When applied strategically, behavioral nudges could become powerful policy tools in the climate-change fight. If, for instance, utility companies implemented a default choice for renewables (opt-out), customers could lower their carbon footprints without doing anything. Supermarkets could reduce the consumption of animal products by designing stores that displayed meat and dairy in less accessible areas. And if cities did more to promote bicycling—with more bike lanes than car lanes, for example—vehicle use could naturally fall. These strategies may be especially relevant at the state and local level, where the bulk of climate action in the U.S. is now focused.
Public health officials are one step closer to identifying the “poison within the poison” that is responsible for the outbreak of lung injuries among e-cigarettes users. The Centers for Disease Control and Prevention have identified an additive, vitamin E acetate, that may be linked to the vaping-related lung injuries that have resulted in the deaths of 39 people and the hospitalization of 2,000 others. The majority of the people impacted by acute lung injuries have been adolescents and young adults.
Although tragic, vaping-related illnesses have jump-started a national conversation about the need to regulate the 10-year-old e-cigarette industry. Thus far, Massachusetts has taken the boldest steps of any U.S. state to curb the use of e-cigarettes, including placing a moratorium on the sale of e-cigarettes and banning the sale of all flavored vaping products. The ban on flavorings was also extended to menthol cigarettes, an action long sought by tobacco control advocates.
Although specific actions have yet to be taken, discussions are underway to raise the national legal age for purchasing e-cigarettes from 18 to 21. Equally important are anticipated rulings on banning the production of flavored vaping products. Both legislative proposals are aimed at stemming the meteoric rise in e-cigarette use among youth. In 2018 alone, teen use of e-cigarettes spiked 78 percent higher than the previous year.
In New York State, 27 percent of all high school students are now using e-cigarettes. Increases in rates of e-cigarette use do not reflect experimentation alone as a recent study found that one in nine adolescents who vape do so on a daily basis. E-liquid or vape juice, comes in a wide variety of appealing flavors including cool mango, banana dragon berry, and strawberry blast. Mirroring data on regular cigarette use, menthol flavoring is the preferred flavor of youth aged 12–17 who vape. Teens report “fun flavors” as leading to initial experimentation with e-cigarettes.
Age restrictions and prohibiting the sale of flavored nicotine containing products are commonsense strategies for reducing the appeal of these products. However, we have been here before. In 2009, Congress passed the Family Smoking Prevention and Tobacco Control Act, which for the first time placed the tobacco industry under the jurisdiction of the Food and Drug Administration (FDA) and banned flavored cigarette products.
At that time, 35 percent of teen smokers reported their preferred brand of cigarette as one containing menthol flavoring. Menthol flavored cigarettes have long been recognized as a starter product for youth smoking. The cooling sensation of menthol masks the harsh taste and burning sensations of cigarettes as youth learn to smoke. Mentholated tobacco products account for one third of tobacco industry profits, approximately, $70 billion annually.
Tragically, menthol was exempted from the cigarette flavor ban of 2009 and following the ban, rates of menthol use further increased among youth. In failing to ban menthol flavored cigarettes, tobacco control advocates point to a clear link to today’s e-cigarette preferences and trends among youth.
Although current attention is focused on e-cigarette use, renewed efforts must be placed on eliminating menthol flavoring in all nicotine-containing products including e-cigarettes, cigarettes, cigars, cigarillos and smokeless tobacco. Menthol regulation is not only a tobacco prevention and control issue but a social justice imperative. Adolescents who use nicotine-containing products prefer menthol flavorings, but there are enormous differences in preferences for menthol among youth of color. Menthol products are preferred by youth from communities who are disproportionately impacted by health inequalities.
For example, 80 percent of African American youth who smoke use a mentholated brand, most commonly, Newport. The largest market share of African-American youth and adult smokers is enjoyed by R.J. Reynolds Tobacco Company, the maker of Newport cigarettes. This is no accident. African American communities have been targeted by the tobacco industry for nearly 50 years with advertisements, free products, and discounted coupons.
A recent study found that the cost of Newport cigarettes was significantly lower in convenience stores located near minority-serving high schools compared to other neighborhoods. The most damning research shows that menthol is linked with higher levels of addiction and difficulty in quitting smoking. The implications are clear: teens who use menthol-containing nicotine products are more likely to be lifelong addicts. Current smoking and lung cancer deaths among African American adults underscore this reality.
Nicotine addiction is an addiction of adolescence with the majority of smokers starting in their teens. The current vaping crisis has created a moment of national clarity about the need to protect the lives of young people by passing commonsense regulation. But again, we have been here before. New York State recently passed a law that raised the minimum age to purchase e-cigarettes from 18 to 21. Compared to whites and Hispanics, African American/black youth are the least likely to have ever used an e-cigarette (50 percent versus 71 percent).
Instead, black youth are more likely to use menthol flavored cigarillos, which can be purchased in packs of three for 99 cents in low-income African American neighborhoods. At the same time New York legislators passed the age increase, they defeated a companion bill that would have banned the sale of all flavored tobacco products. Once again, policy makers have ignored the strong evidence of the negative impact of menthol cigarettes as confirmed by the Food and Drug Administration and the agency’s conclusion that “removal of menthol cigarettes from the marketplace would benefit public health in the United States.”
All youth need to be protected against the health risks of nicotine-containing products. Reducing youth access to e-cigarettes is good public health policy. Banning menthol flavoring is equitable public health policy.