Research Supports Ban on Menthol Cigarettes

Flavored cigarettes have been banned in the United States for more than a decade—with one glaring exception: menthol cigarettes, which are used at substantially higher rates among Black Americans. Despite overwhelming research on the health risks of menthol, the U.S. Food and Drug Administration (FDA) and many state and local governments have failed to remove this flavor from the marketplace.

Now, as COVID-19 and the Movement for Black Lives have brought increased attention to the health vulnerabilities of communities of color, Black legislators and public health leaders are renewing a push for a long-overdue federal ban.

“Health advocates have been pursuing menthol bans for years, with limited success. It’s unfortunate that it takes a pandemic and highly publicized incidents of anti-Black violence to garner more support for this issue,” says Daniel Giovenco, a Columbia Mailman School assistant professor of Sociomedical Sciences who studies patterns of nicotine and tobacco use, including menthol cigarettes. “Nevertheless, it is important for the public to know about ways in which the tobacco industry has exploited Black Americans to sell its products. Menthol cigarettes are a blatant case study of how the industry has used racist marketing strategies to increase profits at the expense of a historically marginalized group.”

According to the Centers for Disease Control and Prevention, Black American adults have the highest percentage of menthol cigarette use compared to other racial and ethnic groups. Nearly nine out of ten Black Americans who smoke use menthol-flavored cigarettes, compared to less than a third of White Americans.  

A 2020 study by Giovenco and colleagues published in JAMA Network Open found that the decline in overall cigarette use in the United States over the last two decades is overwhelming due to decreases in consumption of nonmenthol cigarettes. By contrast, menthol cigarette consumption has been relatively stable. 

So why aren’t more menthol cigarette smokers quitting?

One reason may be that menthol, a substance found in mint plants, produces a cooling, anesthetizing sensation that masks the harshness of the smoke, allowing users to inhale addictive nicotine and other harmful chemicals deeper into their lungs. The result: menthol cigarettes are more difficult to quit. In fact, a Giovenco study in the journal Tobacco Control found that young people who smoke menthol cigarettes are nearly twice as likely to ramp up their smoking habits compared to those who use non-menthol.

Another plausible reason is continued targeted marketing. Giovenco led a team that analyzed storefront advertising in New York City and found menthol styles promoted in 60 percent of cigarette ads—despite the fact that these products are used at lower rates than non-menthol cigarettes. Moreover, nearly a quarter of all ads were for Newport cigarettes, a heavily mentholated brand, and menthol cigarette ads were more likely to be found in low-income, primarily non-white communities. The findings are published in the journal Preventive Medicine.

“The biggest share of advertising we saw was for Newport. Even though menthol cigarettes only constitute around a third of the overall cigarette market, these styles are promoted more aggressively, especially in neighborhoods with a large proportion of Black residents,” the professor explains.

Decades of Targeted Marketing

This marketing strategy is deliberate and dates back to the 1960s. In the decades since, menthol cigarette brands have sponsored concerts and special events geared to Black audiences, advertised heavily in Black media using culturally-tailored images and messages, and donated to leading civil rights organizations.

While menthol cigarettes continue to remain available, many types of flavored e-cigarettes were banned only a few years after entering the marketplace. This is despite growing evidence that e-cigarettes expose users to significantly lower levels of toxicants compared to traditional cigarettes. The difference in policy response was likely related to demographic and political factors, Giovenco explains.

“Concern over the use of flavored e-cigarettes—initially used in large numbers by White youth—was elevated rapidly, gained mainstream media attention, and incited public outcry,” he says. “The result was swift policy action for the protection of youth and public health. Why has action on menthol cigarettes—more harmful products disproportionately used by marginalized populations—received less attention?”

What’s Next?

The FDA recently announced its intention to ban menthol cigarettes, but to date, no progress has been made. The agency is soon expected to respond to a citizen’s petition to ban menthol, signed by groups including the African American Tobacco Control Leadership Council, the American Medical Association, the American Public Health Association, and other leading health agencies. The policy has even broader support: a majority of lawmakers, including those in the Congressional Black Caucus, support a ban.

Giovenco notes that while a federal ban on menthol cigarettes is long overdue, it is important to prevent unintended consequences by supplementing this strategy with expanded and well-supported cessation programs and including policy language that does not criminalize the use or possession of menthol, only its availability in retailers.

Menthol cigarettes have already been taken off the shelves in Canada, Massachusetts, and other localities, a move Giovenco suspects will lead to lower levels of cigarette use. “A federal ban will likely result in thousands of more lives saved and a potential reduction in persistent tobacco-related inequities.”