Without Stronger Policies Against Menthol Combustible Cigarettes, Black Lives Remain Disproportionately At Risk

By Dr. Derek Yach

• Tobacco use is a contributor to the three leading causes of death among Black Americans: heart disease, cancer and stroke
• More than 85% of Black Americans who smoke use menthol cigarettes
• Overall, more than one-in-four menthol smokers are Black

Menthol cigarettes come with added risks compared to their non-menthol counterparts. While all combustibles pose significant health risks, menthol cigarettes are associated with increased smoking initiation among youth, greater addiction potential, and reduced success in cessation, particularly among Black smokers. What’s more, menthol cigarettes increase the risk for fatal tobacco-related diseases including cancer, heart diseases, and stroke—all illnesses for which Black Americans are already predisposed.

Despite these staggering statistics and the glaring health disparities and inequalities that exist in our country, the tobacco industry has yet to be held accountable. Thus far, the US has been reluctant to implement policies that will reduce menthol cigarette consumption and Black Americans continue to suffer.

The FDA is up against an April 29 deadline to make a decision after being sued by multiple public health and medical organizations on their complacency on the subject. Public health officials need to keep pushing for a hard ban on menthol cigarettes in the US and improve education on the relative risks of harm reduction products, not only for the sake of public health, but social justice.

Harm Reduction Products Save Lives

Considering menthol smokers are much less likely to quit, it comes as no surprise that menthol cigarette use has remained steady over the past decade while non-menthol cigarette consumption has decreased. It’s clear that current tobacco control initiatives are not successfully reaching menthol smokers and instead may be counterintuitive to public health initiatives.

The current focus on proposed bans of flavored e-cigarettes is likely doing more harm than good by leaving deadly combustibles on the market and deterring smokers from switching to this safer alternative. In fact, a study by The National Bureau of Economic Research found that a ban on flavored e-cigarettes may result in “increased choice of combustible cigarettes, which is the most harmful alternative.” 

The root of this issue is the lack of effective communication surrounding the relative risks of harm reduction products (HRPs). There are still a significant amount of people who believe that e-cigarettes are equally or more harmful than combustibles, and without a proper education initiative in place in addition to a ban on menthol cigarettes, menthol users will switch to regular cigarettes, rather than these life-saving products.

There is substantial research proving that e-cigarettes can help with cessation and promote a transition away from combustible products. This can be especially effective among menthol users as the flavors available for e-cigarettes provide a safer option to satisfy any menthol cravings.

In addition to e-cigarettes, there are other HRPs that can help smokers get their nicotine fill without risking some of the health consequences of smoking, including snus and heat-not-burn products, which just received authorization from the FDA to be marketed as “modified risk tobacco products” – meaning the FDA has concluded that completely switching from cigarettes to these authorized products lowers certain health risks.

Targeted and Effective Education is Crucial

Considering all of the above, we need to call on the manufacturers of HRPs to amplify efforts to get smokers to switch to these products. Similar to the extensive use of menthol gum by the pharmaceutical industry as a means to quit smoking (most people have heard/know of Nicorette), HRP manufacturers need to step up their marketing efforts to clearly position their products as safer alternatives to cigarettes and ensure these initiatives include strategies to reach Black Americans.

As shown by the impact of menthol cigarettes on Black lives, tobacco control initiatives have consistently failed vulnerable and marginalized communities, and that needs to change in order for any progress to be made. A good example to follow is the COVID-19 vaccine communications, which had to take the extra step to reach the Black community given their higher rates of mortality and leeriness of the medical community. 

On a national level, major brands, media companies, community-based organizations, faith leaders and other trusted messengers, known as the COVID Collaborative, partnered with the CDC to deploy their COVID-19 Vaccine Education Initiative that focuses on spreading their message across all channels to reach Black and Hispanic communities. On the local level, organizations like Health Advocates In-Reach and Research (HAIR) in Maryland and Florida’s Statewide COVID-19 Vaccine Community Engagement Task Force are reaching Black communities through the leaders and peers they trust most.

By using similar tactics, HRP manufacturers and public health officials can effectively reach Black Americans with pertinent information about the relative risks of HRPs and encourage them to switch to these products from combustible cigarettes. 

End the Sale of Menthol Cigarettes-Don’t Touch Menthol Reduced Risk Options

In order to improve and protect the health of millions of Black Americans there are two obvious next steps. The first is to end the sale of menthol cigarettes and other mentholated combustible products in a way that supports addicted individuals through the continued availability of menthol e-cigarettes and other HRPs. The second, which is absolutely necessary in supporting the efficacy of the ban, is for HRP manufacturers to implement a powerful and targeted initiative to educate Black menthol users about the reduced risks of HRPs, and the creation of a regulatory framework that encourages and rewards tobacco companies to invest in lower risk products to replace cigarettes.

A careful line needs to be towed by government regulators when increasing access to HRPs for current addicted smokers and discouraging the use of these products among non-smokers, especially youth. But this can be done with science-based policies and programs specifically for smokers that correct misperceptions about HRPs and promote their use as reduced-risk alternatives. These types of measures will save lives. 

Dr. Derek Yach, President, Foundation for a Smoke-Free World; Former Cabinet Director and Executive Director for Noncommunicable Diseases and Mental Health, World Health Organization