Decades of pervasive tobacco industry advertising disproportionately impacts Blacks
Menthol cigarette manufacturers have found a friend in the Black community dating back to the 1950’s.
The U.S. Food and Drug Administration’s (FDA) announced last week that it was issuing proposed standards in the next year to ban menthol as a flavor in cigarettes citing “clear science and evidence establishing the addictiveness and harm of these products” to minority groups who say that menthol has led to lower rates of quitting and higher rates of death.
The FDA’S long-awaited proposal bans the sale, manufacturing and distribution of menthol cigarettes saying that African Americans have been targeted for decades by cigarette manufacturers
with advertisements, price promotions, and free samples making them appealing.
Thomas Stallworth, 69, of Farmington Hills, spent over 40 years smoking cigarettes, including menthols, before quitting in December 2019 following a heart attack.
For him, smoking in the 1960s meant being cool, adventurous, and rebellious. It was all about fitting in. His very first cigarette, a menthol, was snatched from his grandfather’s pack.
“At 19, the first cigarette I ever smoked was out of curiosity,” he said. “I took a few puffs. Of course I hated it. It didn’t have any filters on it. It basically choked me up. As I progressed onto college I started smoking more regularly. I ultimately became addicted.”
In the U.S., 85% of Black smokers prefer menthol cigarettes, significantly more than any other demographic, according to the FDA.
In 2019, more than 18 million Americans smoked menthol cigarettes, with higher rates among young people, African Americans and other racial groups, according to the FDA. Menthol smoking declined among white teenagers between 2011 and 2018, but not among Black and Hispanic youth.
Stallworth smoked in stressful and social situations and was well aware of the potential for long-term health problems but never thought he would smoke long enough to get to that point.
Decades later, he has heart disease along with other cardiovascular issues from smoking.
For adults, as of 2019, the latest data available from the U.S. Centers for Disease Control and Prevention (CDC), 21.9% of Blacks in Michigan reported they currently smoked cigarettes, over 7% higher than the U.S. rate of 14.8%. Around 17.8% of all white adults in the state reported they currently smoked cigarettes.
For children, as of 2017, the latest data available from the CDC, 2.7% of Blacks in Michigan reported that they currently smoked cigarettes, which was below the 4.4% U.S. rate. That’s compared to 12% of white children in Michigan that reported currently smoking.
What is menthol?
Menthol is an additive that masks the harshness of tobacco products, making them easier to consume, according to Truth Initiative, America’s largest non-profit organization advocating for tobacco-use treatment and prevention.
The group reports that tobacco products with menthol tend to be more addictive and harder to quit by enhancing the effects of nicotine. The cooling effect that menthol has on the throat allows for deeper and longer inhalation of smoke containing nicotine.
Dr. Phillip Gardiner, cochair and founder of the African American Tobacco Control Leadership Council, said the deeper a smoker inhales, the more toxins and nicotine that come into the body and thus the more addicted one becomes.
“We know that when nicotine enters your blood system it enters your liver and stays in your body longer,” he said. “We also know that menthol allows for greater cell permeability, meaning that menthol cigarette smoke will penetrate cells much more efficiently than if there’s no menthol in it.”
Gardiner said that by deeply penetrating cells, menthol smoke can more effectively disrupt the function of lungs, kidneys, and heart leading to increased long-term chronic health problems and death.
Menthol is the only cigarette flavor that was not prohibited under the 2009 federal law that gave the FDA authority over tobacco products, an exemption negotiated by industry lobbyists. The law did, though, instruct the agency to continue to consider a ban. To date, the FDA has yet to eliminate any traditional tobacco products, though it has had that authority for over a decade.
In 2020, Gardiner’s group and several others sued the FDA to make a decision on a ban, according to The Associated Press.
A targeted demographic
After World War II, as African Americans moving north increased, the tobacco industry began to develop new products marketed to them.
Since the 1950s, messaging and marketing increased menthol cigarette use in the Black community from less than 10% to 85% in the following decades.
Minou Jones, CEO of the Making it Count Community Development Corp. and chair of the Detroit Wayne Oakland Tobacco Coalition, said the tobacco industry has aggressively targeted Black communities, especially in urban areas, through magazine advertising, sponsorship of community and music events, free samples of cigarettes, and other tactics.
Jones, whose grandmother and aunt died from smoking-related causes, calls the proposed ban long overdue and added that Black communities can no longer accept health disparities that exist for so many people of color in Michigan.
“Menthol cigarettes continue to be heavily advertised, widely available and priced cheaper in Black communities making them especially appealing to price-sensitive youth,” she said. “Blacks are entitled to equal health protections under the law. Not banning menthol, is discriminatory and a social justice issue.”
Decades ago, Dr. Gardiner said menthol cigarette manufacturers poured millions of dollars into advertising and marketing their products within that community.
“So it has essentially been pushed down the throat of our community by the tobacco industry,” he said.”
Gardiner added that as more people quit smoking, the tobacco industry works to replace those smokers by putting flavors into their products, specifically menthol, to get younger and minority demographics hooked.
“The most debilitating flavor, particularly for the Black community, is menthol,” he said. “It helps the poison go down easier.”
The impact
The increased use of menthol cigarettes in minority communities has led to a significant disparity in the number of negative health outcomes compared to other racial and ethnic demographics.
African Americans represent 12% of the U.S. population, but accounted for 41% of all menthol-smoking-related premature deaths in the U.S. between 1980 and 2018, according to a new study from University of Michigan. Researchers believe the study is the first to quantify the impact of menthol cigarettes in Black communities across the country.
“It is well known that tobacco companies, in the 1960s and ‘70s, targeted menthol cigarettes to African American communities, and menthol cigarettes became ubiquitous in those communities,” said David Mendez, lead author of the study and an associate professor in the Department of Health Management and Policy at the U-M School of Public Health.
Menthol cigarettes were responsible for 1.5 million new smokers,157,000 smoking-related premature deaths and 1.5 million lifeyears lost among African Americans between 1980 and 2018, according to the U-M study.
Another study, released by the Campaign for Tobacco-free Kids, the NAACP, and the African American Tobacco Control Leadership Council, cited tobacco use as the number one cause of preventable death among Black Americans, claiming 45,000 lives every year. Tobacco use, specifically menthol cigarette use, is also a major contributor to three of the leading causes of death among Black Americans — heart disease, cancer and stroke.
Last week, acting FDA Commissioner Janet Woodcock said that banning menthol cigarettes would help address health disparities experienced by communities of color and lowincome populations that are disproportionately affected by tobacco-related disease and death.
One study, conducted by the Canadian arm of the International Tobacco Control Four Country Smoking and Vaping Survey, suggests the ban would lead 923,000 U.S. smokers to quit, including 230,000 African Americans, in the first 13-17 months after the ban goes into effect.
An earlier study, conducted by Daniel Levy, a senior scientist at The University of Baltimore, projected about 633,000 deaths would be averted, including about 237,000 for Black Americans.
Kayla Stringer, 37, of Detroit, has been smoking menthol cigarettes for 12 years but has tried to quit several times. Initially, she smoked a pack a day.
Her father and aunts, all smokers, suffered non-fatal heart attacks. Although she hasn’t experienced any health problems yet as a result of smoking, she’s trying to quit before that happens.