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Home • Lifestyle


MARGINALIZED COMMUNITIES NEED RELIEF FROM BIG TOBACCO

Following the FDA's move to see that menthol cigarettes and flavored cigars are
banned, a cardiologist says this is a necessary step to save lives, particularly
those of Black smokers of all ages.

Getty Images
By Michelle A. Albert, M.D., M.P.H., FAHA · Updated October 26, 2023


The tobacco industry has long targeted Black communities, LGBTQ+ people, kids
and others with menthol cigarettes and flavored cigars, putting them on the path
to a lifetime of nicotine addiction, serious illness and premature death while
profiting at the expense of lives and health.

Now, at long last, the Food and Drug Administration (FDA) is poised to finalize
proposed rules prohibiting the sale of menthol cigarettes and all flavored
cigars. This would be a critical step in reducing the terrible toll of tobacco
use, especially among Black communities, which suffer the greatest burden of
tobacco-related deaths in the U.S.

Removing menthol cigarettes and flavored cigars from the market will save lives,
improve health and reduce health care costs. It also will help close serious
racial disparities in health.

As a cardiologist who has treated hundreds of patients suffering from tobacco
use disorder over the years, I know that most people who smoke want to quit.
There are two main reasons why they can’t: First, the powerful addictiveness of
nicotine; and second, the underlying stressors that drive many people,
especially those in marginalized communities, to use tobacco.



My patients often tell me that tobacco use is an easy way for them to relieve
their everyday stress. Tobacco products are accessible when healthy forms of
stress relief—like exercise—are not convenient or available to them. Research
tells us, however, that whatever short-term relief people who use tobacco may
get is dwarfed by the added stress, anxiety and other health harms of long-term
nicotine addiction.

Put another way, quitting tobacco use is a far better way to decrease stress and
improve health and well-being than starting the habit. Yet, many people who
smoke feel that cigarettes help them cope when they have nothing else.

The tobacco industry knows this. It targets communities of color, those with low
incomes and other marginalized communities at a time when they are most
impressionable – in their youth. The industry strategically markets menthol
cigarettes and flavored cigars to hook young people for life.

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According to the Centers for Disease Control and Prevention (CDC), more than
80% of current adult smokers began smoking before the age of 21. Further
research shows that teens and young adults’ first cigarette is more likely to be
a menthol cigarette. A scientific review of the effects of menthol concluded
that menthol in cigarettes increases the likelihood of regular smoking in youth
and young adults, is linked to greater nicotine dependence in youth and is
associated with reduced cessation success (particularly among Black smokers).



The same goes for flavored cigars. In 2021, nearly 8 in 10 youth who reported
using tobacco products used flavored varieties. In addition to menthol-flavored
cigarettes, other menthol-flavored tobacco products are popular among youth. 

Given the significant rise in stress, anxiety and depression among young people
during the COVID-19 pandemic—and the fact that people with severe anxiety are
more likely to use tobacco than the general population—the FDA’s proposal to
prohibit the sale of menthol cigarettes and flavored cigars is more important
than ever.


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But we also need to think about what happens once these products are removed
from the market. How can we help people experiencing high levels of daily stress
and anxiety choose healthy and effective forms of relief, like exercise and
meditation? How do we help them quit tobacco use altogether? What resources and
supports can we offer them so they don’t turn to other unhealthy habits? These
are questions public health officials and community leaders and advocates must
address together.

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Despite significant progress over the years in reducing overall rates of
smoking, tobacco use remains a leading cause of preventable death in the
U.S.— killing an estimated 480,000 people each year. Marginalized communities
are affected more than others—in significant part because they are strategically
targeted by Big Tobacco’s marketing campaigns to increase sales and profits
while causing immense harm to public health. Menthol cigarettes and flavored
cigars are important tools in the industry’s marketing kit.

The FDA should move forward to prohibit the sale of menthol cigarettes and all
flavored cigars – a move that would constitute an enormous step forward to
protect public health, especially among marginalized communities. At the same
time, the public health community should work to ensure these same communities
have healthy, effective ways of reducing stress so they can stand up against the
dangerous lure of tobacco use.

Michelle A. Albert, , M.D., M.P.H., FAHA, is immediate past president of the
American Heart Association, the Walter A Haas-Lucie Stern Endowed Chair and
professor of medicine, director of the CeNter for the StUdy of AdveRsiTy and
CardiovascUlaR DiseasE (NURTURE Center) and associate dean of admissions at the
University of California, San Francisco

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