Perspectives: Why a national ban on menthol cigarettes is the right choice

a cigarette being snubbed out

May 12, 2021 – The U.S. Food and Drug Administration (FDA) recently announced that it will take steps to ban menthol cigarettes. Three Harvard T.H. Chan School of Public Health experts share their views on the significance of the ban, its potential impact on public health, and why this step is long overdue.

Vaughan Rees
Director of the Center for Global Tobacco Control, Lecturer on Social and Behavioral Sciences

Scientists and advocates working in tobacco control have been concerned about the influence of menthol cigarettes for decades. Menthol is added to cigarettes by manufacturers to create a cooling sensation that reduces the harshness of cigarette smoke. Menthol also has bronchodilatory properties, allowing deeper penetration of smoke into the lung. The cooling sensation and reduced harshness of mentholated smoke leads consumers to perceive those cigarettes as posing a lesser health risk compared with non-mentholated cigarettes. But the truth is that by making cigarettes smoother, cooler, and easier to inhale, tobacco companies have created a product that has a higher addiction potential and is harder to quit than non-mentholated cigarettes. For example, a recent analysis of adult smokers in the FDA’s Population Assessment Tobacco and Health study found that menthol smokers had a lower probability of remaining abstinent from cigarettes compared to non-menthol smokers.

That same study has shown that menthol cigarettes are the preferred cigarette type among youth and black smokers. According to the data, 39% of youth overall and 81% of Black youth prefer menthol cigarettes. Most notably, menthol cigarettes are preferred by 86% of Black smokers. This is not surprising, given that cigarette manufacturers have historically targeted African American communities with menthol marketing campaigns. The proposed ban on mentholated cigarettes will help to address a substantial driver of smoking among African Americans, while eliminating a design feature that misleads smokers about the health risks while making it harder for smokers to quit.

It’s important to point out that bans on menthol cigarettes are not new. In 2017, Canada was one of the first countries in the world to introduce a national ban on menthol cigarettes, as well as most cigars and blunt wraps (hollowed-out cigar wrappers that are often filled with marijuana). Ethiopia, Senegal, Uganda, Nigeria, Moldova, Turkey, and the European Union have implemented similar bans. It is very encouraging to see the U.S. FDA moving to act in accordance with the science and join the efforts of the global tobacco control community.

Mary Bassett
Director of the Francois-Xavier Bagnoud (FXB) Center for Health and Human Rights; FXB Professor of the Practice of Health and Human Rights

The tobacco industry identified menthol cigarettes as a product that they would preferentially market to the African-American population. If you look at the advertisements over time, you can absolutely see menthols positioned as the “Black” cigarette and it is really shameful and put their lives disproportionately at risk. In a recent op-ed I co-authored on this subject, we noted that there’s this persistent perception in the United States that Black people prefer menthol cigarettes. But in fact, that is a result of racist marketing.

These are lethal products. Cigarettes, menthols in particular, each year kill 45,000 Black people, a population that is already saddled with higher rates of heart disease, asthma, and other conditions that smoking can exacerbate. Smoking also makes people more vulnerable to worse COVID-19 outcomes, and, as we know, the pandemic has disproportionally harmed Black communities.

I’m pleasantly surprised that the FDA is taking steps to ban menthols, but I hope it acts swiftly and gets a timeline for the ban in place. The tobacco industry doesn’t flinch, and it will surely mobilize efforts to attack the science and legal merits of a ban on menthol cigarettes.

Howard Koh
Harvey V. Fineberg Professor of the Practice of Public Health Leadership

On my very first day as U.S. Assistant Secretary for Health in June of 2009, I will never forget joining a delegation in the White House Rose Garden to support President Obama as he signed into law the Family Smoking Prevention and Tobacco Control Act. That law allowed the FDA authority to regulate tobacco products for the first time ever. So it was not only a stunning and historic day for public health, but an unforgettable one for me personally. As part of enactment, the law banned flavors in cigarettes, such as candy, bubble gum, or chocolate, but specifically exempted menthol. That was left for another day. So the new menthol ban the FDA just proposed has actually been at least 12 years in the making.

As a physician trained in multiple fields, including cancer, I have witnessed far too much suffering and dying caused by tobacco products, which are projected to cause a billion deaths worldwide in the 21st century. Eighty-five percent of Black smokers use menthol cigarettes. Studies show that menthol cigarettes increase initiation of smoking, decrease cessation, and make it harder for Black smokers to quit compared to non-Black smokers. This menthol ban will save an enormous number of lives—one study estimates that it could prevent more than 600,000 deaths by 2050. Importantly, this ban will also address health inequity issues that arise from the tobacco industry’s long history of manipulation of flavors as part of targeting youth and minority populations.

Despite so many challenges, tobacco control can save lives. It has been an honor to be part of these efforts for several decades now in Massachusetts and nationally. During my time at the Department of Health and Human Services (HHS), we created and implemented the Department’s first ever Tobacco Control Strategic Action Plan entitled “Ending the Epidemic.” In the era of the new Affordable Care Act, the plan helped unite HHS in leveraging FDA’s new tobacco control authority. We were proud to see some progress in denormalizing these products and their use. But there is still so much work to be done. The menthol ban, which includes flavored cigars, does not apply to e-cigarettes, for example. The tobacco industry maintains that cigarette use is a choice when in fact it remains a devastating addiction. The FDA’s proposed menthol ban is an overdue step forward in the long and difficult history of tobacco control.

Chris Sweeney