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In 2009, Congress enacted legislation authorizing the U.S. Food and Drug Administration to comprehensively regulate tobacco and nicotine products. Included in that legislation was the prohibition of flavorings in cigarettes. But the statute excluded menthol as a compromise with the tobacco industry. The law did, however, allow the FDA to examine potential justifications for banning menthol based on public health benefits.
Menthol in tobacco is a serious public health problem. According to the Centers for Disease Control and Prevention, menthol increases the addictiveness of nicotine. Additionally, menthol cigarettes are an easy entryway for adolescents to initiate smoking since they blunt the harshness of tobacco smoke.
Furthermore, according to the CDC, menthol cigarettes have been aggressively marketed to African Americans, creating a significant disparity in use. That marketing has been extraordinarily successful. Eighty percent of Black smokers use menthol cigarettes, compared with 34% of white smokers. In the 1950s, less than 10% of Black smokers used menthol cigarettes.
The Campaign for Tobacco-Free Kids states that the tobacco industry’s targeting of Blacks “has been deliberate, sophisticated, and comprehensive … through magazine ads, sponsorships of community and music events, retail promotions, and even handing out samples in Black communities.” Menthol cigarettes continue to be more heavily advertised and priced cheaper in Black communities.
The use of menthol cigarettes is also disproportionately high among other groups, including other communities of color, the LGBTQ+ community, socioeconomically disadvantaged populations, those with mental health conditions and pregnant women.
Unusually high rates of tobacco adoption with resultant deaths due to menthol cigarettes among Blacks are well-documented. According to TFK, menthol cigarettes have been responsible for 378,000 overall premature deaths from 1980 to 2018, with 41% of those deaths involving Black Americans. TFK also reports that going forward, one-third of the lives that could be saved by banning menthol cigarettes would be among African Americans.
Anti-tobacco public health advocates have long pressed for banning the sale of menthol cigarettes and flavored cigars. Finally, in late 2023, the FDA under the Biden administration was moving to do just that.
The Biden administration met with various groups that oppose the menthol prohibition, including some civil rights groups. There was opposition from some civil rights leaders due to potential concerns about prosecution of individual menthol smokers. The FDA was clear about to whom the menthol regulation would apply. The agency stated that “it cannot and will not enforce against individual smokers for possession or use of menthol cigarettes or flavored cigars. … FDA enforcement will only address manufacturers, distributors, wholesalers, importers, and retailers … that are not in compliance with applicable requirements.”
Unfortunately, the move was indefinitely delayed, likely due to fear of a political backlash from Black voters before the 2024 elections. The Trump administration failed to pick up the fumbled ball. In January, the administration officially withdrew the proposed FDA rule that would have banned menthol in cigarettes.
The support for menthol prohibition includes the African American National Medical Association, the NAACP and the Congressional Black Caucus. Other supporting groups include the U.S. Conference of Mayors, physician professional organizations, state attorneys general, faith leaders and others.
Beginning in 2019, a number of states have banned all or some flavored cigarettes, including flavored vapes. Many have included menthol. Despite the tobacco industry’s aggressive opposition to the menthol cigarette ban, it is time for the federal government to do the right thing and prohibit menthol in cigarettes and vapes.•
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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to [email protected].
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