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Black smokers are being discriminated against with a menthol cigarette ban.
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FDA expects to be able to release details of a proposed menthol ban this spring.
At the time of writing this, the US Food and Drug Administration (FDA) is expected to announce a national ban on menthol flavor in cigarettes and flavored cigars, if we are to believe commissioner Dr. Robert Califf’s recent announcement on Twitter that we should find out the specifics of the ban this spring. The two FDA-proposed standards, one for cigarettes and the other for cigars, are currently with the Office of Management and Budget (OMB) for OMB to determine if the proposed regulations would have a significant effect on the US economy. This step is generally taken as a sign that the rules are in the final stage.
What the final rules on the ban would entail are still to be determined, pending the OMB re-view, which, according to Matt Myers, president of the Campaign for Tobacco-Free Kids (CTFK), added, “This administration has made a commitment to move forward on this specific rule, and what OMB does will be a critical test of their commitment.” One thing that we know is FDA previously announced that it would be banning the manufacture, sale, and import of menthol cigarettes and flavored cigars, but the ban would not extend to personal possession or use.
The ban is a culmination of years of effort. Banning menthol has been a contentious issue for more than a decade. In 2009, when FDA’s ban on flavored cigarette products went into effect, menthol was the sole flavoring additive that was exempted. Not content with banning all other flavors, anti-tobacco and public health advocates turned their focus to demanding that menthol flavor also be done away with. They even sued FDA for taking too long to ban menthol.
In the debate over the menthol ban in the US, the health effects of menthol cigarettes seem to have been overshadowed by a racial justice slant with supporters of the ban painting a grim picture of how tobacco companies “preyed” on Black communities when marketing menthol cigarettes. Ban opposers, on the other hand, say the ban would not only create a market for illicit menthol cigarettes, but would also lead to more altercations between law enforcement officers and Black communities. Some also say a menthol ban is discriminatory against Black communities, taking away menthol cigarettes most Black smokers prefer all while leaving non-menthol cigarettes, which are mostly preferred by non-Hispanic Whites, easily accessible in the market.
The Centers for Disease Control and Prevention (CDC) say 13.7% of US adults (34.2 million) smoke. FDA estimates there are nearly 18.6 million smokers of menthol cigarettes in the US, and out of all Black smokers, around 85% smoke menthol cigarettes, compared to 30% of White smokers who smoke menthols.
When FDA announced last year it was again moving to ban menthol cigarettes, then-acting commissioner Janet Woodcock said banning the flavor would “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.” Somehow, along the way, these other groups of people have been sidelined and barely mentioned in the narrative surrounding the menthol ban, almost as if they are just a blip on the radar, easily overlooked. But we digress.
If we were to take a look at European Union countries – where a menthol ban has already been in place since May 2020, racial justice has not been given as prominent a role, and lowering smoking prevalence is key – a survey by the Foundation for a Smoke-Free World pre- and post-ban found that the menthol cigarette ban had limited impact on the smoking prevalence in the EU, even though the ban aimed to discourage people from smoking or encourage them to quit.
Survey data revealed that quit rates among menthol cigarette smokers was at a low 8% post-ban; an average of 40% of the respondents said they reduced their menthol cigarette consumption, but continued or increased their consumption of non-menthol cigarettes. Almost 20% switched to other menthol tobacco products, like e-cigarettes (57%), heated tobacco (24%), and smokeless tobacco (18%); 13% started buying menthol cigarettes from other sources; and 13% began buying products to manually add menthol flavoring to regular tobacco cigarettes. Apparently, the menthol ban has not really had the effect ban supporters believed it would.
In Canada, where menthol cigarettes are banned, a study titled “Evaluating the impact of menthol cigarette bans on cessation and smoking behaviors in Canada: longitudinal findings from the Canadian arm of the 2016–2018 ITC Four Country Smoking and Vaping Surveys” by Janet Chung-Hall et al found that 78.6% of menthol smokers switched to non-menthol cigarettes or continued to smoke menthol cigarettes post-ban, so it appears that most menthol cigarette smokers did not quit smoking.
The effectiveness of a menthol ban in the US is also questionable. One of the reasons ban supporters often cite is that banning menthol cigarettes will reduce youth smoking rates. However, CDC data show that not only have youth smoking rates dropped to a record-low (4.6% in 2020), but the number of youth smoking menthol cigarettes also dropped from 54.5% in 2014 to 46.1% in 2018. Also, the smoking rate among Black youth (2.8%), was almost half of the smoking rate among non-Hispanic White youth (5.3%). About 4.6% of Hispanic youth smoked. So, if Black youth who are supposed to be more likely to smoke menthol cigarettes have lower smoking rates than other groups, why are menthol cigarettes being targeted?
CDC data also show that in 2019, the smoking rate among Black and White adults were barely different at 14.9% and 15.5%, respectively. If anything, the smoking rate among Black adults was lower. Again, if Black smokers are more likely to smoke menthol cigarettes, but have a lower smoking rate, why are menthol cigarettes being targeted?
A 2020 study by Guy Bentley and Jacob James Rich for the Reason Foundation found that states with more menthol cigarette consumption relative to all cigarettes have lower rates of youth smoking and that states with higher cigarette distribution levels per capita of all types have higher rates of both adult and youth smoking. In other words, menthol cigarette distribution does not increase youth smoking initiation any more than regular cigarette distribution, nor does menthol cigarette availability pose a greater threat to public health than regular cigarette availability.
Even if OMB were to conclude its review of the proposed menthol ban standards in time for FDA to release them this spring, it may still take some time before the ban is able to be fully implemented. There is also still the remote possibility (dare one hope?) that the proposed standards may “die” at the OMB. But irrespective of what will ultimately happen to the menthol ban at the OMB, this is another in a long line of examples of government over-reach taking choice away from consumers, but this time using racial justice to pave the way.