The tobacco industry has long targeted Black communities, LGBTQ+ people, kids and others with menthol cigarettes and flavored cigars, putting them on the path to a lifetime of nicotine addiction, serious illness and premature death while profiting at the expense of lives and health.
Now, at long last, the Food and Drug Administration (FDA) is poised to finalize proposed rules prohibiting the sale of menthol cigarettes and all flavored cigars. This would be a critical step in reducing the terrible toll of tobacco use, especially among Black communities, which suffer the greatest burden of tobacco-related deaths in the U.S.
Removing menthol cigarettes and flavored cigars from the market will save lives, improve health and reduce health care costs. It also will help close serious racial disparities in health.
As a cardiologist who has treated hundreds of patients suffering from tobacco use disorder over the years, I know that most people who smoke want to quit. There are two main reasons why they can’t: First, the powerful addictiveness of nicotine; and second, the underlying stressors that drive many people, especially those in marginalized communities, to use tobacco.
My patients often tell me that tobacco use is an easy way for them to relieve their everyday stress. Tobacco products are accessible when healthy forms of stress relief—like exercise—are not convenient or available to them. Research tells us, however, that whatever short-term relief people who use tobacco may get is dwarfed by the added stress, anxiety and other health harms of long-term nicotine addiction.
Put another way, quitting tobacco use is a far better way to decrease stress and improve health and well-being than starting the habit. Yet, many people who smoke feel that cigarettes help them cope when they have nothing else.
The tobacco industry knows this. It targets communities of color, those with low incomes and other marginalized communities at a time when they are most impressionable – in their youth. The industry strategically markets menthol cigarettes and flavored cigars to hook young people for life.
According to the Centers for Disease Control and Prevention (CDC), more than 80% of current adult smokers began smoking before the age of 21. Further research shows that teens and young adults’ first cigarette is more likely to be a menthol cigarette. A scientific review of the effects of menthol concluded that menthol in cigarettes increases the likelihood of regular smoking in youth and young adults, is linked to greater nicotine dependence in youth and is associated with reduced cessation success (particularly among Black smokers).
The same goes for flavored cigars. In 2021, nearly 8 in 10 youth who reported using tobacco products used flavored varieties. In addition to menthol-flavored cigarettes, other menthol-flavored tobacco products are popular among youth.
Given the significant rise in stress, anxiety and depression among young people during the COVID-19 pandemic—and the fact that people with severe anxiety are more likely to use tobacco than the general population—the FDA’s proposal to prohibit the sale of menthol cigarettes and flavored cigars is more important than ever.
But we also need to think about what happens once these products are removed from the market. How can we help people experiencing high levels of daily stress and anxiety choose healthy and effective forms of relief, like exercise and meditation? How do we help them quit tobacco use altogether? What resources and supports can we offer them so they don’t turn to other unhealthy habits? These are questions public health officials and community leaders and advocates must address together.
Despite significant progress over the years in reducing overall rates of smoking, tobacco use remains a leading cause of preventable death in the U.S.— killing an estimated 480,000 people each year. Marginalized communities are affected more than others—in significant part because they are strategically targeted by Big Tobacco’s marketing campaigns to increase sales and profits while causing immense harm to public health. Menthol cigarettes and flavored cigars are important tools in the industry’s marketing kit.
The FDA should move forward to prohibit the sale of menthol cigarettes and all flavored cigars – a move that would constitute an enormous step forward to protect public health, especially among marginalized communities. At the same time, the public health community should work to ensure these same communities have healthy, effective ways of reducing stress so they can stand up against the dangerous lure of tobacco use.
Michelle A. Albert, , M.D., M.P.H., FAHA, is immediate past president of the American Heart Association, the Walter A Haas-Lucie Stern Endowed Chair and professor of medicine, director of the CeNter for the StUdy of AdveRsiTy and CardiovascUlaR DiseasE (NURTURE Center) and associate dean of admissions at the University of California, San Francisco