Menthol Cigarettes & Race: FDA Shades the Facts

 

The FDA announced on April 29 its decision to ban menthol cigarettes, saying it had “strong scientific evidence” that the action would “reduce tobacco addiction and curb deaths.”  It claimed that “menthol increases the appeal of tobacco” and makes cigarettes “more addictive and harder to quit by enhancing the effects of nicotine.”  The agency, however, failed to explain why menthol cigarettes, despite such appeal, are favored by fewer than 30% of American smokers. 

Media coverage of the ban featured the claim that menthol cigarettes “disproportionately addict – and kill – Black Americans,” as the Washington Post headlined a story that contained this statement: “Black men have the highest rates of lung cancer in the United States, according to the Centers for Disease Control and Prevention.”

In 2018, I answered the question, “Who smokes menthol cigarettes?” using the 2015 National Health Interview Survey (NHIS), which was the last CDC report on the number of menthol smokers.  Although federal officials claim that menthol cigarettes pose an existential threat, they only collect information about them every five years in the NHIS, their main instrument for tracking smoking.

The 2015 NHIS found 10.7 million menthol smokers; 61% were white and 32% were Black.  Here is a further breakdown of race and gender, from highest to lowest numbers:

Table 1. Number of Menthol Smokers in the U.S., NHIS 2015
Race/Gender	Number (millions)
White women	3.8
White men	2.7
Black men	1.8
Black women	1.6
Others	0.8
All	10.7

If menthol cigarettes addict and kill smokers, these numbers reflect the victims’ race and gender distribution.

Let’s look at lung cancer mortality rates (LCMR) and numbers of deaths from the CDC’s most recent five years of data.  The rate is the number of deaths per 100,000 population per year (among persons 45+ years), so it’s the best way to compare different-sized groups.  The number of deaths is related to both the rate and the size of the group.

Table 2. Age-adjusted LCMR (per 100,000 persons per year) and number of deaths from lung cancer, 2012-2016
Race/Gender	LCMR	Deaths
Black men	184	49,578
White men	151	371,140
White women	102	306,234
Black women	93	35,158
Others	*	22,434
All		784,544

*Various groups with different LCMRs

While Black males have the highest lung cancer mortality rate, it is not because they smoke menthol; it is because they smoke more than white men and women, and especially Black women.

Mitch Zeller, director of the FDA’s Center for Tobacco products, played the menthol ban as a race issue: “For far too long, certain populations, including African Americans, have been targeted, and disproportionately impacted by tobacco use.” [Federal officials always say “tobacco” when they mean “smoking’?] 

The numbers prove Zeller is wrong.  While he asserted that Blacks “have been targeted,” far more whites than Blacks smoke menthol.  Zeller claimed that Blacks have been “disproportionately impacted,” but while Black men have the highest lung cancer death rates, Black women have the lowest, at about half the rate of the former.