Menthol Cigarette Use Remains Issue Among African American Communities

February 13, 2018 | ASTHO Staff

State public health agencies play a key role in reducing the public’s use of all forms of tobacco, including smokeless tobacco, e-cigarettes, and menthol cigarettes. Menthol, an organic flavoring compound found naturally in mint plants, is often used as an additive in consumer products such as lozenges, candies, and cigarettes. When added to cigarettes, menthol makes cigarettes more harmful by making smoke less irritating to inhale deeply, and changing how nicotine addiction impacts the brain. Since the 1960s, cigarette manufacturers have been marketing menthol cigarettes specifically to African Americans through culturally tailored messaging in television, radio, and print media advertising. As a result, cigarette smoking is now a key contributor to the increase in death and disease burdens among African American communities.

To gain an in-depth perspective on how state public health agencies can promote awareness about the dangers of menthol cigarettes and reduce their consumption, ASTHO spoke with Delmonte Jefferson, executive director of the National African American Tobacco Prevention Network (NAATPN, Inc.), and Shyanika Rose and Jessica Rath, director and managing director at the Truth Initiative Schroeder Institute®.

Why should state health officers care about the prevalence of menthol tobacco use?

JEFFERSON: Menthol use among African Americans has skyrocketed over the last 65 years from less than five percent in 1953 to over 88 percent currently. This is not by coincidence, but instead is a consequence of coordinated and targeted advertising in television, print media, and radio that reached black audiences; increased advertising and price promotions in focused communities, sponsorship of African American events such as the Kool Jazz Festival, and the intentional co-opting of African American leaders and organizations. As a result, there has been an increase in both the cancer incidence rates and cancer death rates of African Americans.

TRUTH INITIATIVE: Menthol cigarettes are the only remaining flavored cigarette on the market. They are disproportionately used by youth and African Americans who smoke. While cigarette smoking overall has declined over time, menthol cigarette smoking has remained steady for youth and adults, but has increased for young adults aged 18-25. Other research shows that menthol smokers are more likely to report intention to quit, but less likely to make a successful quit attempt compared to non-menthol smokers.

How have menthol cigarettes historically been advertised?

TRUTH INITIATIVE: Menthol has historically been framed as a healthier product and to African Americans specifically as a lifestyle brand. Despite a ban on television advertising of cigarettes that took effect in 1971, these perceptions have continued over time on social media. A recent study concluded that tweets by smokers were positive toward menthol cigarettes, and misperceptions of menthol cigarettes having medicinal effects are still prevalent on social media.

Menthol cigarette brands have been disproportionately advertised in predominately African American neighborhoods and more recent findings show that African Americans and Hispanic young adults may be exposed to tobacco marketing more often in their daily lives.

JEFFERSON: Menthol cigarettes have been strategically advertised in priority population communities. Internal tobacco documents and former tobacco executives have shown that tobacco companies identified focus communities (inner-city, people of color, low socioeconomic status) and non-focus communities (upscale, suburban, white) to direct their marketing of menthol cigarettes at some populations and not others. The promotion of menthol cigarettes in focus communities included larger ads and a greater density of ads for menthol products. In addition and more importantly, menthol cigarettes in focus communities are significantly less expensive than in non-focus communities.

What can state public health agencies do to reduce tobacco-related disparities in the context of menthol tobacco use?

JEFFERSON: State public health agencies can play a significant role in reducing tobacco-related disparities by supporting efforts to ban the sale of mentholated tobacco products using lessons learned from other states and municipalities. For example, the city of Chicago led the way in 2013 by banning the sale of mentholated tobacco products around public schools. San Francisco, Minneapolis, and Oakland have followed suit by banning the sale of menthol citywide. Several states, including Mississippi and Georgia, have included activities to support No Menthol Sunday – an interfaith effort to improve awareness of the harms of menthol tobacco and encourage tobacco cessation – in their annual action plans. 

TRUTH INITIATIVE: Restrict the sale of menthol cigarettes in local communities. Work towards banning flavors across products so that people do not switch to equally harmful combustible products, such as little cigars, of which a high proportion are flavored.

The use of menthol cigarettes remains a public health issue because of how tobacco companies attract youth smokers and contribute to disproportionate tobacco-related disease burdens experienced by African Americans. While FDA discusses seeking public comment on the role that menthol plays in making tobacco products more attractive to consumers, and as U.S. senators call for FDA to ban menthol sales nationwide, states can take action to reduce access to mentholated tobacco products through public policy. In addition, states can publish factsheets and other resources on menthol cigarettes to better educate smoking and non-smoking consumers about the unique health impacts and social context of menthol cigarette use.