We need more than a ban on menthol cigarettes to curb smoking rates - Foundation for a Smoke-Free World

We need more than a ban on menthol cigarettes to curb smoking rates

The U.S. Food and Drug Administration is poised to take its biggest action yet to lower smoking rates by banning menthol cigarettes. But without providing a robust off-ramp to support menthol cigarette smokers who might quit, the effort will fall short of projections for the number of lives that could be saved.  

In 2022, the FDA proposed regulations that would ban the manufacturing and sale of menthol-flavored cigarettes and all flavored cigars as part of its commitment to decreasing deaths from tobacco use and improving health equity. I was pleased to see that the agency cited a study that I and several colleagues published in 2021, which employed the science of modeling to determine that a ban on menthol cigarettes would likely avert 650,000 deaths by 2060 through greater smoking cessation. The White House and the FDA said earlier this year that they planned to finalize the ban this month.  

Menthol cigarettes contain a minty, soothing flavor. Scientists have shown this flavor makes it easier to tolerate the harsh sensation of inhaling smoke. They are the only non-tobacco flavored cigarettes available, and make up more than a third of the U.S. cigarette market.  

Menthol cigarettes are also overwhelmingly popular among Black people who smoke, who consequently disproportionately suffer most of the serious illness and premature death caused by these products. Canada has already banned menthol cigarettes, demonstrating that the regulation could save hundreds of thousands of lives.  

But crucially, our modeling assumes that people who smoke menthol cigarettes would be able to access sufficient tools to help them quit – including menthol-flavored e-cigarettes. Nearly two years after the FDA issued the regulations that would ban menthol cigarettes, the agency has yet to authorize a single non-tobacco-flavored e-cigarette. Curiously, it chose to disregard this aspect of our study. 

This failure of action could severely weaken the anticipated impact of the menthol cigarette ban. Some of my colleagues and I submitted a formal comment on the FDA’s proposed rule noting this discrepancy in August of last year. We fear that without additional reduced risk products being authorized for sale, many of the people who smoke menthol cigarettes will switch to traditional tobacco cigarettes instead of switching to far safer alternative nicotine products. 

Such an outcome could have devastating social justice consequences for Black people, as well as millions of people living with lower incomes, fewer years of education, members of the LGBTQ+ community, members of the military or veterans, or those living with mental health or substance use conditions. Smoking rates are higher in all of these populations in general.  

The FDA’s charge is to authorize tobacco products that it deems “appropriate for the protection of public health.” It should be able to regulate alternative, reduced-risk nicotine products in a way that supports people who smoke and are trying to quit and protects young people and adults who have never smoked from beginning to use nicotine. Both goals align with the agency’s mission to protect public health from tobacco-related death and disease.  

Yet FDA’s current regulation of reduced-risk nicotine products like e-cigarettes seem to heavily prioritize youth, leaving adults who smoke with painfully few new options to reduce their risk and live longer, healthier lives. In thus far rejecting every menthol flavored e-cigarette presented to it for possible sales the FDA has cited concerns that the risks of youth uptake are too great compared to the supposedly unknown benefits of these products for adults who smoke.  

This is simply not true: In addition to what the agency already knows from our study, on which it selectively relied, this year a major meta-analysis found that e-cigarettes are superior to traditional nicotine replacement therapies in helping smokers quit, demonstrating their clear benefit. Additionally, recent research from Yale University suggests that with only tobacco flavored e-cigarettes available, more adult nicotine users would choose to smoke cigarettes 

The FDA has the chance to make history by finalizing this life-saving product standard banning menthol cigarettes, but it will fall short of its lofty goals if it cannot support adults who want to quit smoking. Nicotine replacement therapies are proven to be safe smoking cessation aids, but they do not work for most people. And, simply put, falling short in this instance will cost more lives, with some of the most disadvantaged members of our society suffering the most. 

Adults who want to quit smoking deserve better resources, just as our youth deserve to be protected from nicotine addiction. Currently, the FDA is prioritizing only the latter. The result would be a massive social injustice. 

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