Public health professionals and advocacy groups have long called for a ban on menthol, arguing that it would disproportionately affect Black smokers.
Black menthol smokers to know that support groups can be helpful
As the Biden administration approaches the goal of outlawing flavoured cigars and menthol cigarettes, leading health organisations are working to inform Black smokers about the resources available to help them stop.
As per the Campaign for Tobacco-Free Kids, 85% of Black smokers in the United States smoke menthols. According to data from the Centres for Disease Control and Prevention, 34% of White smokers and nearly 81% of Black smokers used menthol in 2020.
According to Carol McGruder, co-chair of the African American Tobacco Control Leadership Council, an anti-tobacco public health and advocacy group, the discrepancy is the product of decades-long tobacco industry advertising practises that specifically targeted Black communities with menthol cigarettes.
Menthol cigarettes are infamously addictive and very hard to stop smoking when compared to ordinary cigarettes. According to the CDC, the rate of successful menthol smokers quitting is lower than that of nonmenthol smokers, and Black menthol smokers may have even lower success rates than other groups.
Jennifer Folkenroth, national senior director of tobacco programmes for the American Lung Association, noted that despite smokers’ attempts to quit cold turkey or by taking doctor-prescribed medications with little to no counselling, programmes that assist smokers in quitting are underutilised across the nation.
More qualified and experienced facilitators are needed in Black communities, such as churches, according to Folkenroth, “to really assist these quitters in their journey to freedom.”
Each year, smoking causes the deaths of over 45,000 Black people, according to the Campaign for Tobacco-Free Kids.According to McGruder, these individuals include parents, grandparents, mothers, and other Black people who play a significant role in fostering a sense of community. “Our community, the church, and the family are all affected negatively when those individuals pass away.”
Why are menthol cigarettes so incredibly addictive?
According to Sven-Eric Jordt, an associate professor of anesthesiology, pharmacology, and cancer biology at the Duke University School of Medicine, the mint flavour of menthol cigarettes is the straightforward explanation for why they are so alluring.
Jordt, who directs a research project and teaches at the Yale School of Medicine’s Tobacco Centre of Regulatory Science, explained that menthol, to begin with, has a cooling effect that suppresses coughing and lessens throat irritation from tobacco smoke, making it easier to inhale.
According to him, mint can serve as a “very strong” behavioural cue as well. “People or smokers get this craving to basically smoke the next cigarette when they smell mint or something like that.”
According to Jordt, the chemical known as nicotine, which is highly addictive and found in tobacco products, binds to receptors in the brain to release dopamine, a neurotransmitter and hormone involved in many body processes, including motivation and pleasure. According to the CDC, the menthol flavouring in cigarettes intensifies the effects of nicotine on the brain, making it more addictive and leading to increased nicotine dependence.Jordt stated, “It’s also a fact that using menthol cigarettes makes it harder to quit smoking.” The reason for that is still a mystery. But numerous studies have found that it is simply more difficult to stop this behaviour.
“Something needed to shift.”
When Millie Martinez first encountered menthol cigarettes, she was fifteen years old. She was a high school student in New York City in the 1980s.
Martinez, who is now 55 years old and resides in the Bronx, said, “I just started smoking my Newport menthol cigarettes and I got hooked.” From then on, things got worse. It can be very difficult to stop once you get started.
Martinez claimed she had attempted to give up but failed. Following her March visit with her infant grandson, she realised something needed to change.
Martinez said, “It really bothered me” that she smelled like cigarettes and that she didn’t want her grandson to be around it.
Martinez reported that she saw an advertisement for a cessation programme on Craigslist sometime in May. Truth Initiative is a nonprofit that advocates for tobacco product bans as well as programmes to assist individuals in quitting. In June, she signed up for its online Ex Programme, and a month later, she finally stopped smoking.
In her teenage years, Shireat Nelson of West Columbia, South Carolina, also took up smoking menthol cigarettes. Nelson, 59 years old, tried cigarettes for the first time as a 14-year-old middle school student in Connecticut.
“Some friends of mine asked me if I wanted a cigarette one night.” stated Nelson. “And I had the thought, ‘This is going to be my last cigarette.'” I had that thought. Maybe it was just a mental thing, but I kept smoking after that.
Nelson said that she learned about the American Lung Association’s in-person support groups through a friend who is presently undergoing lung cancer, and she attended them in June. According to her, Nelson smoked roughly six cigarettes during the workday and ten on the weekends.
Nelson claimed that she picked up her last menthol cigarette on July 13 and hasn’t smoked since, having attended eight cessation sessions.
She remarked, “I am so appreciative,” of the quit programme. “It was the best thing that had ever happened to me,” the speaker said.
Giving up menthols
Although studies show that it is more difficult for individuals to stop smoking menthol cigarettes, Amanda Graham, chief of innovations at Truth Initiative and adjunct medical professor at the Mayo Clinic College of Medicine and Science, says the fundamental strategies for quitting still work.
According to Graham, the fundamental elements of treatment—drugs to help with nicotine cravings, social support, and what’s known as skills training—apply to both menthol users and regular tobacco users.
“The context in which the intervention is delivered is one of the key components of engaging menthol tobacco users,” the expert stated. This entails admitting that they use menthol products or that they might belong to a racial or ethnic minority where menthol use is more common. It also entails ensuring that the imagery accurately depicts the population that uses the product, she continued.
Among the tools used in nicotine replacement therapy are nicotine gums and patches. These goods aid in the weaning process for smokers and have less nicotine than cigarettes.
According to Jordt of Yale, Chantix, an oral medication that binds to the same brain receptors as nicotine but produces a weakened response, is one approach with the most obvious results. According to him, this ultimately results in less severe withdrawal symptoms.
According to the American Lung Association, higher dosages of nicotine replacement therapy are recommended for menthol smokers, and there is a greater focus on those who smoke menthol occasionally.
According to Folkenroth, “menthol users tend to breathe in deeper and hold their breath longer, but they also smoke fewer cigarettes and less frequently.” Therefore, it is a myth that people who use menthol, in particular, are infrequent smokers when, in reality, they have very high levels of nicotine dependence. This misconception frequently tends to discourage some people from using nicotine replacement therapy.
All tobacco products are the focus of the association’s Freedom From Smoking programmes, but in addition, facilitators receive extensive training from the organisation to facilitate courses “where we take a deeper dive into how the curriculum can be delivered specifically for menthol users,” according to Folkenroth.
It might consist of a mix of nicotine replacement treatments, like a 2 milligramme nicotine gum or lozenge and a 21 milligramme nicotine patch. Given their more severe levels of addiction, this method gives quitters “higher amounts of nicotine to then slowly taper down off that nicotine,” according to the source.
According to Graham, quitting suddenly can be the most uncomfortable method of quitting because “nicotine addiction is wicked.” “Can be pretty intense, especially during the early days, as your body is weaning off of withdrawal,” she continued, describing withdrawal symptoms.
People who quit in a more comfortable way are more likely to “stick with it and be successful,” the speaker continued.
Every expert stressed the value of having support when giving up.
Nelson and Martinez were in agreement.
Martinez claimed that, because quitting smoking is “something that’s hard to do,” her attempt to do so on her own last year, following the birth of her grandson, lasted only two days. Martinez said she felt supported by others who were also trying to give up smoking because she had access to The Ex Program’s online community of counsellors.Nelson claimed that she and her spouse, who is also a former smoker, attempted to stop smoking independently. She made her first attempt at quitting cold turkey about 20 years ago, along with her spouse. Their efforts were short-lived—just 48 hours—as they both turned against one another.
Nelson remarked, “That was really bad.”
Nelson claimed that throughout the years, she attempted a number of drugs, but none of them worked, including Chantix and Wellbutrin, an antidepressant that is also used to help people stop smoking. Nelson claimed that she wore nicotine patches at work but removed them when she went home to continue smoking after returning to school in 2005 to become a healthcare worker.
Nelson was upset and her self-esteem suffered as a result of her struggle to quit. Nelson pleaded with God at one point, asking him to “please just take the desire from me.”
Although it hasn’t been an easy journey, she claims that the program’s support system has kept her from reverting to her previous behaviours. She routinely engages in journaling techniques and joins other programme participants for a monthly dinner. She is motivated to keep going even when she wants to give up by the group facilitators’ support.
“You can do this,” one of the facilitators simply kept saying. You’re capable of doing this, I know. stated Nelson. “She just kept telling me that I could,” even though I was crying and telling her that I didn’t think I could handle it.
Providing access to programmes for quitting
While the White House reviews the Food and Drug Administration’s proposed ban, officials say they aren’t jumping for joy just yet. The Centre for Black Health and Equity’s director of equity-centered policies, Natasha Phelps, stated that although the ban is long overdue, “we’re so far from the finish line.”
The group works with partners and government agencies to ensure that their tobacco cessation funding allows grantees to focus on the systemic racism that drives tobacco-related health disparities, according to Phelps. In addition to supporting policies calling for menthol bans. Since many Black neighbourhoods lack access to medical care and healthier retail outlets, one of its current projects, funded by the Department of Health and Human Services’ Office of Minority Health, examines best practises for transport policy, she continued. Along with working with communities, the organisation is advocating for Medicaid expansion so that the cost of prescription medications for cessation can be reliably covered.
Studies indicate that the consequences of outlawing menthol cigarettes would happen quickly. According to Folkenroth of the American Lung Association, an estimated 923,000 smokers—including an estimated 230,000 Black people—would give up within the first 13 to 17 months of the FDA’s proposed menthol rule going into effect.
Folkenroth believes that the decision regarding menthol will occur prior to Christmas. She stated that the American Lung Association will keep pushing for reform up until that point.
“As Black people, we can all do our part to remind the White House that there are enough resources available to support them in giving up menthol,” Folkenroth stated. There will be no one left behind. Nobody will be left without resources to support their addictions.
EDITED (Nov. 28, 2023, 8:15 p.m. Eastern Time): This article’s earlier version erroneously stated that Black smokers use menthol cigarettes. Eighty-five percent of Black smokers smoke menthol cigarettes; however, this percentage does not include all Black smokers (85%).