Tobacco and Menthol in the United States

Tobacco use is one of the leading causes of preventable disease and death in our communities. 

  • “Cigarette smoking causes more than 480,000 deaths each year in the United States. This is nearly one in five deaths”(2)

  • “Smokers are more likely than nonsmokers to develop heart disease, stroke, and lung cancer” (2)

While the U.S. has slowly increased regulations over time on commercial tobacco use, Big Tobacco Companies continue to fight hard against prevention efforts. Big tobacco is proven to target minority communities, as well as younger populations in the promotion of tobacco use through marketing ads, and deals. This ultimately infiltrates more vulnerable communities, with predatory intentions only to increase Big Tobacco's profits. 

“Commercial tobacco” refers to the harmful products made and sold by the tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes” (4).

Today, one of the most significant issues we face regarding commercial tobacco use is the increase in popular flavors and menthol e-cigarettes, both of which are extremely popular among our youth. Currently, tobacco companies, and the FDA, are facing pressure from states' governmental legislation, organizations, and community members who would like to see stricter and more extensive regulation of both tobacco companies and the sale of these items.

Menthol flavoring paired with tobacco products has been proven more addictive due to its cool, soothing sensation and creates a stronger nicotine dependence within its users. As a result, menthol is now being used in products like e-cigarettes, pouches, and other lozenges, hooking users with the flavor. Additionally, menthol is proven more appealing to young and new nicotine users, making it significantly easier to market the products to select groups of individuals based on age, race, or other factors. An example is the extensive history of unjust marketing and selling of tobacco products to African Americans. 

  • “Menthol cigarettes make up ⅓ or $80 billion of the U.S. cigarette market, and about 18.5 million Americans smoke them” (7).


According to a report by the Truth Initiative (6)

  • “Menthol cigarettes disproportionately harm African Americans. Among African Americans from 1980-2018, menthol cigarettes were responsible for 1.5 million new smokers, 157,000 smoking-related premature deaths, and 1.5 million life-years lost, according to a 2021 study published in Tobacco Control. While African Americans constitute 12% of the total U.S. population, these figures represent, respectively, 15%, 41% and 50% of the total menthol cigarette-related harm” (6).

  • “In menthol-flavored e-cigarettes, there are health concerns related to pulegone — a compound found in prepared oil extracts of certain mint plants. Pulegone is a known carcinogen, and the tobacco industry has in the past reduced the amount of this compound in menthol tobacco products as a result of toxicity concerns. The FDA banned pulegone as a food additive in 2018, yet studies have identified that substantial amounts of this additive are found in mint and menthol e-liquid in the U.S. — raising concerns about the potential toxicity of these popular flavors ” (6).

The Racist Marketing of Tobacco Related Products

Over time we have seen that tobacco companies strategically target Black communities by infiltrating the social and cultural aspects of their lives with marketing initiatives and advertisements. The routes they take to do so have been unjust, manipulative, and discriminatory, leading to many Black communities experiencing significantly higher rates of the adverse health effects associated with tobacco use. 

  • “Tobacco companies have heavily marketed in Black-owned publications, through sponsorship of jazz concerts and certain civil rights groups, through advertisements showing people dressed in clothing popular with rap and hip-hop artists, and in neighborhoods with more Black residents. These aggressive marketing tactics likely have contributed to some groups of people having higher rates of use than others” (4).

  • “Young people living in areas with lower incomes, higher proportions of racial/ethnic minorities, and higher smoking rates in D.C. had 7.2 times the odds of being exposed to flavored tobacco marketing, compared with those not living in those communities according to a 2021 Truth Initiative study published in the Annals of Behavioral Medicine” (6).

  • “Today, the average youth in the United States is exposed annually to 559 tobacco ads while every African American adult is exposed to 892 ads annually” (1).

Policy

The first federal law to limit Big Tobacco was the 2009 Family Smoking and Prevention Act under President Obama, which gave authority to the Food and Drug Administration (FDA) to regulate tobacco products. The law also prohibited characterizing flavors in cigarettes, except for menthol. “Characterizing flavors refers to a noticeable smell or taste other than one of tobacco, resulting from an additive or a combination of additives, for example, fruit, spice, herb, alcohol, or candy which is noticeable before or during the consumption of the tobacco product'” (5).

As of 2021, the FDA established a federal flavor ban, which limited addictive flavors targeting youth participants, yet exempted the menthol flavor. This ruling helps be less attractive to youth; however still perpetuates health inequities, especially for minority communities. 

  • “The Tobacco Products Scientific Advisory Committee (TPSAC) was required by the Tobacco Control Act to conduct a review of menthol cigarettes’ effect on youth and other vulnerable populations. The committee published a report in March 2011, concluding that “the removal of menthol cigarettes from the marketplaces would benefit public health in the United States” (6)

  • “Lorillard Tobacco Company (now R.J. Reynolds Tobacco Company) challenged the integrity of the TPSAC in a lawsuit against the FDA, alleging that several experts the agency appointed to the committee were conflicted and therefore must be removed. The judge in the case sided with Lorillard and prohibited the FDA from using the TPSAC menthol report. The FDA appealed, and, in January 2016, the D.C. Circuit reversed the district court’s decision, allowing the agency to rely on the TPSAC menthol report to take action to regulate menthol tobacco products” ((6)

  • In April 2021, the FDA announced plans to move forward to remove menthol from cigarettes and all flavors, including menthol, from cigars. (6)

Current Policy Solutions in the United States

Summarized by The Truth Initiative (6)

As of December 31, 2021:

  • Massachusetts prohibits the sale of all flavored tobacco products, including menthol, except in smoking bars.

  • In California, 76 localities including Los Angeles County, Oakland, Sacramento, and San Francisco, prohibit the sale of all flavored tobacco products, including menthol.

  • Five localities in Colorado, including Aspen, prohibit the sale of all flavored tobacco products, including menthol.

  • Bangor, Maine prohibits the sale of all flavored tobacco products, including menthol.

  • Eight localities in Minnesota prohibit the sale of all flavored tobacco products, including menthol.

  • Manheim, New York prohibits the sale of all flavored tobacco products, including menthol.

  • Chicago, Illinois prohibits the sale of flavored tobacco products, including menthol, within 500 feet of any city high school.

What is the benefit of a Menthol ban? 

A menthol ban would help to lower the rate of people smoking and the attraction for new-time smokers. A ban would save lives from the long-term health effects and diseases associated with tobacco use, as well as save on the overall cost of our nation's healthcare spending. A ban would also acknowledge discriminatory advertising and divisive messaging to minority communities, who experience disproportionally worse health outcomes regarding menthol use. We need to reach the FDA to establish a commercial tobacco-free future. These actions are especially urgent as the FDA has repeatedly failed to act, despite long-standing, overwhelming evidence that a menthol ban would benefit public health.

  • “A 2018 Truth Initiative survey shows that most adults (56.4%) support a federal ban on menthol cigarettes. Support was especially strong among African Americans (60.5%) and other groups who have been targeted by the tobacco industry, including women (62.5%) and Hispanic/ Latinos (69.3%). More than 1 in 4 current menthol smokers (28.5%) favored a ban” (6).

Suggested resources

We highly recommend the Health Justice Guide written by the Center for Black Health and Equity for a deeper understanding of the Black community's relationship to tobacco in the United States, as well as to understand the significant role tobacco companies continue to play in our nation. https://www.centerforblackhealth.org/

The Truth Initiative is a great resource for tobacco and nicotine-related data. https://truthinitiative.org/ 

We also recommended the Campaign for Tobacco-Free Kids website and fact sheets to learn more. https://www.tobaccofreekids.org/ 

References

  1. Boonn, Ann. (2009). Tobacco Company Marketing to African Americans. Campaign for Tobacco-Free Kids. http://173.213.226.153/alliedHealth/Tobacco%20company%20marketing%20to%20African%20Americans.pdf

  2. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. (2021, October 29). Health Effects of Cigarette Smoking. Center For Disease Control and Intervention (CDC). https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm?s_cid=OSH_misc_M416 

  3. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. (2022). Menthol Tobacco Products are a Public Health Problem. Center for Disease Control and Prevention (CDC). https://www.cdc.gov/tobacco/basic_information/tobacco_industry/menthol-cigarettes/index.html

  4. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. (2022, June 27). Unfair and Unjust Practices and Conditions Harm African American People and Drive Health Disparities. Center For Disease Control and Intervention (CDC). https://www.cdc.gov/tobacco/health-equity/african-american/unfair-and-unjust.html 

  5. Patten, T., & De Biasi, M. (2020). History repeats itself: Role of characterizing flavors on nicotine use and abuse. Neuropharmacology, 177, 108162. https://doi.org/10.1016/j.neuropharm.2020.108162

  6. The Truth Initiative. (2022, April 22). Menthol: Facts, stats, and regulations. https://truthinitiative.org/research-resources/traditional-tobacco-products/menthol-facts-stats-and-regulations

  7. U.S. Food and Drug Administration. (FDA). (2022). FDA Proposes Rules Prohibiting Menthol Cigarettes and Flavored Cigars to Prevent Youth Initiation, Significantly Reduce Tobacco-Related Disease and Death. https://www.fda.gov/news-events/press-announcements/fda-proposes-rules-prohibiting-menthol-cigarettes-and-flavored-cigars-prevent-youth-initiation