In a powerful appeal, the American Lung Association is intensifying pressure on the Biden administration, urging an expedited finalization of rules that would effectively halt the sale of menthol cigarettes and flavored cigars throughout the United States. This urgent call to action comes in the wake of a scathing edition of the association’s annual State of Tobacco Control report, which was published on Wednesday.
The report, a comprehensive evaluation of the nation’s tobacco control policies, outlines the significant impact that a menthol ban could have on public health, especially in historically marginalized Black communities. The association contends that menthol cigarettes, by virtue of reducing the harshness of smoke and cooling the throat, not only make it easier to start smoking but also significantly impede efforts to quit.
Researchers estimate that implementing a regulation banning menthol cigarettes could save a staggering 654,000 lives over the next 40 years, with a disproportionate positive impact on Black smokers, who are statistically more likely to choose mentholated products. Despite these potential life-saving implications, the Biden administration has faced criticism for the delay in finalizing the proposed rules.
In October, the US Food and Drug Administration (FDA) took a crucial step by forwarding rules to ban the manufacturing and sale of menthol cigarettes and flavored cigars to the White House’s Office of Management and Budget (OMB) for review. This review, undertaken by the Office of Information and Regulatory Affairs within the OMB, is a pivotal step preceding the publication of a final rule in the Federal Register.
However, since the submission to the OMB, no discernible action has been taken on this crucial regulation. The report highlights a specific timeline for rule action, with a final rule expected in March. Expressing disappointment, the report notes that the White House failed to move forward in 2023 with the rules, succumbing to pressures from the tobacco industry.
The report further raises concerns about potential political motivations, as the lack of action at the end of 2023 is seen as prioritizing tobacco industry profits over public health. With the deadline for the rule’s finalization slipping away, questions arise about the potential impact of a new administration on the fate of these regulations.
Even if the rules are freed up for implementation, potential legal challenges loom large. The report suggests that tobacco companies are likely to file federal lawsuits seeking relief, arguing that the FDA’s regulations are illegal. This legal battle could pose a significant obstacle to the swift implementation of the proposed menthol ban.
Menthol cigarettes have emerged as a pivotal issue for President Joe Biden, particularly as he faces an election year with concerns over diminished enthusiasm from Black voters. Civil rights leaders with ties to the tobacco industry have expressed worries that a ban could lead to criminalization and increased deadly police interactions. On the contrary, the NAACP and the Congressional Black Caucus have endorsed the ban, along with numerous public health experts, emphasizing its potential to save hundreds of thousands of Black lives.
The FDA’s proposal focuses on banning the manufacturing and sale of menthols without policing individual smokers. The report emphasizes that the regulation explicitly excludes a prohibition on individual consumer possession or use. Instead, the FDA’s enforcement would target manufacturers, distributors, wholesalers, importers, and retailers.
The divide among Black leaders on the proposed ban has turned it into a complex political issue. The report notes that the administration has delayed a decision on the issue three times, underscoring the challenging balance between public health concerns and political considerations.
Tobacco remains the leading cause of preventable death and disease in the United States, with approximately 16 million people living with tobacco-related diseases. The report emphasizes that tobacco use is responsible for 480,000 deaths each year, including 45,000 Black individuals.
Harold Wimmer, President, and CEO of the American Lung Association, stated in a news release, “Once these rules are final, fewer people will start smoking, millions will begin their journey to quit and lives will be saved.” However, he also highlighted the industry’s tactics, saying, “We know that the tobacco industry will do anything to protect their profits at the expense of public health, so the White House must focus on implementing lifesaving policies and push back against the industry’s delay tactics.”
The State of Tobacco Control report serves as a comprehensive evaluation of both state and federal tobacco control policies. In the new edition, the federal government received an A grade for its mass media campaigns against smoking or vaping. However, it garnered a C grade for its federal regulation of tobacco products, a D grade for the coverage of tobacco cessation in federal health care plans, and an F grade for its tobacco tax policies.
The report emphasizes the role of taxes as one of the most effective ways to reduce smoking, especially among children, citing studies. However, it points out that federal tobacco taxes have not been raised in 15 years, remaining at $1.01 per pack. The report calls attention to the urgent need for Congress to address these shortcomings in tobacco tax policies.
The American Lung Association outlines five key actions for the Biden administration and Congress to take in the current year to tackle tobacco-related death and disease. These include the finalization of the FDA’s premarket review of tobacco product applications, maintaining current funding for the US Centers for Disease Control and Prevention’s Office on Smoking and Health, and passing the Helping Tobacco Users Quit Act.
The urgency for swift action is palpable, with the report urging the White House to expedite the finalization of rules on menthol cigarettes and flavored cigars. It emphasizes that the White House’s swift action on this matter tops the list of key actions needed to save lives and mitigate the impact of tobacco-related diseases.
The report concludes with a broader call to lawmakers and public health agencies to intensify efforts in enacting legislation and increasing funding for tobacco control initiatives. Daniel Giovenco, Assistant Professor of Socio-medical Sciences at Columbia Mailman School of Public Health, emphasizes the need for continued efforts to address social inequalities in tobacco use and reduce preventable diseases, disabilities, and deaths in the United States.
In addition, the report highlights concerning trends in tobacco use. It points out that the decline in adult cigarette smoking rates has stalled, with approximately 11.6% of adults reporting smoking in 2022, compared to 11.5% in 2021, according to data from the CDC’s 2022 National Health Interview Survey. Moreover, overall tobacco use among adults increased in 2022, primarily due to a rise in e-cigarette use from 4.5% to 6%.
“The increases in e-cigarette use over the past two years have been driven by the 18- to 24-year-old age group, and 65.5% of e-cigarette users in this age group did not smoke cigarettes previously in 2022,” the report notes. It emphasizes the worrying signs in the increase in adult tobacco use in 2022 and calls for redoubled efforts by state and federal lawmakers to prevent and reduce tobacco use in 2024.
The report’s evaluation of state-by-state tobacco control policies highlights the varying degrees of commitment across the nation. Alabama and Georgia received the lowest ratings, with grades of F in all five categories: tobacco prevention and control funding, tobacco tax policies, state smoking restrictions for smoke-free air, access to cessation services, and restrictions on flavored tobacco products.
The low grades for many states prompted disappointment but not surprise from legal expert Daniel Karon. He expressed disappointment, stating, “Under the 10th Amendment to the US Constitution, any power that is not specifically given to the federal government or withheld from the states is reserved for the states. To me, state involvement should be a bipartisan issue.” Karon emphasized the need for both liberal and conservative states to act independently to participate in saving lives.
California emerged as a standout state, earning A grades for smoke-free air and access to cessation services. The District of Columbia received A grades for tobacco tax policies, smoke-free air, and restrictions on flavored tobacco products. Massachusetts also earned As for smoke-free air and flavored tobacco product restrictions. Notably, California and Massachusetts are the only states with statewide bans on the sale of menthol cigarettes.
The American Lung Association, along with other public health groups such as the Campaign for Tobacco-Free Kids and the Association of State and Territorial Health Officials, has united in urging the White House to ban menthol cigarettes. The collective effort underscores the critical need for immediate action to curb the devastating impact of tobacco-related illnesses and deaths.
In conclusion, the State of Tobacco Control report serves as a comprehensive analysis of the current state of tobacco control policies in the United States. It not only highlights the urgent need for swift action on the proposed ban on menthol cigarettes but also calls attention to broader issues in tobacco control, including the stagnation of federal tobacco taxes, the need for increased funding for cessation programs, and the varied commitment of states to tobacco control measures.