Education

FDA might ban menthol cigarettes. It’s about time, especially for Black America.

In 2009, Congress took the important step of banning flavored cigarettes that enticed youth to start smoking. However, that landmark legislation contained a significant flaw: a loophole that allowed tobacco companies to continue selling  menthol cigarettes.

For decades, tobacco companies have relied heavily on menthol flavoring — a chemical additive found in nature that can also be created in a laboratory — because menthol makes it easier to start smoking and harder to quit. When added to cigarettes, menthol produces a cooling effect that masks the harshness of cigarette smoke and allows the user to inhale more deeply at the same time that it can enhance the effects of nicotine, the addictive element in cigarettes. 

For too long, Black people in America have been on the receiving end of the tobacco companies’ tactics that put their sales ahead of people’s health.

The Food and Drug Administration is finally considering action to close this loophole for good, proposing rules earlier this year to end the sale of menthol cigarettes as well as all flavored cigars. The public comment period, during which the agency solicits feedback to inform potential implementation of the proposed rules, ends Tuesday. It is crucial that we speak out about ending menthol sales now — particularly because of the many Black lives that are at stake.

No doubt thanks to predatory marketing tactics over the past four generations — including billboards, point-of-sale promotions, corporate sponsorships, coupons and free samples concentrated in Black communities — approximately 85% of Black people who smoke use menthols. 

While the rates of menthol cigarette use in other communities are also too high, including 48% of Hispanic people who smoke and 30% of white people who smoke, tobacco companies have clearly and disproportionately targeted Black people with menthols.

The results are devastating: Tobacco use claims about 45,000 Black lives a year, a disproportionately high burden of tobacco-related deaths in America. Black adults are 30% more likely to die from heart disease and 47% more likely to die from a stroke, two of the most severe smoking-related conditions, compared to white adults.

Connected to these statistics is tobacco companies’ long history of ruthlessly targeting Black people and communities with menthol products. In the 1950s, less than 10% of Black people who smoked used menthol cigarettes, according to research commissioned by Philip Morris, but surveys at the time demonstrated that Black Americans had slightly higher preferences than white Americans for those products. 

Moreover, following World War II, migration patterns among Black Americans leaving the Deep South created concentrated population centers throughout the United States that opened up new marketing advantages for companies with the means to capitalize on them. The tobacco industry pinpointed and exploited these factors to its advantage. 

I experienced this firsthand while growing up in East Nashville, Tennessee, a predominantly African American area in my youth. I remember seeing billboards and signs in neighborhood groceries and pharmacies for menthol cigarettes that made them look “cool.”

Those ads, it turns out, were just the tip of the iceberg. Tobacco companies have a long history of recruiting Black celebrities and athletes as spokespeople and advertising heavily in Black news publications and magazines, among other ways of appealing to Black youth. An article published in the National Institutes of Health’s National Library of Medicine called it “a campaign of ‘masterful manipulation’ targeting menthols to African Americans” beginning in the 1960s.

When I became a doctor, I saw almost daily the devastatingly effective impact of this persuasive effort. In my clinical career as a cardiologist in Nashville and Atlanta, I have cared for thousands of patients. I cannot recall a single one with significant atherosclerotic cardiovascular disease who did not smoke. 

Since Congress first banned flavored cigarettes, the case for ending the sale of menthol cigarettes has only gotten stronger. In 2011, an FDA advisory committee concluded that ending the sale of menthols would benefit public health. Research modeling a ban showed it would have put our country on pace to save more than 633,000 lives overall by 2050, more than a third of them African American.

We cannot afford any further delays. Tobacco companies still spend enormous sums of money marketing their menthol brands to keep their highly addictive cigarettes cheap and visible in Black communities. Youth are targeted early. Research in two cities in Ohio found that in areas with high populations of Black children, menthol tobacco products are often advertised near candy displays.

True to form, tobacco companies responded to the FDA’s proposed rules by positioning themselves as community advocates. This is a continuation of a phenomenon from the 2009 legislative fight described in the article in the National Library of Medicine: “Tobacco industry spokespeople insisted that making menthol available put them on the side of African Americans’ struggle for justice and enlisted civil rights groups to help them make that case.”

Today, R.J. Reynolds Tobacco Company, maker of one of the most commonly used menthol cigarettes in the United States, says it wants to preserve “access and choice,” even as it maintains that it is “committed to Tobacco Harm Reduction” and promoting “reduced-risk products.” Altria, parent company of Philip Morris, claims the proposal would create “unregulated, criminal markets.” 

These claims illustrate how tobacco companies oppose public health measures by attempting to stoke fear. It amounts to a cruel irony, given that tobacco companies target these communities — the communities of my youth and the communities I serve today — with products that kill tens of thousands of people every year. None of my patients suffering from a heart attack, stroke or leg amputation because of smoking has ever expressed gratitude to tobacco companies for looking out for them. 

It is past time to say “enough.” With the end of the public comment period on the FDA’s proposal Tuesday, the agency must act quickly to remove menthol cigarettes and flavored cigars from the market. Doing so will save lives and prevent untold disease and suffering. 

For too long, Black people in America have been on the receiving end of the tobacco companies’ tactics that put their sales ahead of people’s health. The FDA’s proposed rules give our nation the chance, finally, to be on the right side of history and show that we truly care about the health of all our communities.

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