The Food and Drug Administration appears likely to move to ban menthol in cigarettes this week — a step, experts say, that has been years in the making and that could have a significant positive impact on the health of Black Americans.
The FDA's decision would not ban menthol immediately, but rather kick off the rule-making process to do so, which could take years.
"The winds are definitely in our favor," said Delmonte Jefferson, executive director of the Center for Black Health & Equity, citing both the decades of data that show that the cooling flavor in cigarettes makes it easier to start smoking combined with the current cultural momentum toward improving the lives of Black Americans.
When inhaled, menthol produces a cooling sensation in the throat, reducing the harsh taste of cigarettes and the irritation of nicotine. The vast majority of Black smokers — 85 percent — use menthol cigarettes. And Black men and women are much less likely than white Americans to be diagnosed with lung cancer at an earlier, potentially more treatable stage. Black men have the highest lung cancer death rate in the country.
"When you combine high rates of smoking with systematic racism in health care systems, you have a tremendous health disparity," said Erika Sward, national assistant vice president for advocacy at the American Lung Association. Both the Centers for Disease Control and Prevention and the National Institutes of Health recently announced plans to address structural racism in health care.
The FDA faces a Thursday court-ordered deadline to respond to a citizen petition sent to the agency in 2013 urging it to ban menthol as a flavor in cigarettes. When the FDA failed to act at the time, two groups — the African American Tobacco Control Leadership Council and Action on Smoking and Health — sued.
It's possible a decision could come earlier than Thursday. And because the lawsuit only mentions regular cigarettes, it's unclear whether electronic cigarettes and other tobacco products that contain menthol would be affected.
The FDA was poised to ban menthol flavoring in 2018 under the leadership of then-Commissioner Dr. Scott Gottlieb, but failed to follow through. Gottlieb did not respond to a request for comment.
Some advocates of a menthol ban say a national focus on the Black Lives Matter movement may spur the agency to take action now.
"Covid-19 and the racial awakening we had last summer exposed the inequities in our system," Jefferson said. Menthol "is just another example of the health inequities that have plagued African Americans for generations."
"Personally, I am more optimistic about the FDA doing the right thing on menthol than I have been" in a decade, Sward said.
Others are less confident the FDA will act, including Pebbles Fagan, the director of the Center for the Study of Tobacco at the University of Arkansas for Medical Sciences. It is possible that the agency could delay a response by asking the court for more time.
Even if a decision to start the banning process does come this week, Fagan said she was skeptical the move would be "prompted by the social issues that surfaced in 2020."
"It took a lawsuit for FDA to pay attention to this issue," she said.
If the FDA does decide to move forward with a ban, menthol will not disappear overnight. In essence, such an announcement would simply be a way to tell the public, as well as the tobacco industry, that the agency intends to ban the flavoring in cigarettes. The rule-making process would likely take several years to finalize and implement. That would provide time to boost smoking cessation programs targeting menthol smokers.
"Every smoker who uses menthol cigarettes needs help to quit," Sward said.
There is evidence that such a ban could pay public health dividends. A study published in the journal Tobacco Control this month examined how menthol cigarette bans enacted in Canada from 2016 to 2017 affected smokers.
While nearly 60 percent of surveyed menthol smokers switched to regular cigarettes, those who used menthol before the ban were significantly more likely to make multiple attempts to stop smoking. More than 20 percent were able to quit.
There was also evidence of reduced relapses among former smokers.
"The enormous success of the Canadian menthol ban makes it even clearer now that the U.S. should finally ban menthol," study author Geoffrey Fong said in an April 6 news release announcing the research.
"From our findings, we estimate that banning menthol cigarettes in the U.S. would lead an additional 923,000 smokers to quit, including 230,000 African American smokers," Fong, a professor of psychology and public health and health systems at the University of Waterloo in Ontario, said.
"Literally half of the kids who smoke use menthol," said Matthew Myers, president of the Campaign for Tobacco-Free Kids. "We would dramatically cut the number of kids who ever become tobacco users if they didn't have menthol as a pathway."
"Prohibiting the manufacture and sale of menthol cigarettes," Myers said, would have the greatest impact on public health "that the government has ever taken."