The US Food and Drug Administration (FDA) has announced that within a year it will ban menthol in cigarettes as well as all flavors including menthol in cigars.
Menthol makes it easier to start smoking, and also enhances the effects of nicotine, making it more addictive and harder to quit, said the FDA in a statement Thursday.
Nineteen organizations — including the American Academy of Pediatrics, American Cancer Society, American Medical Association, American Heart Association, and the National Medical Association — have been pushing FDA to ban menthol for years. The agency banned all flavors in cigarettes in 2009 but did not take any action against menthol. In 2013, the groups filed a Citizen's Petition demanding that the FDA ban menthol. The agency responded months later with a notice that it would start the process.
But it never took any action. Action on Smoking and Health and the African American Tobacco Control Leadership Council, later joined by the AMA and the NMA, sued in 2020 to compel the agency to do something. Now, the FDA has finally acted.
The AATCLC welcomed the move but said the fight is not over and encouraged tobacco control activists to fight to ban menthol tobacco products at the local, state, and federal level. "We know that this rule-making process could take years and we know that the tobacco industry will continue to do everything in their power to derail any attempt to remove their deadly products from the market," said Phillip Gardiner, MD, AATCLC co-chair, in a statement.
The AMA is urging the FDA to quickly implement the ban and remove the products "without further delay," said AMA President Susan R. Bailey, MD, in the statement.
"FDA's long-awaited decision to take action to eliminate menthol flavoring in cigarettes and all flavors in cigars ends a decades-long deference to the tobacco industry, which has repeatedly demonstrated its willingness to profit from products that result in death," said Lisa Lacasse, MBA, president of the American Cancer Society Cancer Action Network (ACS CAN), in a statement.
Lacasse said that banning menthol will help eliminate health disparities, noting that 86% of Blacks who smoke use menthol cigarettes, compared with 46% of Hispanics who smoke, 39% of Asians who smoke and 29% of Whites who smoke. "FDA's actions today send a clear message that Big Tobacco’s strategy to profit off addicting Black communities will no longer be tolerated," she said.
Not all groups are on board, however. The ACLU and several other organizations wrote to the country’s top health officials urging them to reconsider.
"Such a ban will trigger criminal penalties which will disproportionately impact people of color, as well as prioritize criminalization over public health and harm reduction," the letter says. "A ban will also lead to unconstitutional policing and other negative interactions with local law enforcement."
The letter calls the proposed ban "well intentioned," but said any effort to reduce death and disease from tobacco "must avoid solutions that will create yet another reason for armed police to engage citizens on the street based on pretext or conduct that does not pose a threat to public safety."
Instead of a ban, the organizations said, policymakers should consider increased education for adults and minors, stop-smoking programs, and increased funding for health centers in communities of color.
The Biden administration, however, pressed the point that banning menthol will bring many positives.
Acting FDA Commissioner Janet Woodcock, MD, said in a statement that banning menthol "will help significantly reduce youth initiation, increase the chances of smoking cessation among current smokers, and address health disparities experienced by communities of color, low-income populations, and LGBTQ+ individuals, all of whom are far more likely to use these tobacco products."
The FDA cited data showing that in the first year or so after a ban goes into effect, an additional 923,000 smokers would quit, including 230,000 African Americans. Another study suggests that 633,000 deaths would be averted, including 237,000 Black Americans.
Woodcock added that "armed with strong scientific evidence, and with full support from the administration, we believe these actions will launch us on a trajectory toward ending tobacco-related disease and death in the US."
Health and Human Services Secretary Xavier Becerra said in a statement that "banning menthol in cigarettes and flavors in cigars will decrease the appeal of these tobacco products and strengthen health equity."
The FDA estimates that 18.6 million Americans who are current smokers use menthol cigarettes, with a disproportionately high number being Black. Menthol cigarette use among Black and Hispanic youth increased from 2011 to 2018 but declined for non-Hispanic White youth.
Flavored mass-produced cigars and cigarillos are disproportionately popular among youth, especially non-Hispanic Black high school students, who in 2020, reported past 30-day cigar smoking at levels twice as high as their White counterparts, said the FDA. Three quarters of 12-to-17-year-olds report they smoke cigars because they like the flavors. In 2020, more young people tried a cigar every day than tried a cigarette, reports the agency.
"This long overdue decision will protect future generations of young people from nicotine addiction, especially Black children and communities, which have disproportionately suffered from menthol tobacco use due to targeted efforts from the tobacco industry," said Lee Savio Beers, MD, president of the American Academy of Pediatrics, in a statement.
"Pediatricians have long been sounding the alarm on how the tobacco industry has used flavors to hook children and teens to their dangerous, addictive products — menthol, with its cooling mint flavor, is no different," he said. Tobacco use is the number one cause of preventable death among Black Americans, claiming 45,000 Black lives every year, said Savio Beers.
The FDA's announcement "is only a first step that must be followed with urgent, comprehensive action to remove these flavored products from the market," he said.
"We commend the FDA for moving, at long last, to prevent tobacco companies from targeting Black communities, youth, and others with menthol cigarettes that make smoking easier to start and harder to quit," said American Heart Association CEO Nancy Brown in a statement.
"The tobacco industry's sinister history of aiming price promotions and discounts for menthol cigarettes at Black communities has resulted in 85% of Black smokers choosing menthol," she said, adding that the AHA is also happy with the FDA's intention to ban flavored cigars, which "appeal both to adults who have never smoked and former smokers, and they encourage dual use of both cigars and cigarettes." Removing them "would mark a major victory for public health."
Georges C. Benjamin, MD, executive director of the American Public Health Association (APHA), also welcomed the FDA announcement, saying, "This plague upon public health targeted the Black community and has directly worsened already problematic health disparities."
Added Benjamin, "If we want to create the healthiest nation in one generation, we need to begin doing so by reversing harmful practices that have been deeply entrenched in our culture, and today's development does just that.”
Ten Black civil rights organizations, the Congressional Black Caucus, and social justice organizations have urged HHS and the FDA to ban menthol.
Matthew L. Myers, JD, president of the Campaign for Tobacco-Free Kids, said in a statement that the tobacco industry is already claiming — falsely, he contends — that the rules will "subject Black Americans to more law enforcement abuse." Myers notes that the FDA said that its enforcement will focus on manufacturers, distributors, wholesalers, importers, and retailers, and that it "cannot and will not enforce against individual consumer possession or use of menthol cigarettes or any tobacco product."
"The tobacco industry's cynical fear-mongering cannot hide the fact that it is the industry itself that has caused so much harm to Black Americans through the targeted marketing of menthol cigarettes," said Myers, who said the Biden administration "deserves enormous credit for standing up to the tobacco industry and announcing this bold, lifesaving policy today."
Myers also urged the federal government to continue efforts to help smokers quit, noting that quitting is "more critical than ever" because smoking increases the risk of severe illness from COVID-19, which has disproportionately impacted communities of color.
Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including Smithsonian.com, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault.
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Cite this: FDA Moves to Ban Menthol in Tobacco Products - Medscape - Apr 29, 2021.