American Lung Association Urges White House to Act Quickly on Menthol Ban

In a report[1] Published on Wednesday, January 24, the American Lung Association is increasing pressure on the White House to end the sale of menthol cigarettes and flavored cigars in the United States. According to the association, the number of deaths and diseases caused by smoking will increase, particularly in black communities historically targeted by the tobacco industry, if the ban is not implemented quickly.

The American Lung Association's annual "State of Tobacco Control" report assesses state and federal efforts to eliminate the nation's leading cause of preventable death: smoking. Researchers estimate that a menthol cigarette ban could save an estimated 654,000 lives over the next 40 years.

In the United States, current law prohibits the use of any characterizing flavors in cigarettes, with the exception of menthol. For more than a decade, public health organizations have been calling on the Food and Drug Administration (FDA) to remove menthol flavoring from cigarettes, cigars, and cigarillos. After being sued for inaction on this issue, the FDA indicated in April 2021 that it was considering banning menthol in cigarettes and all flavors, including menthol, in cigars. In October 2023, the proposal was finalized by the FDA and sent to the Office of Management and Budget[2] White House for review, marking an important step toward a major public health victory. In December 2023, the Biden administration delayed finalization of the proposed rules until March 2024[3].

State and federal failure to combat smoking

In the report, the Lung Association assigns grades, from A to F, to federal and state policies across the country based on criteria for effectiveness in preventing and reducing smoking.

The association said 2023 was a disappointing year for the adoption of tobacco control policies at both the federal and state levels. In a state-by-state assessment of tobacco control policies, Alabama and Georgia were ranked among the worst in the country.[4], earning F grades in all five categories: funding for tobacco prevention and control, tobacco tax policies, state restrictions on smoking in public spaces, access to smoking cessation services, and restrictions on flavored tobacco and nicotine products. The highest grades went to California, which earned an A for smoke-free spaces and access to cessation services, and Massachusetts for smoke-free spaces and bans on flavored products.

Progress has been made, however, in increasing funding for tobacco prevention programs, with nine states – Florida, Indiana, Kansas, Kentucky, Nebraska, New York, North Dakota, Texas and Wisconsin – seeing funding increases for tobacco prevention and reduction programs of nearly $1 million or more.

Only New York State has adopted a significant increase in cigarette taxes. The state increased its cigarette tax by $1.00 per pack, bringing the price of a pack to $5.351, the highest in the nation.

No states have adopted comprehensive laws banning smoking in public spaces. This is the 11th year in a row that no state has adopted comprehensive smoke-free laws, and some states have seen worrying setbacks, according to the study's authors, such as Louisiana, which reauthorized smoking in casinos.

Despite vigorous campaigns in a number of states, including Hawaii, Maine, Minnesota, New York, Oregon and Vermont, no state has passed legislation eliminating the sale of flavored tobacco and nicotine products.

Finally, access to tobacco treatment improved with the expansion of Medicaid in North Carolina and South Dakota in 2023. However, these successes were overshadowed by the massive enrollment in Medicaid, more than 13 million people who lost their health coverage after the COVID-19 health emergency was lifted.

The federal government, meanwhile, gets an A grade for its media campaigns that encourage people not to smoke or vape. It gets a C grade for federal regulation of tobacco and nicotine products, a D grade for federal health care plans’ coverage of smoking cessation, and an F grade for its tobacco tax policy. Overall, the report finds that the influence of the tobacco industry and its allies remains strong in the adoption and implementation of public health measures. The tobacco industry is particularly supportive of state preemption laws to overturn existing, more restrictive local tobacco control laws. The industry’s goal in these lawsuits is also to prevent such legislation from being passed in the future.

Urgent actions to be implemented

The report also highlights that the decline in adult smoking rates has stalled, with about 11.6 percent of adults reporting smoking in 2022, up from 11.5 percent in 2021, according to data from the Centers for Disease Control and Prevention's 2022 National Health Interview Survey.

The American Lung Association lists five key actions the Biden administration and Congress should take in 2024 to help reduce tobacco use and prevent tobacco-related illness and death. The first action is for the White House to urgently finalize two bills to remove menthol cigarettes and flavored cigars from the market.

Next, the FDA must complete its premarket review of tobacco and nicotine product applications; more than two years after the court-ordered September 9, 2021 deadline, the FDA has still not completed its review of millions of vaping products that have been submitted for marketing authorization, leaving many flavored and illegal vaping products on the market. In a recent statement, the FDA said it would complete its review of all applications by the end of June 2024. The report also suggests that Congress maintain at least current funding for the Office on Tobacco Control and the Centers for Disease Control and Prevention and pass the Helping Tobacco Users Quit Act, which would expand full Medicaid coverage for smoking cessation.

Keywords: United States, anti-tobacco policy, menthol, lobby, interference, White House ©Generation Without Tobacco

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[1] State of Tobacco Control 2024 Report, American Lung Association, accessed January 24, 2024 [2] A department of the United States government whose primary mission is to assist the President of the United States in the task of preparing the budget. [3] Tobacco-free generation, Menthol ban delayed again in the United States, published December 15, accessed January 24, 2024 [4] Tobacco-free generation, United States: Report Finds Significant Geographic Disparities in Smoking in Midwest and Southern States, published July 27, 2023, accessed January 24, 2024 National Committee Against Smoking |