When it comes to nicotine products, No Minor Sale closely monitors flavored products, including those containing menthol. The predatory marketing of menthol cigarettes has affected Black, LGBTQ+, and youth populations disproportionately for decades. This means that menthol not only poses a risk to public health but also health equity. So, what is menthol, why does it threaten health equity, and what can be done to help this issue?



According to the U.S. Center for Disease Control and Prevention (CDC), menthol is a chemical compound found naturally in peppermint and other similar plants; and can also be created in a lab (American Lung Association). Menthol creates a cooling effect, masking the harshness of cigarette smoke (American Lung Association, 2022). And according to a recent study conducted at UMass Medical School researchers at the Center for Comparative Neuroimaging, menthol is believed to cause stronger dependency. Guillaume Poirier, PhD, instructor in psychiatry and co-author of the study mentions that, “Our findings support the notion that beyond flavor, mentholated tobacco may have psychoactive effects that impact nicotine addiction and withdrawal. Adding menthol to nicotine increased the communication between a brain area in the reward pathway and one involved in memory already known to be involved in nicotine addiction and withdrawal (Gray, 2017).” Because of this, menthol cigarettes can be easier to start, and ultimately harder to quit. 

So how does menthol pose a health equity issue? The marketing of menthol cigarettes has targeted Black Americans, LGBTQ+ communities, and youth for decades. For example, the tobacco industry has targeted Black Americans through tailored marketing in urban centers on billboards, buses, and subways, by distributing free “starter packs'' and discount coupons; and by featuring prominent Black athletes and entertainers in menthol advertisements (American Heart Association, 2022). Tobacco companies have also targeted the LGBTQ+ community by advertising in publications with predominantly gay and lesbian readership, sponsoring nightclub events, and marketing products using LGBTQ+ symbolism such as rainbow packaging or using phrases such as “Take pride in your flavor” (CDC, 2024). Flavored products, including those with menthol, have also proven to be more appealing to youth. In a 2023 National Youth Tobacco Survey (NYTS), of the more than 2.1 million youth who currently use e-cigarettes, almost 9 out of 10 use flavored e-cigarettes (FDA, 2024). 

• The result of the Tobacco Industry’s marketing efforts: 
• Over 80% of Black individuals who smoke reported using menthol cigarettes (CDC, 2024).
• 36% of LGBTQ+ people who smoke use menthol cigarettes compared to 29% of straight people who smoke (CDC, 2024).
• And over 40% of middle school and high school students who smoke reported using menthol cigarettes (CDC, 2024).

So, what is being done to help these at risk populations? In 2009, the FDA passed the Family Smoking Prevention and Tobacco Control Act (TCA) which banned the sale of cigarettes with a characterizing flavor (e.g. fruit). Unfortunately, this left out menthol cigarettes, e-cigarettes, little cigars, hookah, and smokeless tobacco(FDA, 2021). To continue restriction efforts, the FDA submitted rules restricting the manufacturing, distribution, and sale of all menthol-flavored cigarettes in April 2022 - 13 years following the passing of the TCA. The Whitehouse had until August 2023 to finalize the ban on menthol cigarettes, but has since decided to indefinitely postpone their decision(Perrone, Miller, 2024).

What does this mean moving forward? There are several ways to help those who may need assistance with quitting nicotine products. The first way to help, is by providing cessation resources. The New Mexico Department of Health (NMDOH) provides two free programs, open to all New Mexicans: 1-800-QUIT-NOW (for adults 18 and older) and Live Vape Free (for youths 13 to 17 years old.) To learn more about what each program offers, you can head over to QuitNowNM.com or LiveVapeFree.com.

Another way to help is by supporting policies that protect these populations. 5 states and over 380 local governments throughout the US have found ways to do this by restricting flavored nicotine products, including menthol(Bach, 2024). No Minor Sale, alongside countless other organizations, fight for health equity by educating the community about this ongoing issue. Through community events, partner presentations with local organizations, city council meetings, and speaking with legislators, No Minor Sale continues to fight for a healthier and more equitable state.

If you would like to join the fight as an adult volunteer, or support the campaign as an organizational partner, head over to NoMinorSale.com/take-action. With continued support, community members across the state can make a difference!

References

American Lung Association. What Is Menthol? Retrieved July 19, 2024 from https://www.lung.org/quit-smoking/smoking-facts/health-effects/what-is-menthol.

American Lung Association. The Science Behind the Addictiveness of Menthol. (2022, September 23). Retrieved from https://www.lung.org/blog/menthol-addiction.

Gray, S. UMass Chan Medical School. Brain imaging study finds link between menthol tobacco, nicotine addiction. (2017, November 15). Retrieved from https://www.umassmed.edu/news/news-archives/2017/11/brain-imaging-study-finds-link-between-menthol-tobacco-nicotine-addiction/.

American Heart Association. Women and Other Groups Targeted for Decades by Menthol Tobacco Marketing. (2022, November 28). Retrieved from https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/menthol-tobacco-marketing-targets-women-and-other-groups.

CDC. Unfair and Unjust Practices Harm LGBTQ+ People and Drive Health Disparities. (2024, May 15). Retrieved from https://www.cdc.gov/tobacco-health-equity/collection/lgbtq-unfair-and-unjust.html.

FDA. Results from the annual National Youth Tobacco Survey (NYTS). (2024, June 26). Retrieved from https://www.fda.gov/tobacco-products/youth-and-tobacco/results-annual-national-youth-tobacco-survey.

CDC. Menthol Smoking and Related Health Disparities | Smoking and Tobacco Use. (2024, May 15). Retrieved from https://www.cdc.gov/tobacco/menthol-tobacco/health-disparities.html.

FDA. FDA Commits to Evidence-Based Actions Aimed at Saving Lives and Preventing Future Generations of Smokers. (2021, April 29). Retrieved from https://www.fda.gov/news-events/press-announcements/fda-commits-evidence-based-actions-aimed-saving-lives-and-preventing-future-generations-smokers. 

Perrone, M., and Miller, Z. (2024, April 26). AP News. Biden admin postpones ban on menthol-flavored cigarettes. Retrieved from https://apnews.com/article/menthol-ban-fda-biden-cigarettes-smokers-e9a28fb0ac70fcb0ad8e106c42d4c951. 

Bach, L. (2024, June 18). Campaign for Tobacco-Free Kids. STATES & LOCALITIES THAT HAVE RESTRICTED THE SALE OF FLAVORED TOBACCO PRODUCTS. Retrieved from assets.tobaccofreekids.org/factsheets/0398.pdf.