Why ending menthol cigarette sales would benefit disproportionally affected groups

Topic

Traditional tobacco products

Subtopic

Menthol

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Menthol: Facts, stats and regulations

5 important things to know about the removal of menthol cigarettes and flavored cigars from the market

The Food and Drug Administration (FDA) proposed rules to end the sale of menthol cigarettes have the potential to save millions of lives, including many of disproportionally affected populations.

As of October 2023, the FDA's proposed rules to remove menthol cigarettes and flavored cigars from the market have been finalized and sent to the White House Office of Management and Budget for review, marking a momentous step toward a major public health victory. This development has been long-awaited since the FDA announced the proposal in April 2021.

“The proposed rules [to end menthol cigarettes and flavored cigar sales] would help prevent children from becoming the next generation of smokers and help adult smokers quit. Additionally, the proposed rules represent an important step to advance health equity by significantly reducing tobacco-related health disparities,” said Health and Human Services Secretary Xavier Becerra.

The removal of menthol cigarettes and flavored cigars would reduce health disparities because these products are not equal opportunity killers; Black Americans and other populations targeted by the tobacco industry – including LGBTQ individuals, women, youth, and those living with mental health conditions – have long faced a disproportionate burden from tobacco-related diseases and death.

Menthol cigarettes are easier to smoke and more difficult to quit, because the flavor reduces the harshness of the cigarette smoke and suppresses the coughing reflex. According to numerous studies, young people are more likely to smoke a menthol cigarette as their first cigarette rather than a non-menthol cigarette, and those who start with menthol cigarettes first are also more likely to continue smoking. In 2023, 40.4% of middle school and high school students who currently smoked cigarettes reported using menthol cigarettes, according to the National Youth Tobacco Survey. To protect young people and all other groups historically targeted by the tobacco industry with menthol cigarettes and flavored cigars, Truth Initiative urges the FDA to finalize the rule and remove these products from the market.

Here are several disproportionally affected populations who will benefit if menthol cigarettes are removed from the market.

Black Americans

The tobacco industry has strategically and aggressively targeted Black Americans with menthol cigarettes for decades by placing more advertising in predominantly Black neighborhoods and publications, appropriating culture in marketing, and sponsoring events such as jazz and hip-hop festivals. As of 2020, 81% of Black smokers use menthol cigarettes.

Black smokers have a harder time quitting smoking and die at higher rates from tobacco-related diseases such as cancer, heart disease, and stroke, partly due to menthol cigarettes and tobacco industry targeted marketing. Menthol cigarettes alone were responsible for 378,000 premature deaths over the 38-year period from 1980 to 2018 according to a February 2021 study published in Tobacco Control, and of those premature deaths, 157,000 were among Black Americans.

Tobacco industry has fueled false claims that eliminating menthol cigarettes will put Black Americans at greater risk from law enforcement

The tobacco industry has attempted to spread fear that menthol bans unfairly target Black Americans and would lead to further criminalization of the community. The tobacco company R.J. Reynolds, maker of the leading menthol cigarette brand Newport, recruited prominent Black leaders including civil rights activist Rev. Al Sharpton, to host town halls across the country on the subject. The tobacco industry also implemented a media blitz of television and social media ads in 2020 to fight a California bill prohibiting the sale of most flavored tobacco products, arguing that it would increase racial profiling by law enforcement, “giving special treatment to the rich, and singling out communities of color.”

However, the FDA has made it clear since April 2021 that enforcement of the rules would be focused on manufacturers and retailers, not individual consumers. The agency reiterated in its April 28 announcement that it “cannot and will not enforce against individual consumers for possession or use of menthol cigarettes or flavored cigars” and that its proposed product standards would “only address manufacturers, distributors, wholesalers, importers, and retailers who manufacture, distribute, or sell such products within the U.S. that are not in compliance with applicable requirements.”

Hispanic/Latino Americans

In the 1970s and 1980s, the tobacco industry began to develop interest in the growing Hispanic/Latino population and launched related marketing initiatives. Internal documents revealed the industry’s interest in the community was due to the fact they deemed the population “lucrative,” “easy to reach,” and “undermarketed.” More recently, the industry has sponsored Hispanic/Latino cultural events, provided scholarships, and made contributions to Hispanic/Latino political action committees – in addition to compensating Hispanic/Latino merchants for displaying advertisements in predominantly Hispanic/Latino communities.

Nearly 1 in 10 Hispanic/Latino adults currently smoke cigarettes. Although this is lower than the national smoking rate of 13.7%, more than 43,000 Hispanic/Latino Americans are diagnosed with a tobacco-related cancer each year and more than 18,000 die as a result. From 2008 to 2010, menthol cigarette use among young adult current smokers (ages 18 to 25) was 47.3% among Hispanics. Tobacco use among Hispanic/Latino youth is also cause for concern. Current use of any tobacco product was 17.2% among Hispanic middle and high school students in 2020, versus 13.2% for non-Hispanic Black and 10.1% for non-Hispanic students of other races. Studies show significantly reduced rates of quitting among Black Americans and Hispanic menthol smokers compared with non-menthol smokers.

The LGBT community

Since as early as the 1990s, the tobacco industry has used a multitude of methods to target the LGBT community, including by advertising in LGBT publications, depicting tobacco use as a normal part of LGBT life, using corporate philanthropy as evidence of its support of the LGBT community, participating in giveaways, and hosting community outreach efforts (e.g. “LGBT bar nights”) featuring specific cigarette brands. In 1995, the tobacco company R.J. Reynolds created a marketing strategy called “Project SCUM” (Sub-Culture Urban Marketing) to boost cigarette sales by targeting gay men and homeless individuals with advertisements and displays placed in communities and stores.

Today, LGBT smokers are significantly more likely to smoke menthol cigarettes. More than 36% of LGBT smokers report that they usually smoke menthols, which are easier to use and harder to quit, compared to 29% of heterosexual/straight smokers. Current tobacco use among LGB students is 14.2%, compared to 7.9% among heterosexual students, and 18.9% among transgender students, compared to 8.2% among cisgender students. Transgender youth reported using cigarettes at 4x the rate of cisgender youth. Removing menthol cigarettes could help stop the cycle of addiction among LGBT youth.

Women

The tobacco industry has a long history of targeting women with menthol cigarettes and continues to target women with cigarette advertising themes related to sex appeal, independence, and stylishness, among others. By the 1960s, tobacco companies began capitalizing on a growing women’s movement by marketing cigarettes with slogans like “It’s a woman thing” and “You’ve come a long way, baby.”

Today in the U.S., 1 in 8 women is a smoker and is nine percent more likely to smoke menthol cigarettes (44%) than a man who smokes (35%). Although overall smoking rates have decreased over the years, they have not dropped as quickly for women as for men. Since 2005, smoking rates among women have declined by 25.4%, compared with a 26.8% decline among men. Every year, smoking-related diseases kill more than 200,000 women, making it the largest preventable cause of death among women in the U.S.

People living with mental illness

Menthol cigarette smoking is also more prevalent among those living with mental illness. People with mental health conditions and substance use disorders are estimated to account for 40% of cigarettes smoked in the U.S., despite only making up 25% of the population.

The tobacco industry has invested significant resources to connect tobacco with mental health, including giving away cigarettes to psychiatric facilities, supporting research that positions cigarettes as a way to self-medicate, and using stress relief themes in marketing. Tobacco users who currently used menthol-flavored tobacco products reported anxiety and depression at higher prevalence than non-menthol tobacco users. Menthol cigarette use also was correlated with more lifetime psychiatric hospitalizations in a study of young adult smokers with severe mental illness.

Truth Initiative research shows most adults (56.4%) support a federal rule to eliminate menthol cigarettes, the last remaining flavored cigarette still sold in the U.S. Support was especially strong among Black Americans (60.5%), women (62.5%), and Hispanic/Latinos (69.3%). More than 1 in 4 current menthol smokers (28.5%) favored the rule.

The public comment period for the FDA proposed rules on menthol cigarettes and flavored cigars ended on Aug. 2, 2022. Truth Initiative submitted comments on both rules and joined 103 other organizations in submitting joint comments. Truth Initiative urges the FDA to implement its regulations expeditiously to turn its decisions into life-saving action.

This article was originally published on September 23, 2022.