USA: Tobacco control advocates encouraged by FDA announcement to ban menthol cigarettes

A late-April announcement that the Food and Drug Administration is moving to ban menthol cigarettes and flavored cigars in the United States is sparking hope for tobacco control and smoking-cessation advocates. Michael Cummings, Ph.D., a researcher at MUSC Hollings Cancer Center and a tobacco control expert, believes it is a step in the right direction.

Cummings said the FDA decision could reduce the number of people being introduced to nicotine. Menthol-based products appeal to younger people and minorities due to targeted marketing and flavoring. Cummings believes menthol-based products could be more addictive then regular cigarettes because of the anesthetic effect they have on the airways.

“When you breathe in menthol cigarette smoke, it cools the airways, so it gives a less harsh impression,” he said. “You can make the argument that it’s actually facilitating nicotine addiction because getting the nicotine out of the smoke and into the lungs is critical to the rapid uptake in nicotine, where it has its effect in the brain.”

Cummings has worked to restrict tobacco and reduce addiction for decades. He said menthol-based products are much more widely used in the United States than in Canada and European Union, both of which have undergone bans.

“In the United States today, it is about 40% of market share for mentholated cigarettes,” Cummings said. “We have specific brands that are exclusively menthol brands. Salem, Newport, Kool – these are brands that were created and have always been marketed predominately as menthol.”

Cummings was part of a study that looked at the impacts that a similar menthol ban had in Canada from 2016 until 2018. Researchers observed smoking behaviors of menthol and non-menthol smokers prior to and after the ban. Of the 138 menthol smokers surveyed, 59.1% switched to non-menthol cigarettes following the ban.

“Don’t expect the ban on menthol to get all menthol cigarette smokers to just stop smoking,” Cummings said. “That’s not going to happen. Most of the people who are addicted to nicotine and cigarettes will, if they can’t get their menthol cigarettes, switch to a non-menthol brand.”

However, the ban was associated with an increase in the number of menthol smokers who quit smoking, reported by 21.5% of those surveyed. Researchers also found that the Canadian menthol ban encouraged more “quit” attempts by menthol smokers, reported by 59.4% of respondents, compared to 56.2% of non-menthol smokers. And 19.4% of those menthol smokers surveyed reported still smoking menthol products, purchased primarily from First Nations reserves, where many of Canada’s indigenous tribes reside, and the government has no jurisdiction.

“It wasn’t a huge change, but if you do that on a population-wide basis, small effects have a big impact,” Cummings said.

Following the Canadian study, researchers used findings to predict what a menthol ban in America could accomplish. They predicted it would result in approximately an additional 1,394,201 daily and non-daily menthol smokers quitting, 392,562 of whom would be African Americans.

“If you assume that one out of two people die prematurely from smoking, and you can get an extra million or two million people to quit, that’s a lot of lives that can be saved.”

Cummings said menthol use plays a big role in the lung cancer death differential between blacks and whites in South Carolina. By reducing the number of people using the products, lives could be saved.

While tobacco control advocates are pleased with the FDA announcement, they also acknowledge it will actually be a long, challenging road ahead to implement change. Cummings said there must be a rulemaking period followed by comments and impact studies before the FDA makes a final decision.

“Assuming that goes forward, the FDA can begin to put forward their rule. But that could be years away.”

Source: Hollings Cancer Center

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