When the U.S. Food and Drug Administration (FDA) banned cigarette flavors such as candy, fruit and coffee in 2009 because they appealed to young people, the agency allowed tobacco companies to continue making menthol cigarettes. Earlier this year, when an FDA rule banning the sale of flavored e-cigarette products went into effect, menthol once again was exempted.
In response, two antismoking groups — Action on Smoking & Health (ASH) and the African American Tobacco Control Leadership Council — sued the FDA in June for failing to regulate menthol cigarettes, even though Congress urged the agency to do so in 2009. In September, the American Medical Association joined the suit as a co-plaintiff.
According to the FDA, more than 19.5 million Americans are current smokers of menthol cigarettes. Banning menthol is vital to reducing smoking, particularly among Black people and young people, says Linda Richter, Ph.D., Vice President of Prevention Research and Analysis at Partnership to End Addiction.
“Menthol plays an essential role in making tobacco products more appealing than they otherwise would be, especially for people who are less prone to use them. These include Black people and young people,” she said. “The tobacco industry has heavily marketed menthol products to these groups.”
The results have been devastating to the health of the Black community, Richter said. The lawsuit states that if menthol had been taken off the market by 2010, 4,700 fewer Black people would have died prematurely by this year, and 461,000 Black people would not have taken up smoking.
“We know tobacco-related disease is the number one cause of death in the Black community. The vast majority of Black smokers — almost 90% — use menthol products. That’s about double the rate of other minority ethnic or racial groups and triple that of white smokers,” she said. “Banning menthol would be one of the most significant things we could do to reduce racial health disparities.”
Flavored tobacco products are very popular among young people, and help get them hooked on regular cigarettes and vaping products, Richter said. According to the Centers for Disease Control and Prevention (CDC), 85% of high school students and 74% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time.
Menthol, made from mint oils, isn’t particularly dangerous on its own. It is added to tobacco products to relieve throat irritation. “It produces a cooling feeling when added to tobacco products and tempers the harshness of smoke and nicotine in the throat,” Richter said. “In general, people who first start smoking, vaping or using any other tobacco products tend to start with flavored products. Now that the FDA has banned other flavors, menthol is the only option.”
Because menthol makes cigarettes and other tobacco products easier to use, it encourages people who try menthol products to stick with them, she explained. Since the nicotine found in cigarettes and vaping products is addictive, the more a person uses these products, the harder it is to quit.
During the COVID-19 pandemic, smoking prevention has become more important than ever, Richter noted. “We know smoking and vaping are significant risk factors both for contracting COVID, and for worse outcomes for people who have it.” According to the CDC, being a current or former cigarette smoker increases a person’s risk of severe illness from COVID-19.
“Black people are more likely to have higher rates of diabetes, heart disease and lung disease — all of which increase the risk of bad outcomes from COVID. This makes smoking and vaping particularly dangerous for them,” she said.
The FDA has repeatedly failed to act on menthol even though it has been known for years that it hooks people on tobacco products, Richter said. She pointed to a report, “Time to Ban Menthol,” by Partnership to End Addiction’s predecessor, CASAColumbia, which in 2014 summarized the evidence for the role of menthol in increasing the risk of smoking initiation and addiction involving nicotine and decreasing smokers’ chances of successfully quitting.
“Multiple studies have shown that young people and Black people say if menthol were banned, they’d quit instead of switching to another tobacco product,” Richter said. “The FDA is tasked with protecting the health of Americans, but instead they are protecting the financial interests of the tobacco industry.”