Flavored Tobacco & Health Equity
The US Food and Drug Administration’s (FDA’s) proposed rules to prohibit the sale of menthol cigarettes and flavored cigars could help reduce health inequities and improve health and longevity for millions of people.
Menthol cigarettes, in particular, have been a driving factor of commercial tobacco–related inequities in health and mortality.* Menthol, like all flavors, makes tobacco more palatable for people who are smoking for the first time, including children and youth. The increased addictiveness of menthol-flavored tobacco products — which is well-established by scientific research — makes it more difficult for longtime users to quit smoking. Tobacco companies have driven unjust racial health inequities by inundating communities of color with menthol advertising and promotions that unfairly exacerbate these harms. These historical and present-day practices illustrate how commercial interests have contributed to structural discrimination and other fundamental drivers of health inequity in our communities.
A Path to More Equitable Policy
ChangeLab Solutions’ roots as a public health law and policy organization lie in tobacco prevention and control. Over the years, we have frequently researched and written about approaches to address the injustices perpetrated by the tobacco industry through the marketing and sale of menthol products. Our publications on this topic include our Point of Sale Playbook, which highlights product-based restrictions on menthol, and our tobacco retailer licensing materials, which offer ready-to-go policy options for restrictions on flavored products, including menthol. Our recent fact sheet Addressing Tobacco-Related Health Inequities discusses how community-centered assessments can reveal tobacco companies’ influence on daily life, providing an opportunity for tobacco prevention staff to help residents identify solutions, combat unfair industry influence, and promote the health of their neighborhoods. Our guide Equitable Enforcement to Achieve Health Equity emphasizes that it is essential to keep regulatory and enforcement efforts focused on the tobacco industry, not on those who’ve been subjected to their unfair practices. The proposed federal bans on menthol cigarettes and flavored cigars align with the work we’ve witnessed and supported in the tobacco prevention field for many years.
Those Who Have Shown the Way
Local governments that have enacted tobacco retail strategies to restrict flavored products like menthol have paved the path to this moment. Chicago was the first US city to restrict menthol sales and was also a leader in restricting the sales of other flavored tobacco products. Over 200 other localities have enacted prohibitions, including San Francisco; Missoula, Montana; and Brown County, Minnesota.
As these examples make clear, local authority to promote public health — through implementing effective policies, listening to local voices, and supporting community-based efforts — is a powerful tool for advancing health equity. But recent challenges to local public health authority — including federal and state preemption of local laws related to tobacco sales — threaten to limit local public health officials’ ability to act and innovate. ChangeLab Solutions’ collaboration with Counter Tools, the Tobacco Point of Sale Preemption Playbook, equips tobacco prevention staff and partners with the knowledge they need to understand how preemption might limit their work.
Of course, successes in enacting tobacco control policies at local and now federal levels were made possible through the actions of many national organizations that have coordinated research, education, narrative shifts, and on-the-ground policy change as well as increased national awareness of the relationships between menthol, communities of color, and health equity. These organizations include, among others, the American Heart Association, American Cancer Society, American Lung Association, Truth Initiative, African American Tobacco Control Leadership Council, The Center for Black Health and Equity, Action on Smoking and Health, and Campaign for Tobacco-Free Kids. This is truly a field of changemakers, well-positioned to support FDA in determining the best way forward, and we are proud to call them partners and friends.
- Until July 5, 2022, FDA is accepting public comments on the proposed rules. Evidence-based best practices, survey data, evaluation reports, and stories from the field are all types of information that can help shape these rules and the processes by which they are enacted and enforced. You can learn about best practices and standards for writing comments on federal rulemaking from the Public Health Law Center.
- FDA will hold public listening sessions on June 13 and June 15. The deadline for requests to make open public comments is June 6.
- Renewed attention and more conversations on menthol products, discrimination and biases, and health equity will occur in the months and years to come. Learn how to frame these issues to facilitate open dialogue and motivate collaboration on effective policy solutions by reviewing this collection of resources on evidence-informed messaging from FrameWorks Institute and ChangeLab Solutions.
* We recognize the important role of ceremonial and traditional uses of tobacco in many Indigenous communities. Tobacco prevention and control measures are intended to address commercial tobacco, not tobacco products used as part of an Indigenous practice or other recognized religious or spiritual ceremonies or practices. All references to tobacco and tobacco products in ChangeLab Solutions’ publications refer to commercial tobacco.
By Sara Bartel & Patrick Glass