April 14, 2022
Researchers at The University of Kansas Cancer Center have received a five-year, $3.9 million grant to explore the effectiveness of menthol-flavored versus tobacco-flavored electronic cigarettes in helping smokers stay away from cigarettes and improve their health. The grant is funded by the National Institute on Drug Abuse and the Food and Drug Administration.
In the U.S., nearly 18.6 million current smokers use menthol cigarettes. But use of menthol cigarettes among smokers is not consistent across different groups: As a result of targeted advertising of menthol to racial and ethnic minority communities, nearly 85% of all Black users smoke menthol cigarettes. Just 30% of white smokers use menthol cigarettes.
Nikki Nollen, PhD, co-leader of the cancer center’s Cancer Prevention and Control research program will lead the project. Dr. Nollen’s team is one of the only groups in the country exclusively focused on improving tobacco use treatment outcomes in African American smokers with the goal of reducing tobacco-related disparities.
In 2018, the FDA put forth new restrictions blocking the sale of e-cigarettes in all flavors except menthol and tobacco in stores where minors can shop. In 2021, the Food and Drug Administration announced it would ban all menthol cigarettes and flavored cigars. The regulation is on track to be finalized by spring 2022 but the timeline for implementation may take many years. Menthol-flavored e-cigarettes were not included in the most recent ban.
While a ban on menthol-flavored e-cigarettes may limit the number of young people who start vaping, some worry it may also discourage adult menthol smokers to switch to e-cigarettes. This could limit menthol smokers’ options to switch to a more-safe method of using nicotine. Ultimately, it could worsen disparities amongst minorities. Menthol cigarettes are higher in nicotine and more addictive. The cooling sensation of menthol allows smokers to inhale more deeply. This may be one of the primary reasons that Black smokers take in as much as 30% more nicotine and carcinogens than whites.
Making the switch
Studies have demonstrated that switching to e-cigarettes may be a safer option compared to traditional smoking. Dr. Nollen led a study and found that switching to e-cigarettes led to a short-term drop in a tobacco-specific lung carcinogen known as NNAL, as well as a reduction in carbon monoxide and self-reported respiratory symptoms. According to Dr. Nollen, that is why the FDA has identified the impact of e-cigarette flavoring on smoking patterns a research priority.
“Our research has consistently shown that menthol cigarettes are more addictive and harder to quit,” Dr. Nollen said. “With this study we hope to shed some light on the usefulness of menthol-flavored e-cigarettes as a tool for smokers to make the switch, and ultimately provide guidance to the FDA as they consider new regulations.”
Dr. Nollen and her team recently wrapped up a small randomized clinical trial providing menthol or tobacco e-cigarettes to smokers. Among menthol smokers, they discovered those who used tobacco flavored e-cigarettes were just as likely to successfully switch to e-cigarettes as those who used the menthol-flavored ones. Their findings are consistent with observational studies that have found that nicotine, not flavor, drive e-cigarette use in adults. It provides strong early evidence to support restrictions on menthol-flavored e-cigarettes.
The grant will support a 12-week randomized trial studying menthol cigarette users and their ability to successfully switch to either menthol e-cigarettes or tobacco e-cigarettes. Participants will be monitored for 26 weeks.
“The FDA’s decision to ban menthol cigarettes is an important step to close the gap in tobacco-related disease and death disproportionately experienced by Black smokers,” Dr. Nollen said. “But we don’t have enough data to know if including menthol-flavored e-cigarettes in the ban would be helpful or cause more harm. This study will help uncover any possible unintended consequences of banning menthol e-cigarettes.”