Putting Menthol on Ice

May 26, 2021|4:06 p.m.| Marcus Plescia MD, MPH | ASTHO Chief Medical Officer

Marcus PlesciaThough the COVID-19 pandemic has dominated public health over the past year, tobacco use remains the leading preventable cause of death in the United States, accounting for over 480,000 deaths each year. State public health agencies have played a significant role in reducing tobacco-related disparities by supporting efforts to ban the sale of mentholated tobacco products.

In April, FDA announced it would start taking steps to ban menthol flavored cigarettes and all flavored cigars within the next year. After a legal public comment period, the regulations would apply to manufacturers, distributors, retailers, wholesalers, and importers—with the goal that those products would never make it to the market. A ban on mentholated tobacco products is certainly a positive shift in favor of years of state and local efforts by tobacco prevention and control programs. It also brings the opportunity for us to more fully realize the intention of the 2009 Family Smoking Prevention and Tobacco Control Act.

State public health policies often prompt federal action. For example, Massachusetts made history last year by becoming the first state to end the sale of all flavored tobacco products, including menthol cigarettes. Maine now appears poised to pass similar legislation. California also passed its own comprehensive flavor bill last year, which is currently on hold pending the results of a tobacco industry supported referendum that will give voters an opportunity to recall the policy in November 2022.

This mandate to end the sale and distribution of menthol cigarettes will have significant and longstanding public health benefits towards preventing another generation of youth addicted to nicotine and end the predatory targeting to communities of color. FDA’s actions will help significantly reduce youth initiation, increase the chances of smoking cessation among current smokers, and address health disparities experienced disproportionately by communities of color, low-income populations, and LGBTQ+ individuals, all of whom are far more likely to use these tobacco products.

Menthol, an organic flavoring compound found naturally in mint plants, is often used as an additive in consumer tobacco products such as lozenges, candies, and cigarettes. The cooling flavor in cigarettes makes it easier to start and keep smoking. When added to cigarettes, menthol makes cigarettes more harmful by making smoke less irritating to inhale deeply, changing how nicotine addiction impacts the brain. Almost 19 million people smoke menthol cigarettes in the U.S. Scientific evidence also indicates that menthol smokers are less likely than non-menthol smokers to successfully quit smoking despite having a higher urge to end their tobacco dependence.

Menthol and other flavored tobacco products are one of the primary reasons that kids start using tobacco products. Tobacco products containing menthol have been disproportionately marketed to African Americans, primarily through culturally tailored messaging in television, radio, and print media advertising since the 1960s. Attention to this disparity comes from over 30 years of work by organizations focused on optimal health for individuals of African descent, including the Center for Black Health & Equity (formerly NAATPN) and the African American Tobacco Leadership Council. This effort would not have been possible without their dedicated voice amplifying this disparity, educating community members, and maintaining this issue as a priority among tobacco prevention and control regulators.

While these FDA actions are a cause for celebration, states and localities can and should continue to play a role in regulating flavored tobacco products. It will likely take multiple years for these rules end up as fully finalized and implemented by FDA. In the meantime, states, counties, and cities can act quickly to protect their communities from the unique public health harms of menthol cigarettes and flavored cigars by prohibiting the marketing and sale of these products. In addition, these FDA actions don’t address the numerous flavored e-cigarette products that continue to be available on the market, which disproportionately appeal to underage consumers. ASTHO and its members are committed to protecting the health of children and adults through policy efforts that restrict the use of tobacco flavors, including menthol, to reduce overall smoking rates in the United States and its territories. ASTHO remains committed to supporting evidence-based strategies that address health disparities.

Alicia D. Justice, MPH, is the director of chronic disease prevention at ASTHO
Josh Berry, MPH, is a senior analyst of chronic disease prevention at ASTHO