Menthol Cigarettes & Race – FDA Fudges the Facts

 

After announcing its intention to ban menthol cigarettes two years ago, the FDA has finally submitted its final rule to the Office of Management and Budget for Executive review.  Meanwhile, the Washington Post is reporting that the ban will be delayed until sometime in 2024 due to “political concerns” around Black smokers’ preference for and access to this flavor. 

In 2018, I answered the question, “Who smokes menthol cigarettes?”, using the 2015 National Health Interview Survey (NHIS).  Although federal officials claim that menthol cigarettes pose an existential threat, they only collect information on the topic every few years in the NHIS, their main instrument for tracking smoking.  The numbers were updated in the 2022 survey.

In 2015, the NHIS reported there were 36.5 million U.S. smokers.  By 2022, that number was down to 28.8 million, an impressive decline of 21%.  Table 1 reflects menthol cigarette popularity.

 

Table 1. Number (millions) of Smokers in the U.S., According to Whether They Usually Smoke Menthol or Not, NHIS 2015 and 2022
Usually Smoke Menthol	2015	2022	Percent Change
Yes	10.7	9.9	-7.5
No	25.8	18.9	-26.7
All	36.5	28.8	-21.1

 

There is no question that the decline in usual menthol smokers lagged behind that in non-menthol smokers.  The numbers don’t tell us how many started and stopped (or died trying), but they do indicate that the menthol cigarette market was not as fragile as that for non-menthol cigarettes.

When we look at the same data according to race in the next table, we see that the number of White women menthol smokers fell the most, followed by White men and Black women.  Unfortunately, the number for Black men stayed the same, and the number for other races increased from 0.8 to 1.2 million.

 

Table 2. Number (millions) of Menthol Smokers in the U.S., NHIS 2015 and 2022
Race/Gender	2015	2022	Percent Change
White women	3.8	3.2	-15.8
White men	2.7	2.5	-7.4
Black men	1.8	1.8	0
Black women	1.6	1.5	-6.3
Others	0.8	1.2	+50
All	10.7	9.9	-7.5

 

From this table we see that White women and men account for over half of menthol smokers (32% and 25% respectively), while Black men and women together account for only about a third (18% and 15% respectively).

Let’s see how lung cancer mortality rates (LCMR) and deaths from CDC data compare for the periods 2012-2016 and 2018-2021.  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 per year is related to both the rate and the size of the group.

Table 3. Age-adjusted LCMR (per 100,000 persons per year) and number of deaths from lung cancer, 2012-2016 and 2018-2021
	2012-2016		2018-2021
Race/Gender	LCMR	Deaths	LCMR	Deaths	LCMR Percent Change
Black men	184	9,916	139	8,687	-24
White men	151	74,228	118	64,983	-22
White women	102	61,247	84	55,693	-18
Black women	93	7,032	74	6,486	-20
Others	*	4,487	*	5,182
All		156,910		141,031

 

While Black men had the highest LCMR in both periods, this group saw the steepest decline.  Keep in mind that Black men don’t have the highest LCMRs because they smoke menthol; it is because they smoke more than White men and women, while the latter groups smoke more than Black women.  In other words, smoking KILLS, but menthol doesn't.

FDA officials consistently portray a menthol ban as a corrective response to the tobacco industry’s targeting of African-Americans, yet far more Whites smoke menthol. 

As for who has been “disproportionately impacted,” Black men have the highest LCMRs of all four groups, but Black women have the lowest, at almost half the rate of the former.  Comparing the two survey periods, LCMRs dropped around 20% for all four groups. Still, over 140,000 Americans die from lung cancer every year.