Why is Menthol Added to Cigarettes?

Menthol in Cigarettes – The Soothing Taste Makes Smoking More Appealing

Dear Dr. Mahler:

I am writing about my father who smokes about 10 menthol cigarettes each day even though he has moderate COPD. He believes that this counteracts the nicotine and toxins in cigarette smoke. He uses two different inhalers to breathe each day. I notice a lot of advertisements promoting mentholated cigarettes. Please provide information to share with my father. Thanks.

Jasmine from Newark, NJ

Dear Jasmine,

Menthol is a natural substance found in mint plants, such as peppermint and spearmint. It gives a soothing sensation, and may be used to relieve minor pain and irritation.

Mint plant contains menthol

Mint plant

Why do Tobacco Companies Add Menthol to Cigarettes?

Newport is the most popular menthol cigarette

Newport is a popular menthol cigarette in the US

The “soothing” taste allows many smokers to feel less irritation in their throat while smoking and to take deeper breaths.  It is currently the only flavor that be added to cigarettes by law. Metholated cigarettes represent about 25% of all cigarettes on the market with Newport being the most popular brand in the US.



Is There Harm in Smoking Mentholated Cigarettes? In 2013, the US Food and Drug Administration published a report that menthol cigarette use is one reason that young adults start smoking. Also, the report cited evidence that menthol in cigarettes is associated with greater nicotine addiction. Mentholated cigarette users are also less likely to successfully quit smoking.

Can Menthol Contribute to Nicotine Addiction? Studies show that it reduces metabolism (the breakdown) of nicotine by the body.   

What About Mentholated Cigarettes in African-Americans? In the United States, menthols comprise about 30% of the total cigarette market. However, these flavored cigarettes are purchased disproportionately by African-American smokers as more than 80% of African-American smokers currently use mentholated cigarettes. This may be a result, at least in part, of adds, discount coupons, and free samples of metholated cigarettes targeted at this group. Studies show that African-Americans suffer higher rates of smoking related health problems even though they smoke at similar rates as Caucasians.

Jasmine – Please share this information with your father. Hopefully, it will help him decide that it is time to quit smoking.


Donald A. Mahler, M.D.

Women Who Never Smoked are Vulnerable to Develop COPD

African-American Women are Susceptible to COPD

Background: COPD is the 3rd leading cause of death in the United States and a main cause of disability.  The prevalence (how often it occurs) has been higher among women than men in most age groups for over 20 years. One reason is that females have narrower breathing tubes allowing cigarette smoke to be more concentrated in their overall smaller lungs. Although cigarette smoking is the major risk factor for the disease, never-smokers may also develop COPD.

Study:  Esme Fuller-Thomson, Ph.D., and colleagues from the University of Toronto published the results of an observational study to examine gender and racial differences for developing COPD among never smokers. The researchers reviewed information on 129,535 Caucasians and African-Americans who were 50 years of age and older who had never smoked. The findings were published in the 2016 International Journal of Chronic Diseases.  http://dx.doi.org/10.1155/2016/5862026

Never-smoking African-American women are at risk for COPD

African-American woman at risk for COPD

Results: Women had a significantly higher chance of developing COPD than men. In particular, African-American women had the highest prevalence of COPD (7.0%) followed by Caucasian women (5.2%), Caucasian men (2.9%), and African-American men (2.4%).

Discussion: The authors suggested that differences in lung size may be a factor for higher likelihood in females. Other possibilities are the role of hormones and exposure to second-hand smoke. Dr. Fuller-Thomson commented that, “We cannot determine causality with this data set, but poverty is associated with increased exposure to city environments. Future research needs to investigate if these factors play a role in the greater vulnerability of African-American females.”

My Comments: These results raise many questions. Why are there sex differences in never smokers developing COPD? Why are there differences in COPD between Caucasian and African-American females?

It is important that health care professionals consider testing older individuals who complain of shortness of breath or persistent cough including those who are never smokers.

According to the CDC, COPD Deaths Down for Most Americans

From 2000-2014, 12% Drop in COPD deaths in the US

Background: COPD is the 3rd leading cause of death in the United States after heart disease and cancer. None of the available medical treatments for those with COPD, such as inhaled medications, have been shown to affect mortality.

Report: The Center for Disease Control and Prevention, known as the CDC, reported on September 8, 2016, that between 2000 and 2014, there was a 12% overall drop in COPD deaths. Dr. Hanyu Ni, a co-author of the findings, commented that the findings were not unexpected because, “they are consistent with the declines in the prevalence of current smoking for men and women in the United States.” The results were reported in the US National Center for Health Statistics.

COPD includes chronic bronchitis and emphysema.

COPD includes chronic bronchitis and emphysema.

COPD deaths were analysed by sex and race. For women, there was little change for Caucasians, while African-Americans had a 4% increase in death rate over the 14 years. For men, Caucasians experienced a drop of 21%, and African-Americans had a decline of about 24%.

Reduced smoking may explain the overall decline in COPD deaths.

Man and woman smoking a igarettte

Dr. Ni commented that the analysis did not explore the reasons for the trends. However, he stated that the figures weren’t unexpected noting that the declines in COPD deaths are consistent with fewer women and men currently smoking in the U.S.

David Mannino, M.D., Professor and Chair of the Department of Preventive Medicine and Environmental Health at the University of Kentucky.

David Mannino, M.D., Professor and Chair of the Department of Preventive Medicine and Environmental Health at the University of Kentucky.

Dr. David Mannino suggested that additional factors unrelated to smoking might affect COPD deaths. He proposed that poverty and/or lack of access to health care “may explain some the racial differences.”