More than 10 years ago, the Food and Drug Administration (FDA) banned flavored cigarettes—a crucial step in protecting people from the dangers of smoking. In fact, research published in the Journal of Adolescent Health examined data from the 2002-2017 National Survey on Drug Use and Health, and found that after the ban was put in place, smoking rates dropped by 43% among people aged 12-17 and 27% among young adults aged 18-25.
While those findings seem promising, the same research also found an uptick in rates of menthol cigarette use—the one flavor that evaded the 2009 ban. “We observed an increase in smoking of menthol cigarettes among youth right after the ban took effect,” lead study author, Matthew Rossheim, PhD, said in a press release, noting that people seem to be more likely to smoke menthols when other flavors aren’t available.
But now, menthol cigarettes may (finally) be on the chopping block. On April 29, the FDA announced its commitment to banning the flavor in both cigarettes and cigars within the next year. The agency said the move would have an “extraordinary public health impact,” especially considering that menthol cigarettes contribute to health disparities.
Who Does Menthol Hurt the Most?
Menthol itself is a harmless chemical that you’ll find in everything from pain-relief creams to cough drops and gum, thanks to its signature minty, cooling sensation.
In cigarettes, however, menthol is basically a “candy flavor” that “helps the poison go down easier” by masking the harshness of the smoke, says Phillip Gardiner, DrPH, co-chair of the African American Tobacco Control Leadership Council (AATCLC).
While menthol, on its own, isn’t necessarily addictive, research suggests it can make cigarettes more addictive, thanks to the way the chemical reduces that uncomfortable irritation in your throat that you’d normally feel after taking a drag. “Every day that menthol cigarettes are still on the market, more people become addicted to them,” says Dr. Gardiner.
Generally speaking, rates of menthol cigarette use are highest among young people, LGBTQIA+ people, and communities of color. But the tobacco industry has been especially aggressive in its marketing of menthol cigarettes to African Americans, says Dr. Gardiner, who recalls seeing predatory marketing practices firsthand in Harlem in the 1970s and ‘80s. “They’d give away free menthol cigarettes in these vans that would travel to different parts of the Black community, with big bull horns playing hip-hop music,” he shares. “That’s called targeted marketing.”
Decades later, Black communities are still being disproportionately targeted with menthol cigarette ads. Sometimes it’s in the form of buy-one-get-one-free deals and special promotions in predominantly Black neighborhoods; in other cases, the tobacco industry might sponsor community events in Black areas. “We also have data that shows menthol cigarettes are cheaper in Black communities,” adds Dr. Gardiner. “It makes them easier to buy, and easier to die.”
In other words, all of that predatory marketing ultimately translates to worse health outcomes for African Americans. For example, diabetes—the risk of which is up to 40% higher for smokers than non-smokers—is the fourth leading cause of death among Black people (compared to the seventh leading cause among white people), according to the Centers for Disease Control and Prevention (CDC). And, of course, smoking cigarettes, whether menthol or not, is linked to a whole host of other health complications, including high blood pressure, stroke, heart disease, and cancer—all of which disproportionately affect Black communities as well.
Banning Isn’t the Same As Quitting
Truthfully, a ban on menthol cigarettes probably won’t become a reality for at least another three to five years, says Dr. Gardiner. The FDA estimates that it will have “proposed product standards within the next year to ban menthol,” but Dr. Gardiner points out that these standards will almost certainly be challenged in court by the tobacco industry. Considering menthols make up roughly a third of all cigarettes sold in the U.S., tobacco lobbyists will likely fight as hard as they possibly can to keep them on the market, explains Dr. Gardiner.
Still, slowly but surely, a ban is on its way—and it could have huge implications for public health. In the FDA’s announcement, the agency said there’s “strong evidence” that a menthol ban could help us avert over 600,000 deaths (including about 237,000 African American deaths) and could lead more than 900,000 smokers to quit, including 230,000 Black people in the first year. In fact, multiple studies suggest that the desire to quit smoking may actually be highest among Black smokers overall, and especially high among Black people who smoke menthols, specifically.
But, when it comes to quitting cigarettes—menthol or otherwise—communities need support, says Dr. Gardiner. “We’re going to need federal support for smoking cessation services, particularly those that are culturally sensitive and culturally appropriate for the different communities using menthol cigarettes,” he explains. A culturally sensitive smoking cessation intervention takes into account the characteristics of the community it’s serving, including race, ethnicity, socioeconomic status, faith, health risk factors, and more. Though more research is needed, some studies show that culturally appropriate smoking interventions for Black smokers can be more effective than traditional interventions.
In its announcement, the FDA noted that it will work with other federal agencies to support menthol smokers with “broad and equitable access to all the tools and resources” that can help them quit. However, time will tell whether these resources are truly tailored to communities that need help quitting menthol cigarettes the most.
“We can ban menthol, but we have to support those people who’ve been smoking these cigarettes for 20 years or so,” says Dr. Gardiner. “This is a major step forward, but at the same time, it’s only the beginning of the end.”
This article has been medically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of Clinical Operations at One Drop.