FELDMAN COLUMN: Banning flavors is important for smoking cessation | Opinion

In 2009, the Food and Drug Administration received authority from Congress to regulate tobacco products.

Although the legislation statutorily contains certain restrictions on tobacco products, it also gives the FDA specific regulatory powers over cigarettes, cigarette tobacco, smokeless tobacco, and hand-rolling tobacco. For other tobacco products, the law requires the agency to make evidence-based determinations for actions necessary to protect public health. As a result, the FDA enacted a 2014 rule extending its authority to e-cigarettes, cigars, hookah, and pipe tobacco. The FDA now regulates the manufacture, importation, packaging, labeling, advertising, promotion, sale, and distribution of virtually all tobacco products.

The FDA has been slow to gradually exercise its authority over tobacco, leading to regulatory loopholes. However, recently the FDA initiated a process to restrict vaping products; and now the FDA is proposing to ban menthol flavors in cigarettes and all flavors in cigar products, including cigarillos.

Flavors in cigarettes were legally prohibited in the original legislation, but menthol was excluded pending further evaluation by the FDA. Flavored cigars also represent one of these regulatory loopholes. His actions on menthol were so criminal that several public health groups filed a petition asking the FDA to ban menthol. In a related 2020 lawsuit, a federal judge ordered the FDA to set a deadline to issue a final rule on menthol, which the FDA is now undertaking. The proposed new rules only apply to cigarettes and cigars and will not apply to certain vaping products, smokeless tobacco and pipe tobacco. The industry will unfortunately increase the marketing of these remaining products.

The tobacco industry has aggressively marketed menthol cigarettes (such as Newport and Kool) to minority groups, particularly African Americans, but also Hispanics and Asians. Eighty-five percent of black smokers, 46 percent of Hispanics, and 39 percent of Asian smokers use menthol cigarettes, compared to about 30 percent of white smokers. The consumption of menthol cigarettes is also higher among LGBTQ people. Menthol cigarettes account for approximately 37% of the cigarette market.

Menthol increases the health risks of smoking. It intensifies the addictive qualities of nicotine, encourages use and makes quitting much more difficult. Because it lessens the harshness of tobacco smoke, menthol smokers tend to smoke more and inhale more deeply, which increases the cumulative dose of toxins. African Americans have higher rates of smoking-related disease, certainly in part due to menthol consumption.

Similarly, young smokers are also attracted to the flavor of menthol and the masking effects of the unpleasant taste and harshness of tobacco. About half of teenage smokers use menthol cigarettes, increasing the risk of lifelong addiction.

The proposed rule will also address menthol and other flavored cigars and cigarillos. Menthol and other sweet flavors make smoking more appealing to young people. After the 2009 ban on flavored cigarettes, there has been a shift to flavored cigars among children (and adults), especially among black and Hispanic youth who are twice as likely to smoke flavored products as whites. One study found that 74% of teens said they smoke cigars because of the aromas.

One objection to banning menthol and flavorings is that it would expose individuals to criminal prosecution for possession of menthol tobacco products. The FDA is clear that the application would only apply to manufacturers, distributors and retailers, not individuals.

The bans are an important step to further promote cessation and reduce premature smoking-related deaths, especially among minorities.

The next step ? FDA limitations on the amount of nicotine in tobacco products.

Dr. Richard D. Feldman is the former Indiana State Health Commissioner. Dr. David Blank is an osteopathic emergency physician in Indianapolis.

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