摘要：Objectives. We examined whether tobacco manufacturers manipulate the menthol content of cigarettes in an effort to target adolescents and young adults. Methods. We analyzed data from tobacco industry documents describing menthol product development, results of laboratory testing of US menthol brands, market research reports, and the 2006 National Survey on Drug Use and Health. Results. The tobacco industry attracted new smokers by promoting cigarettes with lower menthol content, which were popular with adolescents and young adults, and provided cigarettes with higher menthol content to long-term smokers. Menthol cigarette sales remained stable from 2000 to 2005 in the United States, despite a 22% decline in overall packs sold. Conclusions. Tobacco companies manipulate the sensory characteristics of cigarettes, including menthol content, thereby facilitating smoking initiation and nicotine dependence. Menthol brands that have used this strategy have been the most successful in attracting youth and young adult smokers and have grown in popularity. The future of the tobacco industry depends on maintaining current users and recruiting new users to replace older smokers who quit or die from tobacco-related diseases. The industry develops product innovations to encourage experimentation and use among targeted groups. Although the primary goal is to promote or maintain nicotine addiction, new products can also enhance appeal, facilitate nicotine dosing (the amount, method, and frequency of nicotine ingestion that is characteristic of cigarette smoking), and mask toxic and irritating effects. Menthol, a monocyclic terpene alcohol that acts as a stimulant for cold receptors, is used as an additive in approximately 90% of cigarettes manufactured in the United States. 1 Most of these cigarettes contain imperceptible amounts of menthol (approximately 0.03% of cigarettes’ tobacco weight), but tobacco companies promote specific brands as mentholated. 1 These brands, which contain between 0.1% and 1.0% of their tobacco weight in menthol, impart a noticeable cooling sensation and mintlike flavor when inhaled. Brands marketed as menthol cigarettes composed 27% of the US cigarette market in 2005. 2 Hersey et al. found that menthol use among adolescents increased between 2000 and 2002, with the highest use among younger, newer smokers, and suggested that menthol cigarettes may be a starter product for adolescents. 3 Younger smokers may tolerate menthol cigarettes, with their milder sensory properties, better than harsher nonmenthol cigarettes. In cigarettes formulated with lower levels of menthol, so that the menthol flavor and effect are less dominant, the menthol primarily masks harshness, making smoking initiation easier. 4 – 8 Adolescents who experience fewer adverse physiological effects from smoking are more likely to progress from experimentation to regular smoking. 8 , 9 It is not known whether tobacco companies have systematically altered menthol content in brands to target and recruit new smokers. Few published studies have examined differences in the physical design of menthol cigarettes. 10 – 16 Celebucki et al. characterized levels of menthol in 48 commercial cigarette varieties, 17 and a recent paper by Kreslake et al. described factors associated with preferred menthol levels among smokers, including age, race/ethnicity, and duration of menthol use. 8 Three major brands (Kool, Salem, and Newport) have dominated the menthol market, and each features distinct sensory attributes targeted to specific groups. Kool has traditionally been the strong menthol brand, smoked primarily by older (aged ≥ 35 years) African American men who are long-term smokers. 8 , 18 Salem is used primarily by older smokers and female smokers. 1 Newport has lower levels of menthol and is the most popular brand among younger African American smokers (69% of smokers in middle school and high school used Newport in 2000); it is the second leading brand after Marlboro among all adolescents. 1 , 19 We explored tobacco industry manipulation of menthol in brands as a strategy to appeal to adolescents and young adults and the repercussions in product design, advertising trends, and usage. We reviewed internal tobacco industry documents, conducted laboratory tests, examined industry marketing reports for advertising expenditures (for mentholated vs nonmentholated brands), and analyzed a national survey on usage.
