The US Food and Drug Administration has taken a “momentous” step toward banning menthol in cigarettes and flavoured cigars, proposing a rule that public health experts say could save hundreds of thousands of lives.
The agency has now sent a rule proposing such action to the White House Office of Management and Budget for final review.
The FDA has been talking about banning menthol and flavoured cigars for years and has said the issue is important for the agency, report CNN.
In April, it announced it would move ahead with proposed product standard restrictions because this had “the potential to significantly reduce disease and death” and reduce “youth experimentation and addiction” as well as increase the number of smokers who quit.
“The posting of both rules on the OMB website means they have reached the final step of review for regulatory documents,” said Dr Brian King, director of the FDA’s Centre for Tobacco Products.
The American Lung Association said it may be the most significant action the agency has taken in the 14 years since it was given the authority to regulate tobacco.
“It’s a big, vital and critical step on the way to banning these products,” said Erika Sward, assistant vice-president of national advocacy with the American Lung Association. “Truly, it’s momentous.”
The association and several other groups, including the Campaign for Tobacco-Free Kids, are urging the Office of Management and Budget to act quickly and expedite the review so the final regulations could be issued by the end of the year.
But the National Association of Tobacco Outlets, the national retail trade association representing more than 66 000 stores that sell tobacco products, doesn’t think the bans will suddenly make lots of smokers quit. Instead, it says, it will prompt criminal activity.
“The supply of these products will shift from responsible, licensed and regulated retailers to drastically expand an already existing illicit marketplace,” the association said.
Scientists have long understood that menthol flavour can make those cigarettes more addictive than tobacco-flavoured ones. It is particularly appealing to new smokers, because it masks the harsh taste of tobacco, and a 2015 study found that it makes people want to smoke more.
A 2020 study showed that while 43% of all adult smokers smoked menthols, more than 83% of black smokers did. Only about 30% of white smokers chose menthols.
Black people die at significantly higher rates than white people of smoking-related illnesses including stroke, heart disease and lung cancer.
While they comprise 12% of the population in the US, black people account for 41% of smoking-related premature deaths and 50% of the life-years lost associated with menthol tobacco product use between 1980 and 2018, one study found.
Within five years, the elimination of menthol cigarettes could close the gap in lung cancer deaths, researchers believe.
More than half of all children who smoke use menthol cigarettes, according to the US Centres for Disease Control & Prevention, which found that children who smoked menthols were more likely to become regular smokers than occasional smokers.
Flavoured cigars and cigarillos also seem popular with children, particularly black and Hispanic youngsters, who are twice as likely to smoke them as their white classmates.
In 2020, more young people said they tried a flavoured cigar every day than tried a cigarette, said the FDA.
The agency has tried to regulate other kid-friendly menthol products. Last week, it issued marketing denial orders to RJ Reynolds Vapor Co. for six flavoured e-cigarette products under its popular Vuse Alto brand, including menthol-flavored and three mixed berry-flavoured products.
The FDA has been considering menthol regulations for more than a decade. Although the number of cigarette smokers in the US has fallen to one of the lowest levels in history, the proportion who smoke menthols has been increasing, according to the CDC.
Smoking is still the number one cause of preventable death in the country.
Two states didn’t wait for the FDA to ban menthol cigarettes. In 2020, Massachusetts became the first to ban all flavoured tobacco products, including menthol. In 2022, California’s ban went into effect.
In the meantime, in an effort to work around the two state bans and to lay the groundwork for a potential federal ban, tobacco companies have introduced cigarettes with a menthol-like synthetic cooling agent.
A study published in JAMA found that one ingredient in some brands provided even more cooling activity than the menthol equivalent.
Flavours in cigarettes, with the exception of menthol, were banned in 2009. But another ingredient recently introduced to these products produces a kind of vanilla and tropical taste, the JAMA study found.
The final rules could address these tobacco company workarounds, Sward said, but it’s not clear whether they will do so.
Once the federal government makes its final rules, tobacco companies are expected to sue, as they have with nearly every other tobacco restriction.
“It’s a big deal for them because it is how they attract and sustain people’s addiction,” she said. “So if this stands, they will have lost a major tool that they’ve used to addict and sustain an addiction for millions of people.”
See more from MedicalBrief archives:
How far should the menthol ban go? Michigan’s Professor Clifford E Douglas
Is the FDA's cigarette ban just smoke and menthols? – MedPage Today op-ed
Ban on flavoured vaping may have led teens to cigarettes — Yale study
Menthol makes smokers want more