Ban all cigarettes, not just menthols, and urge adult smokers to try less harmful options

Menthol cigarettes and other tobacco products at a store in San Francisco on May 17, 2018. (Photo: Jeff Chiu, AP)

The Food and Drug Administration announced late last month that it wants to ban menthol cigarettes, which are the overwhelming preference of African American smokers. But if a smoking prohibition is good for Black people, who comprise only about 1 in 7 U.S. cigarette smokers, why isn’t it good for whites and other Americans as well? 

A smarter policy would be to phase in an FDA ban on all products that burn tobacco and aggressively urge adult smokers who can’t quit to transition to alternative devices that deliver nicotine in a far less dangerous way.

Smoking causes 480,000 preventable deaths annually in the United States, and the Centers for Disease Control and Prevention reports that “16 million Americans are living with a disease caused by smoking.”

Menthol cigarettes are harder to quit

According to the latest CDC data, Black Americans actually smoke less than whites, but nearly 85% of Black smokers use Newport or other cigarettes with menthol. That flavor makes it easier to start smoking and harder to quit, an FDA-convened panel of experts found. In 2011, the panel recommended that “removal of menthol cigarettes from the marketplace would benefit public health in the United States.” 

Civil rights groups like the NAACP also advocated banning menthol cigarettes, but the tobacco industry pushed back, arguing that prohibition would create a huge illicit market and loss of government tax revenue and jobs.

Since 2011, however, a lot has changed. Alternative nicotine delivery devices now provide a way for smokers to switch more easily, with far less risk. A 2015 report by Public Health England, a government organization, stated that “best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether.”

Cigarette butts on April 15, 2021, in Washington, D.C. (Photo: J. Scott Applewhite/AP)

Research published by the Journal of the American Medical Association and elsewhere has found that vaping exposes users to much lower levels of toxic chemicals than smoking. And the FDA has given authorization as modified-risk tobacco product to snus, a moist powdered tobacco that has become a popular smoking-cessation aid in Sweden, and to IQOS, a device that heats tobacco but does not burn it.

Doctor: New smoking and vaping bans put us on a path to less addiction and better health

An FDA news release last July noted that IQOS “significantly reduces the production of harmful and potentially harmful chemicals.” A study found that the introduction of heat-not-burn products in Japan coincided with an annual reduction in smoking of 10% annually between 2015 and 2018, compared with a 2% annual decline in the prior four years.

Offer incentives to quit or switch

Electronic cigarettes turn liquid nicotine and other chemicals into a vapor. They were in use by 4.4% of U.S. adults in 2018, and the companies that make them are applying for FDA clearance.

Snus, heat-not-burn devices and e-cigarettes all offer mint or menthol flavorings, and the Biden administration was wise not to ban these along with menthol cigarettes. If the policy aim is to get Americans to stop smoking, then it makes sense to make the alternatives as attractive as possible.

Various brands and flavors of disposable vape devices at a store in the Brooklyn borough of New York. (Photo: Marshall Ritzel, AP)

The European Union banned menthol cigarettes last year, and while a survey showed that 18% of menthol smokers switched to an alternative, mainly vaping, more simply moved to nonflavored cigarettes – often dosing them manually with menthol. A ban on a single type of cigarettes won’t get many people to stop smoking, but a more comprehensive ban will, especially if it is accompanied by an aggressive strategy of encouraging the use of e-cigarettes and other noncombustibles.

Public health tragedy: E-cigarettes are safer than smoking but few know it 

That is what the United Kingdom’s National Health Service has done. “While nicotine is the addictive substance in cigarettes,” the NHS website says, “it’s relatively harmless. Almost all of the harm from smoking comes from the thousands of other chemicals in tobacco smoke.”

Public Health England reported that vaping prevalence among former smokers was 12% to 13% in 2019; meanwhile cigarette smoking “has fallen significantly.”

By contrast, the CDC in the United States has taken a position on vaping that is ambivalent at best. That lack of support for alternatives is all the more poignant for African Americans, who are more likely to try to quit than whites but less likely to succeed, according to the CDC. America now has the chance to take a leadership role in global health by banning all cigarettes and providing incentives to switch to alternatives. Banning menthol is not enough.

James K. Glassman (@JamesKGlassman1), former undersecretary of State for Public Diplomacy under President George W. Bush, chairs the International Commission to Re-Ignite the Fight to End Smoking, which will release a report in September. The commission is sponsored by the nonprofit Foundation for a Smoke-Free World, which is funded by Philip Morris International and describes itself as independent. 

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