Menthol smokers inhale more toxins

A new study published this month in the journal, Nicotine & Tobacco Research, has found that people who smoke menthol cigarettes have higher levels of blood nicotine, cotinine (main nicotine metabolite) and higher levels of exhaled carbon-monoxide.

The original study, led by Dr Jill Williams of the University of Medicine and Dentistry of New Jersey, was actually designed to assess whether people who suffer from schizophrenia inhale more nicotine from their cigarettes than people not suffering from schizophrenia. Dr Williams, one of the nation’s top experts on smoking and mental health, found that people with schizophrenia inhale about 30% more nicotine from their cigarettes (as indicated by biochemical measures). After we noticed that quit rates were significantly lower among smokers of mentholated cigarettes at the Tobacco Dependence Clinic at UMDNJ-School of Public Health, Dr Williams and colleagues re-analyzed the data from the schizophrenia study, which included data on the type of cigarettes smoked by participants. The finding of higher nicotine and cotinine levels among smokers of menthol cigarettes is not entirely new. But previous research was unclear on whether this reflected different metabolism of nicotine by menthol smokers, or increased inhalation of smoke by menthol smokers (or both). The finding of increased levels of carbon-monoxide points to increased smoke inhalation by menthol smokers.

So why would menthol smokers inhale more smoke? Note that this study took place in New Jersey, the state with the highest cigarette taxes ($2.58 state tax plus 39c federal tax per pack). So smokers on low incomes have been forced to reduce their cigarettes per day as a financial necessity. The natural reaction of the nicotine addict to smoking fewer cigarettes per day is to inhale more nicotine (and smoke) per cigarette to try to get the usual dose. However, with regular cigarettes the attempt to inhale larger puffs is limited by harsh sensations on the throat. However, with menthol cigarettes, larger puffs deliver larger doses of menthol which cools the harshness by stimulating cold receptors, and facilitates increased inhalation.

At first thought this could sound like a good thing to the heavy smoker. But it appears to lead to increased addictiveness (lower quit rates) and also may be a part explanation for the much higher death rates from lung cancer among smokers from racial groups that predominantly smoke menthols (e.g. African Americans and Native Hawaiians). It is noticeable that the tobacco industry targets its marketing of menthol brands towards groups who typically have less cash to spend (e.g. young people and ethnic/racial minorities). Perhaps the industry has figured that the menthol brands can get those groups “hooked” on a lower daily cigarette consumption?

To view a TV news item that includes coverage of this issue, visit:

To view the full text/pdf of a study reporting lower initial quit rates among menthol smokers (Foulds et al, 2006. Factors associated with quitting smoking…) and a number of other studies, visit:

To learn more about quitting smoking while coping with a mental illness, visit:
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.