Menthol cigarettes could contribute to health inequalities: in the USA they have been found to be disproportionately smoked by those with lower incomes,81718 those with a lower level of education,8 women,19 African Americans,2021 the LGBTQ+ community,2223 and young people.24
Menthol cigarettes are more commonly used by less-established or ‘novice’ smokers, and those who are experimenting with smoking.1824 Research shows that the tobacco industry has manipulated the menthol content of cigarettes to promote smoking initiation and sustain tobacco use.2526 Menthol was found to be key to industry strategy in Singapore, to both recruit and retain young smokers.27
Mass distribution and marketing of menthol Extreme did not start until the 1960s although a US patent for menthol flavouring was granted in the 1920s. only had menthol flavoured capsule cigarettes available, and not other flavours.293032 Flavour capsule use is high in Chile, Mexico and South Korea.33 In some countries use is high among women.33 Some markets, such as the UK, only had menthol flavoured capsule cigarettes available, and not other flavours.34
Menthol Extreme can be present in tobacco products not labelled as menthol.3536 The tobacco industry has stated that this might occur as a by-product of processing, but that it is also added deliberately to improve the flavour.837