What comes to mind when you hear the word “menthol”?
Soothing, refreshing, cool?
What if you read the words “menthol cigarettes”?
You might also think “soothing, refreshing and cool”, and perhaps “less harmful” or “safer”.
Why then, did the US Food and Drug Administration (FDA) recently issue rules that, if finalised, will prohibit menthol in cigarettes across all American states?
Masking taste and pain
Tobacco kills up to half of its users.
This leads to the death of more than eight million people every year, of which more than one million are deaths in non-smokers exposed to secondhand smoke.
The vast majority are victims of nicotine, one of the most addictive substances known to man.
Flavours tend to enhance the addictive nature of nicotine.
It also significantly increases tobacco use because it enhances the appeal of tobacco, especially among youth and young adults.
Studies have shown that 80% of youths become addicted to tobacco after having started with flavoured tobacco products.
Flavours such as menthol give the false impression that it is safer, especially as the cooling sensation makes it more palatable by masking the harshness and bitterness of tobacco.
Menthol is a compound that has a minty cooling effect when added to cigarettes.
It also has the additional advantage of blocking pain receptors in the mouth and throat.
Instead of being less harmful, menthol masks the bad taste of cigarettes, which actually lead to individuals taking deeper breaths when smoking these cigarettes.
Targeting youth and minorities
There is a long history of aggressive and targeted marketing of flavoured tobacco products.
This, alongside specific and well-conceptualised package designs and colours, have lured youth into experimentation with tobacco products.
Unfortunately, it takes less than one packet of cigarettes to become addicted, and consequently lead individuals to lifelong use and premature death.
The above factors are the predominant concerns of the US FDA, and the rationale for wanting to ban at least one form of tobacco in order to reduce the prevalence of smokers (it is worth noting that menthol cigarettes account for more than one-third of all cigarettes sold in the United States).
There is also concern in the US that the tobacco industry has especially targeted minority groups such as the Black and LGBTQ (lesbian, gay, bisexual, transgender and queer or questioning) communities with predatory forms of marketing when it comes to menthol cigarettes.
Nearly 85% of Black smokers use menthol cigarettes.
As of 2019, the US FDA found that there were 18.5 million people in the US who smoked menthol cigarettes.
The effect of bans
Flavoured tobacco products are already banned in some states in the US.
These include New York, Illinois and California.
The United Kingdom banned the sale of menthol cigarettes, menthol filters and papers, and “skinny” cigarettes in 2020 in an effort to stop youth from smoking.
A medical paper published in the JAMA Network Open journal examined the impact of the ban by using national surveys before and after the ban.
The authors found that the prevalence of teenagers who smoked menthol-flavoured products fell from 12% to 3% after the ban.
Another study published in the journal Tobacco Control looked at the impact of a similar ban in Canada, where menthol cigarettes were made illegal in 2017.
The study not only found evidence of decreased use, but also found that more adults who used menthol cigarettes went on to quit smoking altogether, compared to those who smoked non-menthol cigarettes.
Saying it’s ‘safer’
Flavoured tobacco products are said to be “safer” – one of many attempts to mislead us into thinking that one cancer-causing agent is better than another.
It is a similar tactic to that of some tobacco companies that have been more recently promoting the “less harmful” effects of heated tobacco products (HTPs).
These products heat up tobacco using electronic heating elements, releasing aerosol that is inhaled by the user (in contrast to the usual practice of burning tobacco and inhaling the smoke through a filter).
The lack of combustion ostensibly leads to a drop in health complications and has also been promoted as a quit smoking tool.
However, HTPs still contain chemicals that are toxic and carcinogenic.
These chemicals lead to high numbers of preventable diseases such as lung cancer, stroke, heart disease and emphysema.
A similar case can be made against electronic cigarettes (e-cigarettes or vaping products), which come in an array of colours and flavours.
Once again, there is concern that these are disproportionately and inappropriately targeted at youth.
Flavours such as strawberry and raspberry, with names such as Naked and Orgasm, are unlikely to be targeted at those who intend to quit smoking.
New legislation
The ongoing battle on flavoured tobacco products is part of the greater war against the tobacco industry’s persistent efforts in maintaining its customer base.
After all, it needs new addicts as current users die one by one.
Closer to home, the Health Ministry is proposing new measures to curb smoking prevalence.
There is a need for a new Act as current legislation is insufficient.
The Control of Tobacco Product Regulation (CTPR) 2004 controls only conventional cigarettes, while e-cigarettes that contain nicotine are regulated under the archaic Poison Act 1952.
A new Act that is more comprehensive will allow us to have the necessary tools to improve the rakyat’s health.
There are ongoing debates among the medical fraternity if these should not only include the generational endgame, but also include a ban on flavoured products, and even other “less harmful” options before they become more widespread.
Ultimately, the goal is to reduce the prevalence of smokers in Malaysia.
So, the next time you hear the words “menthol cigarettes”, instead of thinking “soothing, refreshing, cool” and “less harmful, safer”, perhaps think “dangerous, harmful and misleading”.
Dr Helmy Haja Mydin is a respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidence-based policies. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Already a subscriber? Log in
Get 20% OFF The Star Digital Access
Cancel anytime. Ad-free. Unlimited access with perks.
