Banning menthol cigarettes is likely to benefit public health and can lead to social justice and equity

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As the Food and Drug Administration moves forward with its proposal to ban menthol cigarettes, Rutgers researchers insist the move is a step toward social justice and greater health equity in the black community, where menthol cigarettes were heavily marketed by tobacco companies.

In a comment published in Open JAMA Networkresearchers from the Rutgers Center for Tobacco Studies (CTS) said the ban will help prevent young people from starting to smoke and reduce national smoking rates, especially among vulnerable groups.

Indeed, the FDA’s proposed product standard cites 26 research studies authored or co-authored by members of the CTS team.

Cristine Delnevo, director of the center and professor at the Rutgers School of Public Health, and Andrea Villanti, deputy director of the CTS and associate professor at the Rutgers School of Public Health, have published several studies and have been expert reviewers for the FDA “Assessment science of the impact of menthol in cigarettes.”

Delnevo, Villanti, Ollie Ganz, instructor at the Rutgers School of Public Health and researcher at CTS, and Kevin Schroth, associate professor at the Rutgers School of Public Health and researcher at CTS explain why scientific evidence trumps all the arguments of industry.

Why should menthol cigarettes worry public health officials?

Delnevo: The FDA Tobacco Products Scientific Advisory Committee concluded that menthol in cigarettes reduced smoking harshness and was associated with increased initiation, higher dependence, and lower success rates.

Our study published in the journal Nicotine and Tobacco Research, draws attention to the continued availability of menthol cigarettes in the United States as a social justice issue. Most black smokers in the United States smoke menthol cigarettes, and extensive research shows that the tobacco industry has targeted African American communities with advertisements for menthol cigarettes for decades.

Data from the National Youth Smoking Survey also shows that while menthol use declined overall among youth from 2011 to 2018, there was no decline among black and Hispanic college students.

How has the consumption of cigarettes, particularly menthol cigarettes, changed over time and why is this important in the context of a ban on menthol cigarettes?

Delnevo: Our study published in Open JAMA Network, analyzed data on cigarette consumption in the United States between 2000 and 2018 and found a 46% drop in cigarette consumption during this period, but 85% of this drop was attributed to menthol-free cigarettes. This is a trend consistent with evidence that menthol cigarettes increase initiation and progression to regular smoking and decrease smoking cessation success.

We also found that the introduction of menthol capsules, a product feature that allows consumers to crush a liquid-filled capsule through the filter, may have slowed the downward trajectory of cigarette smoking. The industry continues to innovate and policy makers need to be comprehensive in their approach to flavor bans.

Why is it important to ban menthol cigarettes and why has it been difficult to enact a national ban?

Gantz: Research shows that a ban on menthol cigarettes would have a significant public health impact and a positive impact on the African American community. A 2011 study modeling the effects of a menthol ban in the United States estimated that 633,252 deaths could have been prevented and that one of those three lives lost would be a black person. Other vulnerable communities are also at risk if a menthol ban is not implemented. Our study concluded that inaction on menthol was due to a lack of political will.

Will an FDA ban on menthol cigarettes survive tobacco industry lawsuits?

Schroth: Our comment explains why the FDA has a strong chance of prevailing as the tobacco industry inevitably takes legal action to challenge the FDA’s final rule. The Tobacco Control Act of 2009 clearly gives the FDA the power to issue a product standard like this and sets the parameters for a lawsuit. A product standard must be appropriate for the protection of public health, with two main considerations: it must help current smokers to quit and contribute to reducing the initiation of smoking. A compelling body of evidence shows that menthol cigarettes contribute to youth initiation and reduced success in people trying to quit smoking. The persuasiveness of this scientific evidence is likely to be the deciding factor in a lawsuit.

Will an FDA ban on menthol cigarettes criminalize menthol cigarettes or lead to increased criminal activity, with a disproportionate effect on the African American community?

Schroth: As our comment acknowledges, this question reflects a topic of discussion that RJ Reynolds Tobacco Company has brought into the public domain. However, the idea that a menthol ban will contribute to criminal activity or violence is not consistent with tobacco law enforcement practices. It is companies and manufacturers who will be affected by the enforcement of a ban on menthol cigarettes, not individuals.

But it looks like the FDA is taking this issue seriously. The FDA invites public comment on how it can clarify the roles of law enforcement authorities and any potential racial and social justice implications of the proposed product standards.

How can we maximize the public health benefits of an FDA ban on menthol cigarettes?

Delnevo: We need to keep a watchful eye on youth smoking behaviors, including the use of multiple products, substitution with other products, or alternative methods of minty flavor delivery. We also need to comprehensively assess the effects of menthol or flavor bans on tobacco-related health inequalities.

Villanti: In a new comment published in Open JAMA NetworkWe emphasize that the FDA’s proposed ban on menthol cigarettes is a pivotal moment for health equity and suggest a range of activities, including:

  1. Raise awareness and counter misconceptions and misinformation about flavored tobacco policy objectives
  2. Ensure policy enforcement is focused on retailers and manufacturers
  3. Limit policy exemptions to avoid loopholes or inequitable implementation
  4. Strengthen smoking cessation resources

Schroth: Individuals and groups should consider contributing to the FDA’s virtual listening sessions on June 13 and 15 and/or submitting public comments by July 5.

Source:

Journal reference:

Villanti, AC, et al. (2022) US Food and Drug Administration Action on Menthol Cigarettes and Flavored Cigars – A Pivotal Moment for Health Equity. Open JAMA Network. doi.org/10.1001/jamanetworkopen.2022.17150.

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