The unprecedented rise in youth vaping is a pressing public health challenge. More than one-quarter of all high school students now use e-cigarettes.
Reducing e-cigarette use among youths is critical to preventing another generation of kids from becoming addicted to nicotine. We applaud efforts to prohibit the sale of menthol-, mint-, candy-, and fruit-flavored e-cigarettes. But government and public health leaders must not repeat the same mistake they made a decade ago when they allowed combustible menthol cigarettes to remain on the market.
Failure to prohibit all flavored tobacco products will adversely affect the health of structurally disadvantaged groups such as youths, people of color, low-income communities, and people who identify as LGBTQ+. These groups already disproportionately bear the burden of tobacco use and related health harms, in part due to past policy decisions.
In 2009, the landmark Family Smoking Prevention and Tobacco Control Act granted the Food and Drug Administration broad authority to regulate the manufacture, distribution, and marketing of tobacco products. It outlawed flavored cigarettes — except menthol cigarettes.
The menthol exemption has had a significant adverse effect on the health of African Americans and other groups. It is a stark reminder of how essential public health protections for people of color and other marginalized communities frequently get left on the negotiating room floor.
The current public focus on vaping and flavored e-cigarettes presents an opportunity for the public health community to make clear the social justice imperative to end the sale of all flavored tobacco products, and demand that menthol cigarettes and flavored little cigars and cigarillos be included in any ban.
Between 2004 and 2014, young adults continued to smoke menthol cigarettes at increasing levels even as overall smoking rates declined. More than 4 in 5 black smokers and 7 in 10 young LGBTQ+ smokers use menthol cigarettes. Studies also find that individuals with lower incomes, less education, and those who identify as LGBTQ+ more frequently consume flavored cigars, especially mentholated cigars.
The tobacco industry has for decades systematically and perniciously targeted structurally disadvantaged groups. Although they no longer blanket communities with free cigarettes, predatory industry targeting continues to this day. For example, packs of Newport, a popular brand of menthol cigarettes, are cheaper and more heavily promoted in communities with higher percentages of black high-school students.
There is no question that health outcomes are inconsistent across places and populations. But our policy responses sometimes fail to address these inequities and can, at times, reinforce systemic injustice. Even though the control of tobacco has been one of the most successful public health movements in modern history, stark racial, socioeconomic, and other demographic disparities persist in tobacco use and tobacco-related harm. Many of these disparities have even grown larger over time.
Public health advocates committed to centering health equity in their work must consider how to operationalize those values. When we learn about the ways that public policies have created or reinforced inequities, it is essential to acknowledge such harms while making the social justice case for correcting them. All too often, even the most well-intentioned policies can inadvertently exacerbate health disparities.
Although eliminating flavored e-cigarettes is a necessary step to preventing a new generation from becoming addicted to nicotine, policies that fail to tackle menthol cigarettes and all other flavored tobacco products risk further entrenching health inequities. Now is the time to prohibit the sale of menthol cigarettes and all other flavored tobacco products. We have an obligation to learn from our past as we plan our future, and to ensure that, this time around, no communities get left behind.
Derek Carr is a senior attorney and Pratima Musburger is a program director and senior attorney for ChangeLab Solutions, a nonprofit organization that advances equitable laws and policies that ensure healthy lives for all.