The addition of menthol to cigarettes likely resulted in increased smoking and nicotine dependence (ND) among youth in the United States, according to results of a cohort study, published in JAMA Network Open.

Data for this study were sourced from the Population Assessment of Tobacco and Health (PATH) Study which collected data from 2013 to 2019 in 5 waves. Nationally representative youth aged 12-17 years were evaluated for any past 30-day cigarette smoking during any study waves. Trends in smoking frequency and ND were evaluated on the basis of menthol use. ND ranged from 7 (no dependence) to 35.

The study participants (N=1096) were comprised of 50.6% boys, 67.2% were White, 60.5% reported household tobacco use. They spent 11.3 (95% CI, 9.5-13.0) hours around smokers, 57.2% reported lifetime drug use, they smoked 5.3 (95% CI, 4.7-5.9) days during the previous 30 days, and the mean ND score was 10.2 (95% CI, 9.8-10.5).

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More youth reported using menthol cigarettes (n=848). Stratified by menthol use, menthol users reported smoking cigarettes on 12.8 days in the previous 30 days compared with 9.4 smoking days in nonmenthol users (n=644). Similarly, more menthol users reported smoking on ≥20 of the previous 30 days (34.1% vs 22.5%).

Stratified by transitions, 261 reported maintaining using menthol, 120 switched from menthol, 93 switched to menthol, 494 reported starting smoking with menthol cigarettes, and 410 reported started smoking with nonmenthol cigarettes.

Menthol use was associated with increased risk for being a frequent smoker (adjusted risk ratio [aRR], 1.38; 95% CI, 1.12-1.70) and an 8% higher ND score. Switching from menthol was associated with decreased risk for being a frequent smoker (aRR, 0.68; 95% CI, 0.50-0.92) and a 3% lower ND score.

This study was not designed to evaluate motivations for changing smoking behaviors nor did the PATH study evaluate whether individuals smoked exclusively menthol cigarettes.

“The findings of this cohort study suggest that the addition of menthol to cigarettes is associated with increased smoking frequency and ND among youth. As such, these results provide strong support for recommendations to ban menthol as a characterizing flavor in cigarettes as a protection for youth,” concluded the study authors.


Leas EC, Benmarhnia T, Strong DR, Pierce JP. Use of menthol cigarettes, smoking frequency, and nicotine dependence among US youth. JAMA Netw Open. 2022;5(6):e2217144. doi:10.1001/jamanetworkopen.2022.17144