A new study published online ahead of print this month in the International Journal of Clinical Practice finds that menthol makes cigarettes more addictive (see: Gandhi KK, Foulds J, Steinberg MB, Lu S-E, Williams JM. Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic. International Journal of Clinical Practice 2009).
The study examined quitting rates among 1700 African American and Latino smokers who attended a tobacco treatment clinic. Despite fewer cigarettes per day, individuals who smoked menthol cigarettes were much less likely to be able to quit smoking than those who smoked non-menthol cigarettes. Among African Americans, this effect was huge. Menthol smokers were half as likely to be able to quit as non-menthol smokers.
According to the press release issued by "'We previously found that menthol cigarette smokers take in more nicotine and carbon monoxide per cigarette. This study shows that menthol smokers also find it harder to quit, despite smoking fewer cigarettes per day,' said study author Kunal Gandhi, MBBS, MPH, a researcher in the division of addiction psychiatry at the UMDNJ-Robert Wood Johnson Medical School."
"Jonathan Foulds, director of the Tobacco Dependence Program, added 'These results build on growing evidence suggesting that menthol is not a neutral flavoring in cigarettes. It masks the harshness of the nicotine and toxins, affects the way the cigarette is smoked and makes it more deadly and addictive.'" According to Foulds, 'More than 80 percent of the African American smokers attending our clinic smoke menthols, and they have half the quit rate of African Americans who smoke non-menthol cigarettes.'"
"The researchers believe the cooling effect of the menthol makes it easier to inhale more nicotine from each cigarette and, therefore, to obtain a stronger and more addictive nicotine dose. 'That may be part of the reason why African Americans have much higher rates of lung cancer,' Foulds said. The researchers also are concerned that more young and Latino smokers are becoming addicted to menthol cigarettes. The tobacco industry may target its marketing of menthol cigarettes to groups with less cash to spend, such as youths, with the aim of getting them hooked even on fewer cigarettes per day, they said."
"Their study findings may have implications for future regulation of cigarettes. Recent legislation in New Jersey and pending federal legislation bans fruit- and candy-flavored cigarettes but allows menthol to be added."
The Rest of the Story
This research demonstrates the stupidity of the proposed FDA tobacco legislation. The bill being considered by Congress bans all flavored cigarettes that are not actually used to addict consumers - such as strawberry, chocolate, banana, pineapple, and apple (when was the last time you saw a chocolate cigarette?) - but exempts the one flavoring that has now been demonstrated to increase the addiction of cigarettes, largely explaining why African Americans generally have more trouble quitting smoking than whites.
Based on this evidence, banning menthol is probably the one thing Congress could do which would actually put a dent in smoking rates. Menthol has now been shown not only to aid the addiction of young people but to deter smoking cessation among adults.
Ironically, the FDA legislation exempts the one area where Congress could actually make a difference but bans the presence of flavorings that have never even been used in cigarettes. The result is a bill which is largely window dressing. Anti-smoking groups can rave about how they are getting rid of all flavorings in cigarettes, but the truth is that the bill's flavorings ban does absolutely nothing to protect anyone's health, while at the same time, providing a special protection for Big Tobacco that ensures that the companies retain their ability to heavily addict Americans - young and old alike.
In my introductory social and behavioral sciences course at Boston University School of Public Health, I teach students about the various forms of racism. The FDA legislation serves as an example of what I consider to be institutional racism. This is indeed an example of the systematic exclusion of African Americans from the health protection that is deemed necessary for other Americans. Flavorings are treated as an unacceptable component of cigarettes, except for the cigarettes that are overwhelmingly preferred by African Americans.
When I emphasized to my class that this was an example of unintentional institutional racism, they didn't buy it. I was aggressively challenged by my students, who argued that the crafters of this legislation had a number of choices to make regarding what concessions they would be willing to make to appease Philip Morris at the bargaining table. Their decision to make this particular concession was an intentional one. They were not forced to use the health of African Americans as a bargaining chip to keep Philip Morris happy. But they chose to do so.
I'm not in a position to argue with my students, especially since this decision was made by a public health group that could easily have stood its ground and demanded that the exemption be dropped from the bill. I am also not in a position to argue with my students because the group which negotiated the bill - the Campaign for Tobacco-Free Kids - did not include representation from the African American public health community in negotiating the bill and deciding what compromises would or would not be acceptable to the African American community.
If the Campaign for Tobacco-Free Kids is going to take it upon itself to decide to give Big Tobacco a special protection that institutionalizes its ability to use menthol to addict African American youths and to make it much harder for African American adult smokers to quit, then the least it should have done was seek some representation and input from the African American community.
The only one the Campaign negotiated with, however, was the nation's leading cigarette company.
Today's story adds to our understanding that the proposed FDA legislation is not an evidence-based policy. It focuses on actions for which there is little evidence for any effect on the public's health and it precludes those few actions for which there is abudant evidence that there would be a substantial protection of public health.
A stronger and more effective national policy to reduce tobacco-related death and disease could easily be worked out by an open, transparent process that includes a variety of stakeholders, including groups that represent communities of color which have been largely ignored in tobacco control.
Whether that process will take place, or whether this is a done deal and we can put a fork in the prospect for a truly effective national tobacco control strategy, is something that we'll find out in the coming weeks.