Eliminate Flavored Tobacco and Reduce Nicotine to Non-addictive Levels

The U.S. Food & Drug Administration’s announcement on April 29th of a timeline leading to a full ban on mentholated cigarettes and e-cigarettes is one of the most important public health policies of the last few decades. It will be even more impactful if combined with reductions in the nicotine in these products – and all cigarettes — to below-addictive levels.

All tobacco use is deadly, and efforts to curb smoking have been delayed for decades by the tobacco industry’s powerful lobby. This is unconscionable. Smoking is the #1 preventable illness and yet kills one in five individuals in the U.S. every year. More than 16 million Americans today are living with a disease directly caused by smoking, a toll that far exceeds Covid-19.

Menthol-flavored tobacco products help Big Tobacco build sustainable markets of lifelong addicts. Mentholated tobacco is more addictive because it enhances the effects of nicotine on the brain. The mint taste may make it more palatable to children and reduces the irritant effect of tobacco. Childhood smoking is a major factor in creating stable markets for tobacco companies among adults. Approximately 95% of adult smokers in the U.S. started by age 21.

Use of menthol cigarettes in communities of color is disproportionately high. Out of all Black smokers, nearly 85% smoke menthol cigarettes, compared to 30% of white smokers. In addition, from 2011 to 2018, declines in menthol cigarette use were observed among non-Hispanic White youth but not among non-Hispanic Black or Hispanic youth.

As we have painfully witnessed during the pandemic, these communities are already experiencing lower overall health due to many circumstances, including economic realities and poor access to quality health care. That they are bearing a disproportionate burden from menthol cigarettes is another important component of the health parity long overdue to these populations.

I hope that the FDA will implement this ban quickly. I commend Acting FDA Commissioner Janet Woodcock, M.D for taking this step to, in her own words, “significantly reduce youth initiation, increase the chances of smoking cessation among current smokers, and address health disparities experienced by communities of color, low-income populations, and LGBTQ+ individuals, all of whom are far more likely to use these tobacco products.”

This is not enough, however. The single most important public health policy measurement the FDA can take is to reduce the additive levels of nicotine in all tobacco products. This would be a truly massive game-changer.

If we can bring COVID-19 vaccines to market in less than a year, we can move after all these decades to eliminate the scourge of tobacco-related illness and death. Every step we take now will preserve the lives of hundreds of thousands and the health of millions in the years ahead.

Get Insights From Ron

Sign up for the latest news and updates from Ron DePinho, MD