Lighting It Up

This Fourth of July, light up a firecracker and not a cigarette. Cigarettes kill. But removing these dangerous products – or at least a common flavor that makes them more acceptable – seems far from likely.

Tobacco products are responsible for a large proportion of deaths and illness in the United States. Despite their cancer causing components, the Food and Drug Administration has not been able to ban the product. Even though taxation and package warnings (which will now be graphic) discourage use of tobacco products, an estimated 400,000 Americans die from smoking every year.

A recent law, the Family Smoking Prevention and Tobacco Control Act, authorized the FDA with the ability to regulate tobacco and tasked it with considering a ban on menthol flavorings. By blunting the harshness of the tobacco flavor, menthol is responsible for aiding the initiation of and hindering the abstention from smoking. The Act did specifically ban most other flavorings EXCEPT menthol.

No real life evidence exists regarding a menthol ban in the United States since there are no bans currently in effect. However, researchers using a computer simulation of smoking  (SimSmoke) have recently developed estimates about how such a ban could improve the health of the nation.

The computer model used information gathered from the Tobacco Use Supplement to the Current Population Survey (2003 and 2006 editions). Data from a preliminary analysis of the 2010 survey indicated that 36.2 percent of all menthol smokers and 25.7 percent of Black menthol smokers would switch to a non-menthol brand if a ban were enacted. On the contrary, a ban would induce 39.0 percent of all menthol smokers and 46.8 percent of Black menthol smokers to quit smoking altogether. Therefore, the researchers incorporated 3 scenarios into their computer model: (1) 10 percent quit and 10 percent switch, (2) 20 percent quit and 20 percent switch, and (3) 30 percent quit and 30 percent switch.

Even if no smoking ban were initiated, current anti-smoking efforts would result in a decreased percentage of Americans who smoke from 18.1 percent in 2003 down to 8.2 percent in 2050. However, of those smokers, more and more gravitate towards menthol brands. In the scenarios which call for menthol bans, smoking rates would decline more dramatically. Specifically, the overall prevalence of American smokers in 2050 falls to 7.1 percent, 6.9 percent, and 6.7 percent (for the 10-10, 20-20, and 30-30  simulations, respectively). For Blacks, who have a higher rate of menthol cigarette smoking, the results would be vastly more dramatic.

The researchers then converted these reductions in smoking to potential lives saved. Since some people would never start smoking and others would quit, an estimated 323,000 to 633,000 lives would be saved. Nearly one-third of these lives saved would be among Black Americans.

Commentary

In light of this and other data indicating that numerous lives could be saved simply by prohibiting menthol from being a flavoring additive to cigarettes, the FDA panel tasked with studying the issue stated that the “removal of menthol cigarettes would benefit public health in the United States.” Unfortunately, in the eyes of many public health experts, that the Tobacco Products Scientific Advisory Committee did not formally recommend a ban on menthol serves as a victory for tobacco manufacturers.

On this issue, the evidence is clear. There is no health benefit to smoking. Menthol – a peppermint-based flavor designed to mask the harshness of tobacco – encourages smoking. Therefore one must conclude that menthol proves to contribute to the death of thousands of Americans.

While the tobacco industry claims that banning menthol would simply lead to a black market for the product (and perhaps it will), what sense does it make to allow people to smoke their lives away? If Congress, the FDA, or state governments are unwilling to ban tobacco products outright, bans on the components and additives to tobacco should still be pursued. And if governments are unwilling to do that, the 25 states whoseare too low to account smokers’ costs to society must increase their tobacco taxes.

Levy DT, et al. Modeling the future effects of a menthol ban on smoking prevalence and smoking-attributable deaths in the United States. Am J Public Health. 2011 Jul;101(7):1236-40. Epub 2011 May 12.

 

Siegel M. A lost opportunity for public health–the FDA advisory committee report on menthol. N Engl J Med. 2011 Jun 9;364(23):2177-9. Epub 2011 May 4.

 

Benowitz NL and Samet JM. The threat of menthol cigarettes to U.S. public health. N Engl J Med. 2011 Jun 9;364(23):2179-81. Epub 2011 May 4.

by

Cedric Dark, MD, MPH

 

• A great article from The Grio covering this same research
• Visit the page on the FDA website