Update 11/15/18: The FDA announced that it will propose a ban on menthol cigarettes through a regulatory process known as Notice of Proposed Rulemaking. The regulations could take years to go into effect and could be challenged by the cigarette industry. FDA Commissioner Scott Gottlieb said in a statement:
"I believe these menthol-flavored products represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes. The menthol serves to mask some of the unattractive features of smoking that might otherwise discourage a child from smoking. Moreover, I believe that menthol products disproportionately and adversely affect underserved communities. And as a matter of public health, they exacerbate troubling disparities in health related to race and socioeconomic status that are a major concern of mine."
Update 11/13/18: In the coming days, the FDA plans to propose banning menthol cigarettes as part of a campaign against flavored tobacco products and e-cigarettes, The New York Times reports, though it could take several years for the change to go into effect.
Update 3/20/18: The FDA is taking the first step toward possibly limiting the use of menthol in cigarettes. Specifically, the agency announced that it's asking for public input on how menthol and other flavors make tobacco products more addictive and dangerous and what should be done about it. It's what's known as advance notice of proposed rulemaking and the public comment period will be open for 90 days.
New Jersey is taking steps to become the first state to ban the sale of menthol cigarettes, according to a recent Associated Press report. The state assembly’s health and senior services committee approved legislation outlawing the cigarettes in late January; the bill now heads to the appropriations committee.
Even if you don’t smoke, you’re probably familiar with menthol, the compound in plants like peppermint that impart a minty taste. It’s been added to cigarettes since the 1920s. Problem is, because of the flavor and the cooling sensation you get from a menthol, some smokers think they’re a safer alternative than regular cigs. They’re not.
“All of these cigarettes cause cancer. Period,” says Raja Flores, director of the thoracic surgical oncology Program at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai.
Menthol cigs, however, may be especially problematic for people’s health. Last August, a group of senators asked the Food and Drug Administration to ban their sale, citing a 2011 FDA study which raised alarm bells. That preliminary report called out the cigarettes’ potentially greater addictive properties as well as questionable ways they’re marketed. The authors wrote:
“Menthol smokers show greater signs of nicotine dependence and are less likely to successfully quit smoking. These findings, combined with the evidence indicating that menthol’s cooling and anesthetic properties can reduce the harshness of cigarette smoke and the evidence indicating that menthol cigarettes are marketed as a smoother alternative to non-menthol cigarettes, make it likely that menthol cigarettes pose a public health risk above that seen with non-menthol cigarettes.”
The presence of menthol in cigarettes leads to a cooling, numbing sensation in the throat that counteracts the telltale burning of traditional cigarettes, creating a more comfortable puffing experience, Flores says.
“Menthol will make you inhale more. The more you smoke, the greater your chances of getting cancer,” Flores says. Indeed, menthol smokers took bigger, longer puffs compared to people lighting up non-menthols, per a 2017 study from the Centers for Disease Control and Prevention.
Still, Flores adds that doctors can’t say definitively that menthol cigarettes cause more cancers. And one study in Circulation in 2016 found that menthols also did not increase someone’s risk of cardiovascular disease more than regular cigarettes did (rather, they were both bad). Another 2011 FDA review concluded that menthols aren’t more harmful than regular cigs. “…Both cigarettes produce significant negative effects on health outcomes, including respiratory disease, cardiovascular outcomes, and cancer,” author Allison C. Hoffman writes.
The takeaway: Regular and menthol cigarettes are at least equal players when you’re talking about the negative impact on health, Flores says. That’s a big problem if people smoke menthols because they think they’re the lesser of two evils or only took up smoking because menthol was an option.
The FDA banned other flavored cigarettes in 2009, in part because they were especially attractive to young people, the AP says. Menthol cigarettes were exempted for further study and so they stayed on shelves, though some lawmakers argue they should have been outlawed then, too. The FDA seemed like it was considering a ban on menthols in 2013, but thus far it hasn’t happened. Meanwhile, San Francisco legislators already banned menthols (but a measure to repeal the ban will be on a June ballot), and the European Union will outlaw them starting in 2020.
Aside from their effects on health, doctors and public health experts also take issue with the way menthols are marketed, often skewing toward younger, newer smokers and people of color. “Menthol reduces the harshness of the smoking experience and makes the smoking process easier. That’s more appealing to new users,” says Adam Goldstein, a UNC Lineberger Comprehensive Cancer Center member and director of UNC Tobacco Intervention Programs at the University of North Carolina, Chapel Hill. “We’ve seen a large increase among young people—over half of youth smokers use menthol cigarettes,” he adds.
Banning menthols may prevent some young smokers from picking up the habit in the first place. “Since 90 percent of adult smokers start smoking before age 18, and there is good data that for many youth, menthol is involved in the initiation process and progression to regular use of cigarettes, bans on menthol likely would reduce youth initiation of smoking,” Goldstein says.
Traditionally, menthol cigs were marketed much more aggressively to people in black communities, Goldstein notes. For instance, one study found that Ebony magazine was 9.8 times as likely as People to have an ads for menthol cigarettes between 1998 to 2002. Indeed, menthol use was three times as common in current and former black smokers compared to white smokers (84 to 27 percent, respectively), per a 2016 study. The NAACP has supported the restriction of menthol cigarette sales, and the African American Tobacco Control Leadership Council has made a similar push, according to the New York Times reported.
So, should menthols become illegal? “I think it all should be banned—cigarettes and menthol. Because I see the cancers, strokes, and heart diseases it causes,” Flores says. “While we want the freedom to choose what we want to do, [after you start smoking], it’s not a free choice. They manipulate kids’ brains with advertising and a culture that promotes this stuff. They become addicted to the substances in cigarettes, all so that tobacco companies can enrich themselves. It’s an evil in our society and we need to address it head on” he adds.
Goldstein agrees: “I absolutely believe that menthol flavoring should be removed from cigarettes, and legislators, stakeholders, and policy-makers in local and state jurisdictions across the country increasing agree.”
Of course, not everyone across the board is in support. Opponents of New Jersey’s proposed menthol ban argue that it would negatively affect convenience stores and small businesses as well as reduce the state’s tax revenue. Goldstein says that rather than worrying if smokers would travel to other states to buy these cigarettes, the real question is how the discussion to remove flavors from cigarettes will continue to move forward. He says supporting local efforts to ban them outright or restrict their sale, like in San Francisco, Oakland, and Minneapolis, is important.
“These are cities that say, in absence of federal leadership, ‘we’ll take action.’ The movement is favored by youth, the African American community, church groups, and policy makers. It may take a year—or maybe ten—but it will probably happen,” Goldstein says.
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This article originally appeared on VICE US.