The announcement at the end of April of the Food and Drug Administration’s intention to ban menthol cigarettes and flavored cigars in the United States has raised hopes among advocates of tobacco control and smoking cessation. Michael Cummings, Ph.D., a MUSC Hollings Cancer Center researcher and tobacco control expert, believes this is a step in the right direction.
Cummings said the FDA’s decision could reduce the number of people introduced to nicotine. Menthol products appeal to young people and minorities due to targeted marketing and aroma. Cummings believes that menthol products may be more addictive than regular cigarettes because of the anesthetic effect they have on the airways.
“When you breathe in minty cigarette smoke, it cools the airways, making it feel less harsh,” he said. “You can argue that it actually eases the nicotine addiction because the removal of nicotine from smoke in the lungs is essential for the rapid absorption of nicotine, where it has its effect in the brain.”
Cummings has worked to curb smoking and reduce addiction for decades. He said menthol products are used much more widely in the United States than in Canada and the European Union, both of which have been banned.
“In the United States today, that’s about 40% of the menthol cigarette market share,” Cummings said. “We have specific brands which are exclusively menthol brands. Salem, Newport, Kool – these are brands that were created and have always been marketed primarily under menthol.
Cummings was part of a study that examined the impacts of a similar menthol ban in Canada from 2016 to 2018. Researchers observed the smoking behaviors of menthol and non-menthol smokers before and after the ban. Of the 138 menthol smokers surveyed, 59.1% switched to non-menthol cigarettes following the ban.
“Don’t expect the menthol ban to force all menthol cigarette smokers to quit,” Cummings said. “It’s not going to happen. Most people addicted to nicotine and cigarettes, if they can’t afford their menthol cigarettes, will switch to a menthol-free brand.
However, the ban was associated with an increase in the number of menthol smokers who quit, reported by 21.5% of those surveyed. The researchers also found that Canada’s menthol ban was more likely to encourage menthol smokers to attempt to quit, which was reported by 59.4% of respondents, compared to 56.2% of non-smokers from menthol. And 19.4% of menthol smokers surveyed said they still smoke menthol products, purchased primarily on First Nations reserves, where many of Canada’s indigenous tribes reside, and where the government has no skill.
“It wasn’t a huge change, but if you do it at the population level, small effects have a big impact,” Cummings said.
Following the Canadian study, the researchers used the results to predict what a menthol ban in America might accomplish. They predicted that this would result in an additional 1,394,201 additional daily and non-daily menthol smokers, of which 392,562 would be African Americans.
“If you assume that one in two people die prematurely from smoking and you can get a million or two million more people to quit, that’s a lot of lives that can be saved.
Cummings said menthol consumption plays a significant role in the differential in lung cancer deaths between blacks and whites in South Carolina. By reducing the number of people using the products, lives could be saved.
While tobacco control advocates are happy with the FDA’s announcement, they also recognize that it will actually be a long and difficult road to implement the change. Cummings said there must be a period of rule-making followed by commentary and impact studies before the FDA makes a final decision.
“Assuming this progresses, the FDA can start proposing its rule. But it could take years.
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