Surgeon General’s Report: Not Enough Evidence to Support a Menthol Ban
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Surgeon General’s Report: Not Enough Evidence to Support a Menthol Ban

One of the report's less-publicized conclusions is that there is not enough evidence to conclude that banning menthol cigarettes would reduce smoking.

As soon as next week, Congress may vote on a bill that would ban the sale of all flavored tobacco products. Among the products on the chopping block are menthol cigarettes.

A ban of all flavored tobacco products would represent the most significant prohibition in three generations, so, as members of Congress weigh the pros and cons of the ban, it’s worth highlighting a recent report from the Surgeon General on smoking cessation.

A mammoth document of 700 pages, the report examines the health impact of individual-, system-, and population-level interventions in the context of smoking cessation. One of the report’s less-publicized conclusions is that there is not enough evidence to conclude that banning menthol cigarettes would cause more people to quit smoking.

“The evidence is suggestive but not sufficient to infer that restricting the sale of certain types of tobacco products, such as menthol or other flavored products, increases smoking cessation, especially among certain populations,” says the report.

The report also fails to review any potential costs associated with menthol prohibition.

Menthol cigarette bans have not been implemented outside of a few small jurisdictions. Brazil banned menthol cigarettes in 2012, but implementation was held-up due to litigation. In May, menthol cigarettes will be prohibited throughout the European Union. As of yet, there is no real-world evidence showing how the prohibition of menthol will impact smoking rates, the illicit tobacco market, or broader criminal activity.

On public health grounds alone, a menthol ban offers few benefits. It’s frequently claimed that menthol cigarettes pose a unique threat to youth because they are allegedly more attractive and harder to quit. But the evidence fails to bear this out. In fact, according to a recent analysis by Reason Foundation, states with higher volumes of menthol cigarettes sold, relative to regular cigarettes, have the lowest youth smoking rates.

Menthol cigarettes are no more prevalent among youth than regular cigarettes. According to an analysis of the National Youth Tobacco Survey (NYTS) data for the years 2014-2018, the percentage of high school smokers using menthol cigarettes fell from 54.5 percent to 46.1 percent. The number of high schoolers smoking menthol cigarettes every day is now so low it can’t be measured with any accuracy. In 2019, the overall youth smoking rate fell to its lowest level on record: 5.8 percent.

Menthol cigarettes are no more, or less, dangerous than their tobacco flavored counterparts. A study of 85,806 people published in the Journal of the National Cancer Institute found menthol and nonmenthol smokers showed equal odds of quitting, and lung cancer incidence was, in fact, lower in menthol smokers.

“I don’t think there is enough scientific evidence to justify a ban of menthol cigarettes in comparison with nonmenthol cigarettes,” said study author William J. Blot, Ph.D.

Menthol prohibition would, however, have a disproportionate impact on African Americans. Of African Americans who smoke, the vast majority, both youth, and adults use menthol products. But few are aware of the fact that black high school students smoke at lower rates than their white and Hispanic peers. Black and white adults, on the other hand, smoke at similar rates.

Given the popularity of menthol products among African American smokers, any action taken to clamp down on a subsequent illicit market for menthols would have a disproportionate impact on this community. The National Organization of Black Law Enforcement Executives (NOBLE), National Association of Black Law Enforcement Officers (NABLEO), Law Enforcement Action Partnership (LEAP), and the National Newspaper Publishers Association (NNPA), have made the case that menthol prohibition disproportionately affects communities of color. Prohibition can end the legal supply of a product but cannot stop the demand for it.

Because H.R.2339 would ban menthol in safer nicotine alternatives like e-cigarettes, current menthol smokers may be more likely to buy menthol products from the black market or switch to an equally deadly cigarette than they otherwise would be if the bill banned menthol cigarettes alone. On public health grounds, an effective, evidence-based case for prohibition of these products has yet to be made. Banning menthol cigarettes would be arbitrary, discriminatory, and provide a multibillion-dollar profit opportunity to organized crime.