FDA menthol cigarette ban hailed as triumph, especially for Black health

A proposed ban on menthol cigarettes announced Thursday by the U.S. Food and Drug Administration could have a dramatic impact on combating smoking and reducing health disparities, particularly among African American, Michigan advocates and health experts said.

“This is historic,” said Mikisha Plesco of the Grand Rapids African American Health Institute, a nonprofit health education and advocacy organization.

“We know about the high smoking rates of menthol cigarettes for Blacks, so when we move on a smoking ban it has a dramatic impact on lung cancer, stroke, heart disease. We are so excited we are going to be able to reduce in those areas, to have a healthier community.”

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Her perspective is buttressed by a 2021 University of Michigan study that found while African Americans represent about 12 percent of the U.S. population, they accounted for 41 percent of all menthol-smoking-related premature deaths in the United States between 1980 and 2018. African American males also have far higher rates of lung cancer. 

It’s estimated anywhere from 77 percent  to 85 percent of Black adult smokers in the U.S. smoke menthol cigarettes, compared to 25 to 30 percent of white adult smokers. According to the U-M study, menthol cigarettes were responsible for 157,000 premature deaths and 1.5 million life-years lost among Black smokers in the years between 1980 and 2018. 

A Detroit-area advocate for health equity praised the FDA announcement, calling it “long overdue.

“It’s definitely a step in the right direction, but I am just hoping the FDA moves swiftly to enforce this,” said Minou Jones, chair of the Detroit Oakland Tobacco Free Coalition and founder of Making It Count, a Detroit-based nonprofit that supports tobacco-free communities.

Jones noted that cigarettes have exacted a painful toll on her family, adding: “I lost my grandmother to lung cancer and my father has emphysema and (chronic obstructive pulmonary disease) because he was a menthol cigarette user.”

Another U-M researcher pointed to a study — still under review — that projects the menthol ban would save 255,000 U.S. Black lives and add 3.9 million years in lives gained by 2060.

“The hope is that the ban will encourage current smokers to quit and prevent some people from smoking,” Rafael Meza, professor of epidemiology and global public health at the University of Michigan, told Bridge.

Menthol is a flavor additive derived from mint, peppermint oil or made synthetically. It is added to reduce the harshness of tobacco and also has a cooling or numbing effect that allows users to draw in more nicotine. The minty taste also makes smoking easier and more attractive to teenagers, according to the FDA, which said more than 18.5 million Americans ages 12 and older smoked menthol cigarettes in 2019.  

“Menthol cigarettes kind of eases people into smoking,” Meza said. “It serves as a gateway to regular smoking.”

Noting the health toll on Black smokers and other racial and ethnic minorites, advocates for a menthol ban have traced the product’s popularity in part to marketing campaigns by tobacco producers that date as far back as the 1950s, targeting Black smokers for brands like Kool and Salem. 

“It is well known that tobacco companies, in the 1960s and ’70s, targeted menthol cigarettes to African American communities, and menthol cigarettes became ubiquitous in those communities,” David Mendez, lead author of the study and an associate professor in the Department of Health Management and Policy at the U-M School of Public Health, said at the time of the study’s publication.

Such marketing is not a relic of the past. A 2018 study by researchers at the University of North Carolina, published in the journal Health and Place, found that exterior advertising and price promotions for menthol cigarettes are more common in Black, low-income neighborhoods, with cheaper deals in neighborhoods with more youth. 

If the proposed U.S. ban has the same impact as one enacted in Canada in 2017, it’s estimated that more than 1.3 million U.S. smokers would quit, including nearly 380,000 Black smokers.

The proposed ban — which also includes menthol in flavored cigars — was announced after intense lobbying by tobacco and retail interests who oppose the ban. The rule will be open for public comments for at least 60 days and finalized with possible revisions. It is expected that it will take at least a year to go into effect.

The tobacco companies appear likely to contest the rule in court, which could lead to a protracted legal battle.

The NAACP praised the proposed ban in a statement that said in part: “For decades, the tobacco industry has been targeting African Americans and have contributed to the skyrocketing rates of heart disease, stroke and cancer across our community. The tobacco industry is on a narrow quest for profit, and they have been killing us along the way.”

But support wasn’t unanimous among Black advocates, with some saying it could have unintended consequences. The Rev. Al Sharpton voiced concern that such a ban could lead Black smokers to seek out unregulated menthol varieties and promote “criminal activities.”

Sharpton, president of the National Action Network, wrote a letter to Susan Rice, the Biden administration’s Domestic Policy Council director, that said in part: “A menthol ban would impose serious risk, including increasing the illegal sale of smuggled, black market menthol cigarettes as well as the street sales of individual menthol cigarettes — ‘loosies’ and in turn place menthol smokers at a significant risk of entering the criminal justice system.”

Sharpton’s statements drew blowback from critics who noted his organization has received funding for decades from tobacco maker R.J. Reynolds. Sharpton declined to say how much the company has contributed. Reynolds produces Newport cigarettes, which it calls “America’s No. 1-selling menthol cigarette brand.”

Other African American critics of the ban argued that it unfairly targets Black smokers and will likely lead to more potentially violent encounters with police. 

The families of Trayvon Martin, George Floyd and Eric Garner (who died following a police choke hold after being stopped on suspicion of selling unlicensed cigarettes) wrote the White House last week to warn a ban will lead to more police stops involving contraband cigarettes and, potentially, violence.