Encouraging a final rule to ban menthol products by 2024

Hon. Shalanda Young
Director
Office of Management and Budget
1650 Pennsylvania Ave. NW
Washington, D.C. 20502

Hon. Richard L. Revesz
Administrator
Office of Information and Regulatory Affairs
Office of Management and Budget
262 Old Executive Office Building
Washington, D.C. 20503

Pending EO 12866 Regulatory Review, Tobacco Product Standard for Menthol in Cigarettes, RIN 0910-A160

Dear Director Young and Administrator Revesz:

The American College of Chest Physicians (CHEST) writes to urge the Office of Information and Management Affairs (OIRA) to complete its review of the Tobacco Product Standard for Menthol in Cigarettes (menthol cigarette rule) and to allow it to be issued in final form without delay. The proposed product standard prohibiting menthol as a characterizing flavor in cigarettes will reduce youth smoking, save lives, and advance health equity. The proposed rule will have an enormous public health impact both in the short and long term. It is imperative that the rule be finalized without delay.

CHEST represents over 21,000 physician and clinician members who serve patients around the globe suffering from respiratory disease. Since 1960, CHEST has been a tireless advocate against tobacco and has fought for key milestones, including recognition that tobacco, cigarette smoking, and now vaping causes harmful and preventable disease and often leading to mortality. Our members work with their patients toward smoking cessation goals and in the treatment of the diseases caused by cigarettes. We develop tools and programs and advocate to support them in these efforts. We hope you will help us make this job more tractable by issuing the proposed standard.

Prohibiting menthol cigarettes will reduce youth smoking. Menthol cools and numbs the throat, reduces the harshness of tobacco smoke, and makes cigarettes more appealing to new smokers, particularly young people. As is well-documented in the proposed rule, menthol facilitates experimentation, progression to regular smoking of menthol cigarettes and contributes to greater nicotine dependence. Half of youth who have ever tried smoking started with menthol cigarettes, and menthol cigarettes were responsible for 10.1 million additional new smokers between 1980 and 2018. Early menthol use has been significantly associated with progression to established, frequent smoking. Further delay in regulation will ensure CHEST members and their patients will continue to face the prospect of preventable lung disease by delaying continued progress in youth smoking reduction.

Prohibiting menthol cigarettes will increase smoking cessation and save lives. Smoking remains the leading cause of preventable disease and death in the United States. Prohibiting menthol cigarettes, which are more difficult to quit than non-menthol cigarettes, will reduce this burden by increasing smoking cessation. Research estimates that prohibiting menthol cigarettes would prevent 654,000 smoking attributable deaths, including 255,000 deaths in the Black community, by the year 2060. That means that for every year menthol cigarettes remain on the market, there will be approximately 16,000 more smoking-caused premature deaths, including over 6,500 more deaths in the Black community. Menthol is a powerfully reinforcing component of tobacco smoke, making it more difficult for our patients to quit in response to treatment. Examination of industry documents has confirmed prior awareness of menthol’s cooling and sensory effects and the resulting change in smoking behaviors that result in increased overall exposure to the toxic effects of tobacco use. It is CHEST’s position that this abuse should not be allowed to stand.

Prohibiting menthol cigarettes would decrease tobacco-related health disparities and advance health equity, especially among Black Americans. Menthol cigarettes have caused substantial harm to public health, and particularly to Black Americans. For more than 60 years, the tobacco industry has targeted Black Americans with marketing and price promotions for menthol cigarettes, and as a result, 85% of Black smokers smoke menthol cigarettes compared to 29% of White smokers. Consequently, Black Americans are less likely to successfully quit smoking and suffer disproportionately from tobacco-related disease and death. Despite accounting for 12% of the population, Black Americans represented 41% of premature deaths caused by menthol cigarettes between 1980 and 2018. In addition to youth and Black smokers, preference for menthol is also disproportionately high among Hispanic and Asian smokers, lesbian, gay, and bisexual smokers, smokers with mental health problems, socioeconomically disadvantaged populations, and pregnant women. Importantly, the proposed product standard is expected to substantially decrease tobacco-related health disparities and to advance health equity across population groups. A recent analysis by researchers at the Council on Foreign Relations found that a ban on menthol cigarettes would eliminate the disparity in lung cancer death rates between Black Americans and other U.S. racial and ethnic groups within 5 years – 25 years sooner than it would otherwise happen.

On behalf of CHEST members and the patients they directly serve every day, we urge this lifesaving rule be issued in final form by the end of the year.

Respectfully submitted,

Doreen J. Addrizzo-Harris, MD, FCCP
President
American College of Chest Physicians