The cigarette regulation loophole that disproportionately costs Black lives

The FDA is finally thinking about doing something. The time has come.

In 2009, Congress did something very important: they banned flavoured cigarettes, which were a big reason why young people started smoking. But that important law had a major flaw: it had a loophole that let tobacco companies keep selling menthol cigarettes.
Since menthol makes it easier to start smoking and harder to quit, tobacco companies have relied heavily on it for decades. Menthol is a chemical additive that can be found in nature or made in a lab. When added to cigarettes, menthol has a cooling effect that masks the harsh taste of cigarette smoke and lets the smoker inhale more deeply. It can also boost the effects of nicotine, which is what makes cigarettes so addictive.

The Food and Drug Administration is finally thinking about taking action to close this loophole for good. Earlier this year, they proposed rules that would end the sale of all flavoured cigars and menthol cigarettes. The public comment period ends on Tuesday. During this time, the agency asks for feedback to help decide whether or not to implement the proposed rules. We need to speak out now about stopping the sale of menthol, especially because so many Black lives are at risk.
About 85 percent of Black people who smoke use menthols. This is likely because of predatory marketing techniques used over the past four generations, such as billboards, point-of-sale promotions, corporate sponsorships, coupons, and free samples that were mostly distributed in Black communities.
Even though too many people in other groups smoke menthol cigarettes, too, like 48% of Hispanic smokers and 30% of white smokers, tobacco companies have clearly and disproportionately marketed menthols to Black people.
The consequences are terrible: About 45,000 Black people die every year because they use tobacco. This is a disproportionately high number of deaths in America that are caused by tobacco use. Compared to white adults, black adults are 30% more likely to die from heart disease and 47% more likely to die from a stroke, which are two of the worst health problems caused by smoking.

With these numbers goes the long history of tobacco companies targeting Black people and communities with menthol products in a mean way. Philip Morris paid for research that showed less than 10% of Black people who smoked used menthol cigarettes in the 1950s. However, surveys at the time showed that Black Americans liked these products slightly more than white Americans did.
Also, when Black Americans left the Deep South after World War II, they moved to places where there were a lot of people. This created new marketing opportunities for companies that could take advantage of it. The tobacco industry knew about these things and used them to its advantage.
I knew this for sure because I grew up in East Nashville, Tennessee, which was mostly black when I was young. I remember seeing billboards and signs in stores and pharmacies around my neighbourhood that made menthol cigarettes look “cool.”
It turns out that those ads were only the tip of the iceberg. Tobacco companies have a long history of using black celebrities and athletes as spokespeople and putting a lot of ads in black magazines and newspapers as well as other ways to reach out to black youth. Starting in the 1960s, an article in the American Journal of Public Health called it a “masterful manipulation” campaign to get African Americans to smoke menthols.

When I became a doctor, I saw almost every day how powerfully this kind of persuasion could work. As a cardiologist in Nashville and Atlanta, I’ve taken care of tens of thousands of people. I can’t think of a single person with a serious heart disease caused by atherosclerosis who did not smoke.

Since Congress first banned flavoured cigarettes, the case for stopping the sale of menthol cigarettes has only gotten stronger. In 2011, an FDA advisory committee said that it would be good for public health if menthols were taken off the market. Research that modelled the effects of a ban showed that it would have put the United States on track to save more than 633,000 lives by 2050, with more than a third of those lives belonging to African Americans.
We can’t afford to wait any longer. Tobacco companies still spend a lot of money marketing their menthol brands to keep their highly addictive cigarettes cheap and easy to find in Black communities. Young people are an early target. Researchers in two Ohio cities found that menthol tobacco products are often advertised near candy displays in places where there are a lot of Black children.
The tobacco companies did what they always do in response to the FDA’s proposed rules: they posed as community advocates. This is the same thing that happened during the legislative fight in 2009, which was written about in the American Journal of Public Health article: “Speakers for the tobacco industry insisted that letting people buy menthol put them on the side of African Americans’ fight for justice, and they used civil rights groups to help them make that case.”

Today, R.J. Reynolds Tobacco Company, which makes one of the most popular menthol cigarettes in the United States, says it wants to keep “access and choice” while also saying it is “committed to tobacco harm reduction” and promoting “reduced-risk products.” Philip Morris’s parent company, Altria, says that the plan would lead to “unregulated, criminal markets.”
These claims show how tobacco companies try to fight against public health measures by making people afraid. It’s a cruel irony that tobacco companies target communities like the one I grew up in and the one I work in now with products that kill tens of thousands of people every year. No smoker who has had a heart attack, stroke, or leg amputated because of their habit has ever thanked the tobacco companies for taking care of them.
It’s time to say “enough.” Since the public comment period on the FDA’s proposal ended on Tuesday, the agency must move quickly to take menthol cigarettes and flavoured cigars off the market. This will save lives and stop a lot of sickness and pain.
Too long, Black people in America have been hurt by the ways that tobacco companies try to sell more cigarettes instead of caring about people’s health. The proposed rules from the FDA give our country a chance to finally be on the right side of history and show that we care about the health of everyone in our communities.

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