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It will soon be time to take that last drag on a Salem. And don’t even think about switching to flavored cigars. The U.S. Food and Drug Administration (FDA) said today that it will issue a proposal “within the next year” to ban menthol in cigarettes and ban all flavors, including menthol, in cigars. The long-expected action is response to a lawsuit filed by antismoking and public health groups intended to force the FDA to act.
It has been estimated that menthol cigarettes helped recruit an estimated extra 10 million U.S. smokers between 1980 and 2018, leading to 378,000 premature deaths and a cumulative total of 3 million years of life lost, according to a February 2021 study published online in the journal Tobacco Control.
Black Americans have been hit harder than other groups. More than 85 percent of Black smokers use menthol cigarettes, according to federal data, as do more than half of all smokers aged 12 to 17.
“Banning menthol—the last allowable flavor—in cigarettes and banning all flavors in cigars will help save lives, particularly among those disproportionately affected by these deadly products,” said Acting FDA Commissioner Janet Woodcock, M.D., in a news release. She said the action would particularly benefit “communities of color, low-income populations, and LGBTQ+ individuals, all of whom are far more likely to use these tobacco products.”
Effects on Black Americans
A genetic variant found only in people of African descent significantly increases a smoker’s preference for cigarettes containing menthol, a 2019 study found. The variant of the MRGPRX4 gene is five to eight times more frequent among smokers who use menthol cigarettes than other smokers, according to an international group of researchers supported by the U.S. Food and Drug Administration and the National Institutes of Health. The paper was published online in the journal PLOS Genetics on February 15, 2019.
An earlier study found that menthol acts in combination with nicotine to desensitize receptors in lungs’ airways that are responsible for nicotine’s irritation. “We know that a menthol cough drop soothes a scratchy, sore throat. The question we looked at is if and how it works when the irritant is nicotine,” said a study author, Kenneth Kellar, PhD, a professor of pharmacology at Georgetown University Medical Center.
“The issue may be that menthol in the presence of nicotine may reduce the irritation enough that a smoker can inhale more deeply, bringing not just nicotine but toxic smoke products farther into the lungs,” said co-investigator Gerald Ahern, PhD, an associate professor of pharmacology at GUMC. Deeper inhalation could increase the damage done by smoking, Ahern said.
Menthol cigarettes have also been cited as a motivator for teens to take up smoking. A 2014 Canadian study found that teens who use menthol cigarettes smoke more than their peers who smoke non-menthols.
“The appeal of menthol cigarettes among youth stems from the perception that they are less harmful than regular cigarettes. The minty taste helps mask the noxious properties, but the reality is that they are just as dangerous as any unflavored cigarette,” said Sunday Azagba, a scientist at the Propel Centre for Population Health Impact and lead author on the paper.
Canada banned menthol cigarettes in 2016, leading to a significant increase in the number of smokers who attempted to quit, smokers who quit successfully, and lower rates of relapse among former smokers, according to a research study from the International Tobacco Control Policy Evaluation Project (the ITC Project) at the University of Waterloo.
“Our study demonstrates the substantial benefits of banning menthol cigarettes,” said Geoffrey T. Fong, Professor of Psychology and Public Health and Health Systems at Waterloo, and principal investigator of the ITC Project. “The enormous success of the Canadian menthol ban makes it even clearer now that the U.S. should finally ban menthol, which the tobacco industry has used for decades to attract new smokers and to keep many of them as customers, especially among the African-American community.
“From our findings, we estimate that banning menthol cigarettes in the U.S. would lead an additional 923,000 smokers to quit, including 230,000 African-American smokers,” Fong said.
The FDA noted that the restrictions, once adopted, will only affect manufacturers, distributors, wholesalers, importers and retailers. “The FDA cannot and will not enforce against individual consumer possession or use of menthol cigarettes or any tobacco product,” the agency said.
“Together, these actions represent powerful, science-based approaches that will have an extraordinary public health impact. Armed with strong scientific evidence, and with full support from the Administration, we believe these actions will launch us on a trajectory toward ending tobacco-related disease and death in the U.S.,” Woodcock said.