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Ann Am Thorac Soc
Ann Am Thorac Soc
AnnalsATS
Annals of the American Thoracic Society
2329-6933
2325-6621
American Thoracic Society

39212422
202405-476ED
10.1513/AnnalsATS.202405-476ED
Editorials
Unveiling the Tobacco Industry’s Exploitative Legacy: A Call for Racial Equity through a Menthol Ban
https://orcid.org/0000-0002-9062-409X
Kathuria Hasmeena 1 2
Ewart Gary 3
Neptune Enid R. 4
https://orcid.org/0000-0002-6310-3520
Upson Dona 5 6
1 The Pulmonary Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts;
2 Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin;
3 Washington Office, American Thoracic Society, Washington, District of Columbia;
4 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland;
5 Pulmonary, Critical Care & Sleep Medicine, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico; and
6 Pulmonary, Critical Care & Sleep Medicine, School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
1 9 2024
1 9 2024
1 9 2024
21 9 12451246
Copyright © 2024 by the American Thoracic Society
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0. For commercial usage and reprints, please e-mail Diane Gern.
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pmc

In this issue of AnnalsATS, Baugh and colleagues (pp. 1238–1241) provide a sobering reminder of the insidious relationship between the tobacco industry and Black Americans (1). Through a historical and contemporary lens, they illuminate the industry’s exploitative practices that have perpetuated Black–White racial health disparities. The tobacco industry’s exploitation of Black Americans traces back to the era of American slavery, when tobacco cultivation relied heavily on enslaved labor. Emancipation did not end the exploitative relationship between Black labor and the tobacco industry. Baugh and colleagues remind us of how discriminatory farm policies to exclude Black farmers from more profitable cash crops, perpetuated by the tobacco industry, ensured their continued dependence on tobacco cultivation for economic survival.

Even as the tobacco industry exploited Black labor, they sought to exploit Black lungs. A cornerstone of the industry’s marketing strategy was to target the sale of menthol tobacco products, well known to be addictive and deadly, to Black communities (2). Tactics such as higher concentrations of menthol cigarette advertisements in Black neighborhoods compared with other racial groups underscore the industry’s callous disregard for public health and its willingness to prioritize profits over people’s well-being.

The evidence vividly underscores the disproportionate toll of menthol cigarettes on Black Americans’ health. Approximately 80% of Black adults who currently smoke cigarettes use menthol cigarettes, compared with 34% of White adults (3). Between 1980 and 2018, 40% of excess deaths attributable to menthol cigarette smoking in the United States were among Black people, although Black people constitute about 12% of the population (4).

The disproportionate toll menthol cigarettes have taken on Black Americans is not accidental but rather part of a well-documented decades-long marketing campaign to lure Black Americans, in particular Black youth, into nicotine addiction. Menthol increases the bioavailability of nicotine, and its anesthetic and cooling effects make initiation of smoking easier (5, 6). From historical economic coercion to contemporary targeted marketing to Black people, the industry’s tactics have perpetuated health disparities and undermined public health efforts to reduce tobacco-related morbidity and mortality.

Yet the tobacco industry claims allyship and support for Black communities (7). What are its true intentions? Although the tobacco industry has made significant contributions to Black politicians and Black businesses, Baugh and colleagues (1) also note the counterpoint contributions the tobacco industry has made to politicians who proudly and loudly endorsed policies antithetical to Black Americans, including opposition to desegregation, the Civil Rights Act, the Voting Rights Act, and discriminatory zoning policy.

Menthol bans work. The European Union, Canada, and more than 170 localities and two states in the United States have enacted them. Pooled results from a recent meta-analysis showed that 24% of menthol cigarette smokers stopped smoking after a menthol ban, 50% switched to nonmenthol cigarettes, and 12% switched to other flavored tobacco products. Twenty-four percent continued smoking menthol cigarettes, with smoking rates highest in areas with local bans and lowest with national bans, suggesting that national bans are more effective than local or state bans (8). Although banning menthol cigarettes would have a meaningful and enduring impact on improving the health of Americans, especially Black Americans, the tobacco industry persists in its efforts to obstruct initiatives. The message is clear: the tobacco industry is no friend of Black Americans.

In a guise of speaking for Black Americans, the tobacco industry and its allies have cynically used genuine issues such as the criminalization of Black Americans and more questionable lines of argument such as freedom of choice to smoke to block a final U.S. Food and Drug Administration rule to ban menthol cigarettes (9). Existing and proposed laws specifically hold manufacturers and sellers accountable, without extension to individuals who use menthol cigarettes or sell “loosie”-like products. Second, arguments that support an individual’s freedom to make harmful health choices would challenge the validity of laws such as mandating seatbelt use and those that establish smoke-free policies.

Many African American organizations (e.g., the NAACP, the National Urban League, the National Medical Association, the African American Tobacco Control Leadership Council, the Association of Black Cardiologists, the Black Women’s Health Imperative, the Delta Sigma Theta sorority, The Links, Inc.) are in favor of a menthol ban. Some (e.g., the National Action Network, the National Association of Black Law Enforcement Officers, the National Association of Criminal Defense Lawyers) oppose the legislation over concerns about overpolicing or encroachment on minority rights to adverse health choices. Clinicians, including Black clinicians serving patients identifying as Black, overwhelmingly endorse a menthol ban, viewing it as integral to social justice efforts aimed at reducing health disparities rather than exacerbating them.

Baugh and colleagues (1) clearly articulate a familiar truth: the tobacco industry has never acted in the best interests of Black Americans. But we already know this, so why does the perspective piece by Baugh and colleagues matter? It matters because it contextualizes the tobacco industry’s latest tactic: the claim that banning menthol cigarettes will diminish Black support in the upcoming presidential election, a narrative that has evidently caught President Biden’s attention. Once again, this is a false narrative.

Recent polling data (1,000 registered voters with an oversample of 400 Black voters), commissioned by the Campaign for Tobacco-Free Kids and conducted by the Mellman Group, refute this claim. Biden’s margin among all voters remained unchanged at 2 points after respondents were asked to assume that the administration implemented the menthol rule (44% Biden to 42% Trump at baseline, 45% Biden to 43% Trump if the ban were enacted) (10). Among Black voters, Biden’s margin held steady at 58 points (74% Biden to 16% Trump) after respondents were asked to assume that the administration implemented the menthol rule (10).

Among voters as a whole, the menthol ban is supported by a 29-point margin (58% to 29%) with even stronger support among Black Americans (62% to 25%). Similarly, other polling studies have revealed widespread public support for a menthol ban: a poll conducted by Morning Consult/Politico in May 2022 revealed that voters favored the proposed ban on menthol cigarettes by a significant margin of 58% to 24%, with 55% to 30% support among Black voters (11).

The frustrations of the years-long unsuccessful effort to implement menthol regulation are that the benefits are clear and validated and will inevitably improve health equity. With clear intention, the opposition has made the issue noisy, falsely invested with racially sensitive attachments such as policing and paternalism. More cynically, they are attempting to use the current charged political moment to paralyze the administration with nonneutral polling and race-based subterfuge. President Biden has made health equity a priority for his administration and through the Cancer Moonshot has reaffirmed his commitment to the fight against cancer. President Biden’s commitment to these priorities and his bold leadership on climate, air pollution, and conservation policy show his dedication to public health. To address the disparities and harms perpetuated by the tobacco industry, it is imperative that the administration continue its commitment to health equity and ethical leadership by finalizing the rule to ban menthol cigarettes.

Author disclosures are available with the text of this article at www.atsjournals.org.
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