- Menthol cigarettes are popular among African American smokers, research shows.
- Joe Raedle/Getty Images
- On Thursday the US Food and Drug Administration (FDA) announced that it wants to ban all cigarettes flavored with menthol.
- In the US, menthol is a popular cigarette flavor, especially among African American and young smokers.
- The cool, minty flavor may mask some of the unpleasant aspects of starting to smoke, the FDA commissioner said.
- Some research suggests that menthol in cigarettes may make it harder to quit smoking.
Federal officials revealed plans this week to ban cool, minty menthol flavoring from traditional cigarettes as part of a larger push to curb vaping and smoking in young people.
In a statement released on Thursday, the US Food and Drug Administration (FDA) said it’s seeking to limit sales of flavored vapes to ensure customers are over 18, in addition to banning menthol cigarettes and flavored cigars.
The move is meant to address rising rates of flavored e-cigarette use among teens.
From 2017 to 2018, there was a 78% increase in e-cig use among high schoolers and a 48% increase among middle schoolers . More than two-thirds are using flavored e-cigarettes, the statement said.
Read more: Government regulators are banning menthol cigarettes and chipping away at flavored e-cigs – but not in the way some thought
So why is the FDA including menthol cigarettes in its crackdown?
It’s possible that the flavor of menthol could make it easier for young people to start smoking normal cigarettes, FDA commissioner Dr. Scott Gottlieb explained in the statement. (That matters, because nearly 90% of current smokers first tried smoking by the time they were 18.)
“I believe these menthol-flavored products represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes,” Gottlieb said in the statement. “The menthol serves to mask some of the unattractive features of smoking that might otherwise discourage a child.”
More than 50% of smokers aged 12 to 17 smoke menthols, according to the FDA.
But their use among young people isn’t the only potential issue linked to menthol cigarettes. A vast majority of African-American smokers smoke menthols – a disparity that’s often attributed to marketing campaigns targeting African-American communities. There’s also some research suggesting that menthols may be harder to quit than other types of cigarettes. Here’s what you should know about them.
Menthol cigarettes are popular among African American smokers
- More than 80% of African American smokers prefer menthol cigarettes.
- Getty Images
A whopping 84.6% of African-American smokers smoke menthols, compared with 44.4% of Hispanic smokers, 37.5% of Asian smokers, and 28.5% of White smokers, according to the FDA.
Some say this disparity is the result of cigarette companies historically targeting African American communities in their advertising.
As early as the 1960s, menthols were marketed toward African-Americans as a “‘smooth, ‘cool, and ‘healthier,’ alternatives to non-menthol cigarettes,” a 2010 report from the American Lung Association (ALA) said. “Four decades later, in 2002, a review … showed that magazines targeted to the black community were nearly 10 times more likely to have cigarette ads than more general audience magazines. And nearly 70 percent of all the cigarette ads in those targeted magazines were for menthol brands.”
Read more: This photo of an airport smoking section shows the disgusting damage caused by cigarettes
Newer research offers evidence that this trend may be continuing. One 2012 study looked at tobacco sales near California high schools. It found that higher enrollment of African-American students was linked with a higher percentage of ads for menthols. And in 2013, a study of St. Louis concluded that menthol marketing was highest in areas with the highest percentages of black residents.
Even though African-Americans typically smoke fewer cigarettes and start smoking at older ages than whites, they’re more likely to die from smoking-related diseases, according to the CDC (Centers for Disease Control and Prevention). High menthol preference among African-American smokers has been suggested as a possible explanation for this troubling gap, the ALA report added, partly because some research indicates menthols may be harder to quit.
Some research suggests that menthol may make it harder to quit smoking
- Menthols may be harder to quit.
- Valentyn Ogirenko/Reuters
A 2011 preliminary report from the FDA said that, while there’s little evidence that menthols are more toxic or cause more disease than non-menthol cigarettes, the added flavor may still present additional problems. The report continued:
“Adequate data suggest that menthol use is likely associated with increased smoking initiation by youth and young adults. Further, the data indicate that menthol in cigarettes is likely associated with greater addiction. Menthol smokers show greater signs of nicotine dependence and are less likely to successfully quit smoking.”
Not every study on this topic has shown a link between menthols and quitting difficulties, as one 2011 review pointed out. But many have found a connection.
There are some potential explanations for why menthols may interfere with quitting attempts, according to a 2010 study published in the journal Addiction. The cooling effect of menthol may cause smokers to inhale more on each puff, possibly ramping up nicotine levels in their bodies, the authors wrote, and menthol smoking may also slow down the metabolism of nicotine in the body, which could contribute to greater dependence.
The bottom line is still that smoking cigarettes – menthol or otherwise – kills. But the FDA’s push to ban menthol flavoring could help prevent teens from picking up the habit.
“I will not allow a generation of children to become addicted to nicotine through e-cigarettes,” Gottlieb said in the FDA statement. “We won’t let this pool of kids, a pool of future potential smokers, of future disease and death, to continue to build.”
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- Eduardo Munoz/Reuters
- Federal regulators on Thursday proposed a ban on menthol cigarettes and a move to place flavored e-cigarettes like the Juul behind a stronger regulatory fence.
- The move is less severe than what some expected to see: an immediate ban on flavored e-cigs being sold at convenience stores and gas stations.
- Menthol and mint e-cigarettes aren’t affected by the government’s proposal.
- Earlier this week, the Silicon Valley e-cig startup Juul announced it would temporarily stop selling its flavored e-cigarettes in stores – a move it probably made in anticipation of the government’s latest statement.
Instead of announcing what was expected to be a sweeping and immediate ban on flavored e-cigarettes like the Juul, government regulators on Thursday proposed banning regular menthol cigarettes and revisiting a year-old policy designed to put new e-cig products behind a stronger regulatory fence.
Food and Drug Administration’s commissioner Scott Gottlieb said his agency would revisit its policy as it applied to all flavored e-cigs except for tobacco, mint, and menthol varieties. The FDA didn’t provide a timeline for the changes in its statement.
The changes Gottlieb aims to see, he said, would protect teens and minors by ensuring those products are sold only in locations that cater exclusively to adults. Online sales would also be allowed “under heightened practices for age verification,” he said.
The move may surprise Juul Labs, the Silicon Valley startup that has 80% of the e-cig market.
Earlier this week, the company announced its own immediate (albeit temporary) ban on flavored e-cigs at all retail stores.
“As of this morning, we stopped accepting retail orders for our Mango, Fruit, Creme, and Cucumber Juul pods to the over 90,000 retail stores that sell our product, including traditional tobacco retailers and specialty vape shops,” Juul CEO Kevin Burns said in a statement on Tuesday.
Read more: Juul will soon stop selling flavored e-cigarette packs in retail stores, but a workaround could make the ban pointless
Juul’s move was most likely made in anticipation of an expected similar action from the FDA, experts say. Last week, The Washington Post reported that the agency would ban “most flavored e-cigarettes in tens of thousands of convenience stores and gas stations across the country.”
But the FDA didn’t ban flavored e-cigs on Thursday.
A ban on menthol cigarettes and a plan to eventually put e-cigs behind a stronger regulatory fence
- Matt Cardy/Getty Images
Instead of banning flavored e-cigarettes, the FDA on Thursday proposed barring the sale of menthol cigarettes, which Gottlieb said he believed “represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes.” FDA also plans to propose a ban on flavored cigars.
He also outlined plans to eventually regulate e-cigs more strictly using a policy he initially proposed last year and then waived.
Thanks to that policy, any e-cig introduced before August 2016 was essentially grandfathered in to the market, meaning its makers did not have to seek FDA approval to sell their products until at least 2022.
That waived policy has been the door through which e-cig companies like Juul were able to aggressively market and sell their products.
Read more: $15 billion startup Juul used ‘relaxation, freedom, and sex appeal’ to market its creme-brulee-flavored e-cigs on Twitter and Instagram – but its success has come at a big cost
Gottlieb said he hoped that revisiting that policy would place e-cigs back behind a regulatory fence and ensure that they are marketed and sold in a responsible manner that doesn’t target youth.
The government is also publishing new data that suggests a troubling increase in e-cig use among teens. From 2017 to 2018, Gottlieb said, there was a 78% rise in e-cig use among high-school students and a 48% increase among middle-school students.
“These data shock my conscience,” Gottlieb said in the statement.
“The bottom line is this: I will not allow a generation of children to become addicted to nicotine through e-cigarettes,” he added.
‘Most scientists believe flavorings are used to target teenagers’
- California Department of Public Health
Flavors have been at the epicenter of much of the debate around young people and e-cigarettes.
Experts say e-cig varieties like Apple Pie, Watermelon, and even Hot Sauce are designed intentionally to hook teens on nicotine, a highly addictive substance that’s especially influential on a developing brain.
“Most scientists believe flavorings are used to target teenagers into becoming users,” Ana Rule, a professor of environmental health and engineering at Johns Hopkins University who was an author of a recent study on e-cigs and teens, told Business Insider this summer.
“There are of course many other factors such as marketing and peer-pressure, but when you look at the flavoring names, one has to wonder.”
In Juul’s statement announcing its own temporary halt on flavored e-cigs, the company acknowledged that its flavored varieties might appeal to youth.
Other regulators have taken action on flavors as well.
Over the summer, San Francisco residents voted to pass a sweeping tobacco-flavor ban that barred the sale of flavored e-cigs as well as menthol cigarettes. Several big names including former Mayor Michael Bloomberg of New York came out in support of the ban, suggesting at the time that it could spur similar moves in other cities.
“This vote should embolden other cities and states to act, because it demonstrates the public will not allow tobacco companies to stand in the way of policies that are proven to reduce smoking and save lives,” he said in a statement.
Read more: San Francisco has passed a sweeping ban that should scare the $23 billion vaping industry
With these moves and the Washington Post story in mind, many experts believed the FDA would crack down immediately on both flavored e-cigs and menthol cigarettes today. But while the menthol cigarette ban is directly outlined in the new policy, no such ban is outlined with regard to flavored e-cigarettes.
Instead, flavored e-cigs will still be widely available – so long as the locations they are sold in follow age-restriction protocols.
“The changes I seek would protect kids by having all flavored [e-cig] products … sold in age-restricted, in-person locations and, if sold online, under heightened practices for age verification,” Gottlieb said in the statement.
- Cigarette butts are among the most abundant types of human-produced garbage in the world’s oceans.
- Most of the roughly 5.5 trillion cigarettes manufactured globally every year contain a plastic-based filter. Those filters can take decades to decompose after the cigarette butt has been discarded.
- The conversation around the waste that accumulates in the ocean has gained new momentum as major companies and metropolitan areas seek new ways to address non-biodegradable garbage.
Cigarette butts are among the most abundant types of human-produced garbage in the world’s oceans.
Most of the roughly 5.5 trillion cigarettes manufactured globally every year contain a plastic-based filter, made of cellulose acetate, according to the Cigarette Butt Pollution Project.
Those filters can take decades to decompose after the cigarette butt has been discarded. As the plastics break down the chemicals can be consumed by wildlife. According to environmental researchers cited by NBC News, scientists have found traces of these chemicals in roughly 70% of seabirds and approximately 30% of sea turtles.
“More research is needed to determine exactly what happens to all of that,” Nick Mallos, director of the Trash Free Seas campaign for the Ocean Conservancy, told NBC News.”The final question is what impact these micro-plastics and other waste have on human health.”
The conversation around the waste that accumulates in the ocean has gained new momentum as major companies and metropolitan areas seek new ways to address other types of nonbiodegradable garbage, like plastic straws.
Vaping appears to be wildly popular among teens who use e-cigs illegally. And in an ironic twist, teens who try vaping are at a far higher risk of becoming smokers compared with teens who don’t.
A new study puts the figure into stark numerical terms: while as many as 2,070 adults used e-cigs to quit in 2015, another 168,000 young people who used the devices went on to become smokers of conventional cigarettes. The analysis, led by researchers at the Geisel School of Medicine at Dartmouth University, was published this month in the journal PLOS One.
It comes alongside a new report from the Centers for Disease Control and Prevention which found that roughly four out of five adolescents are exposed to e-cig advertisements.
“Based on the existing scientific evidence … e-cigarette use currently represents more population-level harm than benefit,” the Dartmouth researchers wrote in their study.
As many as 168,000 new smokers
For the new study, Dartmouth researchers used 2014 census data and surveys to build a mathematical model of the link between vaping and smoking. Their evidence suggests that during 2015, roughly 2,070 smokers successfully quit with the aid of e-cigs.
But within the same time frame, their model suggested that as many as 168,000 young people who’d never previously smoked cigarettes started smoking regularly after vaping for the first time.
That said, the study is a model – it’s not a controlled study that looks at actual habits, so the findings are somewhat limited. There’s also no way to know, for example, if the e-cig users in the study who went on to smoke conventional cigarettes might have become smokers anyway, although the researchers attempted to control for that in their model.
But the new analysis is far from the first study to show evidence that teens who vape are more likely to go on to smoke.
A spate of research dating back as far as 2015 has suggested that teens who vape are anywhere between two and seven times more likely to eventually smoke conventional cigarettes as teens who never try e-cigs.
Still, scientists aren’t clear why this is happening.
While some have argued that vaping could be linked with a so-called “gateway effect” whereby young people who vape become addicted to nicotine and are thus more likely to transition to traditional cigarettes, others have said this doesn’t make sense.
“I honestly can’t think of why this would be,” Ana Rule, a professor of environmental health and engineering at Johns Hopkins University and an author of another study on e-cigs and teens told Business Insider about the phenomenon. “It is my understanding that vaping is a much more pleasurable experience, is socially acceptable (as opposed to smoking) and delivers a good dose of nicotine.”
Either way, public health experts are worried about vaping’s growing popularity among young people.
Why vaping is so popular among teens
- Eduardo Munoz/Reuters
At high schools across the country, vaping has become a fad with its own verb.
This is not entirely surprising. Kids and teens are exposed to a plethora of advertising for e-cigs that mimics much of the cigarette advertising of the 1960s. A CDC report published Friday found that roughly four in five middle and high school students saw e-cig ads in 2016.
Although ostensibly healthier than deadly cigarettes, e-cigs still contain highly addictive nicotine. The devices also possess a handful of qualities that make them especially appealing to young people.
Unlike conventional cigarettes, which have a natural stop mechanism – they burn to the end – e-cigs can be re-filled and reused. Additionally, e-cigs are discrete and sometimes odorless (or have a non-offensive smell). Vaping isn’t universally banned in indoor and outdoor places. Many vape pens are sleek, small, colorful, and fairly affordable.
But the evidence is mounting that teens who vape are more likely to go on to smoke conventional cigarettes.
A 2015 study published in the Journal of the American Medical Association suggested that teens who vaped had three times the risk of eventually smoking conventional cigarettes as teens who never tried e-cigs. A larger follow-up study done the following year appeared to confirm those findings, as did a 2018 study published in the Journal of Adolescent Health which looked at roughly 1,150 British adolescents aged 11 to 18.
For the 2018 paper, teens whose nicotine exposure began with e-cigs appeared to have as much as a 12 times greater chance of smoking cigarettes 4 months later than kids who didn’t vape, even after the researchers controlled for several big risk factors for smoking.
The first large and comprehensive review of all the published research on e-cigs added some additional weight to that conclusion, finding “substantial evidence” that young people who vape are more likely to smoke conventional cigarettes than those who don’t.
“Vaping among teens is my (and most public health professionals) biggest worry,” Rule told Business Insider last month.
- Pax Labs
- The Juul vape pen, an e-cigarette that comes with a vaporizer and pre-filled containers of nicotine liquid, is soaring in popularity.
- Young people appear to be especially drawn to the device, which is discrete enough to hide.
- Juul is emphatic that its product is made to appeal to adults looking to switch from smoking to vaping.
- But some of the same characteristics that make the Juul appealing to adults may also be attractive to teens.
Vaping is becoming increasingly popular, and now a vape pen that’s small, discrete, and easy to use is taking over high schools – and the e-cig market.
The Juul (pronounced “jewel”) appears to have a loyal and growing following among young people, who brag on social media about being able to sneak puffs in class or in the bathroom. But it’s not just teens who are using it – the device represents a third of the market share of the total e-cig category, according to Nielsen data, meaning a large share of adults are also turning to the Juul.
Compared with smoking conventional cigarettes – a process that involves setting ablaze a handful of tobacco, tar, and toxic metals – vaping seems objectively healthier. Nothing is burned – only heated – and tobacco doesn’t need to be involved at all.
But vaping still comes with health risks, and these risks may be especially worrisome for young people.
“The people that are marketing these new devices claim that their main focus is to reduce the risk of smokers, and I agree, vaping probably represents a reduction in risk from smoking,” Ana Rule, a professor of environmental health and engineering at Johns Hopkins University and an author of a study on e-cigs and teens, told Business Insider.
“But they fail to address the increased risk to this huge market they are creating among teenagers and young adults that never have smoked, and would have never even considered smoking,” she added.
- Pax Labs
Among teens, the Juul is not just a noun. It’s also a verb.
Instagram and YouTube are full of videos of teens posting clips of themselves vaping, or “Juuling,” in class and in front of teachers; a string of high schools along the East Coast has acknowledged “Juuling” in bathroom stalls as a widespread problem, and dozens of teachers report confiscating Juul devices disguised as Sharpies and other classroom items.
That runs counter to Juul’s mission as a company, Ashley Gould, Juul’s chief administrative officer, told Business Insider.
“Juul is a company that was started by smokers with an objective to switch smokers to non-combustible products,” Gould said, adding that the company is vehemently opposed to anyone under 18 using their products and even has a number of campaigns aimed at addressing and curbing underage use.
Nicotine is a highly addictive substance – one analysis ranks it below heroin and cocaine but above barbiturates (anti-anxiety drugs) and alcohol. Some 85% of people who try to quit smoking on their own relapse.
Some evidence suggests that e-cigs may be helpful to adults who are looking to quit smoking. But research also suggests that vaping is an appealing habit to teens, and that those who pick up a vape pen are at a greater risk of smoking conventional cigarettes than those who never vape.
That means that while adults who pick up the Juul may be using it to quit, teens who use it may become addicted and eventually turn to traditional cigarettes.
Why vaping is so appealing to teens
- Eduardo Munoz/Reuters
E-cigs have a handful of qualities besides highly addictive nicotine that may make them especially appealing to young people.
Unlike conventional cigarettes, which have a natural stop mechanism – they burn to the end – e-cigs can be re-filled and reused. Additionally, where cigarettes are highly noticeable and easily policed, e-cigs are discrete and sometimes odorless (or have a non-offensive smell). Vaping isn’t universally banned in indoor and outdoor places.
The Juul is also sleek, small, colorful, and fairly affordable, at $35 for the pen and $16 for a four-pack of pre-filled cartridges (or “Juul pods”).
But the device is different from most e-cigs in one key way: its nicotine.
Not only does the Juul have a higher nicotine concentration than other comparable devices (a Juul pod is 5% nicotine by volume; a Blu e-cig cartridge is 2.4%), it also uses a slightly different nicotine formula than most vape pens use.
Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University who studies nicotine and recently published a review of Juul devices, said she found the product’s high nicotine content “scary.”
“It is much higher than what we’re seeing in conventional e-cigs. It’s a tremendous amount,” Halpern-Felsher said.
Instead of straight liquid nicotine, otherwise known as “freebase,” Juul uses a patented formula that combines nicotine with salt. The company says the nicotine-salt combination is similar to what’s naturally found in the leaves of a tobacco plant; the end result is a stronger e-liquid that vaporizes more smoothly.
James Pauly, a pharmacologist at the University of Kentucky who studies nicotine, told Business Insider that he’d been reading a lot about Juul devices because their “concentration of nicotine is so high.” He said the salt mixture likely makes the vapor less harsh, meaning it’s easier to inhale more strongly for longer.
While an adult smoker might enjoy this aspect of the Juul experience, a teen who’s never smoked might end up vaping a dangerous amount of nicotine in one sitting with no knowledge of how much they’ve consumed.
Other health concerns tied to vaping
Beyond nicotine addiction, several other health concerns about vaping are starting to emerge.
One study published last month found some of the same toxic metals in conventional cigarettes in e-cigs. Another found that at least some of those toxins appear to be making their way through vapers’ bodies, as evidenced by a urine analysis run by researchers who randomly sampled nearly 100 people in the Bay Area who vape. And research presented recently at a large conference concluded that there was substantial evidence tying daily e-cig use to an increased risk of heart attack.
So although evidence may suggest that vaping is a healthier habit for adults looking to quit smoking, it is an entirely different issue when it comes to young adults.
“Vaping among teens is my (and most public health professionals) biggest worry,” Rule said.
If you have questions or concerns for Juul related to underage vaping, you can email them at firstname.lastname@example.org.