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How many times must a man look up
Before he can see the sky?
Yes, ‘n’ how many ears must one man have
Before he can hear people cry?
Yes, ‘n’ how many deaths will it take till he knows
That too many people have died?
The answer, my friend, is blowin’ in the wind,
The answer is blowin’ in the wind.

Copyright © 1962 by Warner Bros. Inc.; renewed 1990 by Special Rider Music

The song “Blowin’ in the Wind” came to prominence during the 1960’s and it poses a series of rhetorical questions about peace, equality, war and freedom. The choral refrain – “The answer, my friend, is blowin’ in the wind” – can be interpreted as both unambiguous – the answer is so discernible it is right in your face – as it is intangible, like the wind.

With respect to tobacco use and its consequences for public health – there are many things that we know and have known since the first Surgeon’s General report on tobacco was released in 1964. Tobacco is the number one cause of preventable death and premature death in the United States. About 1,200 people die every day in the country from tobacco-related disease. We also know that cigarette prevalence rates have declined to about 20 percent nationwide –  which is good news. However, that decline has “stalled” in recent years.

This stall is due to a number of factors including use of mentholated tobacco products. Despite a 22 percent decline in overall packs of cigarettes sold between 2000 and 2005, menthol sales remained stable. Menthols are smoked disproportionately by youth and African-Americans. Amongst African American smokers, greater than 80 percent smoke menthols compared to 27 percent amongst white smokers. Many research studies have found that menthol-flavored cigarettes are a starter product for youth, possibly due to the fact that the minty taste reduces the harshness of cigarette smoke which may be more appealing to young, inexperienced smokers. We know that menthol users are less likely to successfully quit smoking than other smokers, despite increased quit attempts and intentions to quit. According to the U.S. Centers for Disease Control and Prevention, cessation rates are significantly lower among Blacks (37 percent) than their white peers (51 percent).

Historically, the African American community has long been targeted disproportionately by tobacco industry advertising, promoting menthol cigarettes like the popular and omnipresent Newport and Kool brands. It then comes as no surprise that for African Americans who smoke, a stunning 83 percent smoke menthols. The disease and death that this brings upon the community cannot be underscored enough.

Tobacco manufacturers have promoted menthol cigarettes as a safer alternative to regular cigarettes. The tobacco industry has a well-documented, predatory track record of targeting menthol brands to racial and ethnic minorities and youth. Interestingly enough, while overall smoking rates have declined in the past eight years, depending on age, the proportion of smokers who use menthol cigarettes has held steady or increased.

With the passage of the 2009 Family Smoking Prevention and Tobacco Control Act, 13 specific “candy-like flavorings” were banned. Menthol, however, was excluded from this ban. The Federal Drug Administration (FDA), the agency tasked by the law to regulate tobacco products, has been provided an opportunity to remedy this oversight. A scientific advisory group established by FDA – the Tobacco Product Scientific Advisory Committee (TPSAC) – were required to tackle the menthol question as one of the first issues it addressed and recommended in March 2011, that removal of menthol cigarettes from the marketplace would benefit public health in this country.

As of the writing of this commentary, the FDA has yet to comment on, let alone act on, the recommendations of their TPSAC, although a report is said to be in the works. There is much concern that perhaps the TPSAC’s sage advice will be ignored or that it may be compromised by tobacco industry influences. Regardless of this report and any subsequent action or inaction, Legacy will continue to support and advocate for a ban on menthol cigarettes. If menthol removal from cigarettes causes even a fraction of Americans to quit smoking or never to start – thousands of lives would be positively impacted.

The FDA needs to do the right thing and ban menthol, for adults who currently smoke and young people who may be susceptible to initiating smoking. As Bob Dylan succinctly pointed out in his iconic lyrics – how many deaths will it take till he knows that too many people have died? The answer my friend is blowing in the wind: make menthol history.

Amber E. Bullock, MPH, CHES
Executive Vice President, Program Development

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