Menthol Cigarettes: Targeting Youth and Exploiting Communities

In this episode of the Community Check-In, Dr. Lisa Harris, senior vice president and corporate medical director for Excellus BlueCross BlueShield sheds light on the controversy surrounding menthol flavored cigarettes and their potential ban. Dr. Harris also offers actionable steps for parents, teachers, health professionals and health insurers to contribute to the fight against menthol cigarette use.

Episode Transcript

(00:03):
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring Excellis BlueCross Blue Shield experts. You'll get to
know our team as we discuss thelatest in healthcare, health education, and
community health. Find us at ExcelusBCBS dot com and follow on Instagram and

(00:26):
Facebook. I'm Joelomonico and welcome tothe Community check In. Cigarette smoking has
been on the decline for a numberof years, but menthol cigarettes are one
segment of the tobacco market that hasremained stubbornly strong. In twenty twenty two,
the Food and Drug Administration proposed somenew rules to prohibit these products and

(00:49):
flavored cigars in response to public healthconcerns about the dangers of menthol cigarettes and
their huge popularity among young people andBlack, Hispanic and Asian Americans smokers.
To talk more with us about thisis doctor Lisa Harris, the Senior vice
president and Corporate medical director for ExcellisBlue Cross Blue Shield Health Plan. Doctor
Harris, Welcome to the Community checkIn. It is nice to meet you.

(01:11):
Thank you so much for having mein like way. It's nice to
meet you. Doctor Harris is boardcertified in Internal Medicine and pediatrics and as
a Certified Physician Executive through the AmericanCollege of Physician Executives and a Fellow with
both the American College of Physicians andthe American Academy of Pediatrics. Menthol flavored
cigarettes have been in the news fora while now, and I wanted to

(01:34):
share with you part of a publicservice campaign that we have aired recently.
Menthol is not just a flavor.It's a manipulative way for big tobacco to
target, attract, and addict BlackAmericans. Tobacco companies aggressively market menthol products
using elements of black culture, puttingmore products on shelves in black communities and

(01:56):
making them cheaper. We're going toget to unpacking a lot in just that
little bit of time. As wementioned, in twenty twenty two, the
FDA did make proposals to ban thesale of menthol cigarettes menthol flavored products.
Doctor Harris, I wonder from yourperspective you could explain the controversy and what
the deal is that prompted going afterflavor additives to tobacco products like cigarettes.

(02:21):
Sure, so, thank you verymuch. So I want to just start
off by saying that everything that I'mgoing to talk about today is directly from
the Center for Disease Control and Prevention, just in case listeners want to know
where this data is coming from.So we know smokey's not good for you.
I mean, that's not new news. Everybody knows that. But we
also know that the makers of tobaccoproducts still want to sell their products,
and they want to make sure they'reattracting new customers and keep them for as

(02:44):
long as possible. So flavor additiveslike menthol added to commercial tobacco products make
them seem less harsh. They appealto young people and appeal to people who
have never used tobacco products. Soyou got that flavor, It tastes really
good, it gets you hooked onit. And so if you get someone
hooked on cigarettes when they're young,you increase the chances of having a customer

(03:05):
for life. It's the nicotine andthe tobacco products that's incredibly addictive, and
studies show that young adults are morelikely to try a menthol or flavored cigarette
as their first cigarette rather than thenon menthol cigarette, and those that start
with a menthol are more likely tocontinue smoking. It enhances the effects of
nicotine. That's really the bad part. That mental enhances the effects of nicotine

(03:25):
in the brain and can make iteven more addictive. And if that wasn't
bad enough, tobacco companies have increasedthe amount of nicotine in some of the
menthol cigarettes. Okay, So theaddiction is the nicotine in cigarettes, and
menthol then comes in as a sortof sort of a kick in the pants
to it to help you sort ofboost the effectiveness of it to get people

(03:49):
to keep using the product. Absolutely, it's a double whammy. So it's
the nicotine that gets smokers hooked,and tobacco companies know that menthol will make
it more difficult to quit smoking.So you get nicotine that gets you addicted,
to get the menthol that enhances theeffects of the nicotine, and it
changes the way the brain registers sensationsof taste and pain. So we know

(04:09):
first time smokers, the first timeyou smoke people cough hack, you know
it's harsh on your lungs, butthat menthol actually eases those effects, so
people tend to try those menthol cigarettesmore often. And we know that statistically,
people who smoke menthol cigarettes are lesslikely to be successful to quit.
So from the CDC, we knowthat people who smoke menthol are less likely

(04:30):
to quit young adults and people whosmoke menthol make more attempts to quit than
those who smoke non menthol, andthat's really the big issue. So that
menthol is compounds the effects of thenicotine and increases the level of addiction.
Yeah, when you mentioned you know, you try that cigarette and you know
coughing response, that's the first thingthat may happen to a lot of people.

(04:51):
There's a reason why menthol is containedin cough drops, folks. There's
a reason why it is there becauseit helps well that response. So let's
step back a little bit and takea bit more of a top down look
at exactly when we talk about menthal. What are we talking about. Yeah,
so, menthal is a chemical compoundthat's found naturally in pepperment and other

(05:13):
similar plants. And as you justalluded to, menthal is used as a
cough suppressant. It eases the irritationand the respiratory track, and so it
can be produced in a lab,but it can also come from naturally from
plants, and some research shows thatmental cigarettes can be more addictive than non
menthal. So tobacco companies have doneextensive research. This is what they do,

(05:33):
right. They try to find outwhat things are most appealing to their
consumers, and they adjust the amountof mental and cigarette brands to make each
brand the most appealing to the peoplethat they target. So, for example,
some of them lower the amount ofmenthal and some brands to make them
more appealing to young people and thosejust starting to smoke, but increase the
amount of mental and other brands tomake them more appealing to older people.

(05:57):
So in twenty nineteen and twenty thesales of menthal cigarettes alone made up thirty
seven percent of all cigarette sales inthe United States. That's the highest proportion
in fifty five years. So,like you said, even though tobacco use
has decreased, the sale of mentholcigarettes has increased. And we can take
it even a step further on that. This is according to an article from

(06:17):
the University of Texas MD Anderson CancerCenter. When you break it down even
further, eighty five percent of blacksmokers smoke menthols. Is according to the
research that they presented, of that'syou know, sort of eighteen point five
million people in the US that areregular menthal smokers forty six percent Hispanic smokers,

(06:38):
thirty nine percent Asian American smokers.That's a substantially high percentage there.
So, as we mentioned in thebeginning of the show, that little snippet
of that ad campaign menthal cigarettes specificallytargeting from tobacco companies specific communities. It
seems that the research does bear thatout. Let's talk a little bit more

(06:58):
about that. Yeah, apply,I mean, the CDC calls out the
tobacco industry for targeting Black Americans andLatinos with mental cigarettes. So they're advertising
specifically to those communities. They're doinggiveaways, special pricing, lifestyle branding,
and event sponsorship, and their goalis to get those communities addicted so that
they become customers for life. AndI guess the bottom line question is is

(07:20):
it working? If the research isbearing anything out, it really does seem
to be absolutely so. Just basedon the statistics we were just talking about,
more than seventy percent of black youngpeople ages twelve to seventeen who use
mental who smoke use menthal cigarettes andin twenty nineteen, eighty five percent of

(07:40):
non Hispanic, Black or African Americanadults use mental cigarettes. It's the highest
percentage of mental cigarette use in anyracial or ethnic group. So marketing targeting
that population is borne out by thestatistics and the information to show that those
are the groups of people that areusing menthal. And so given how mental
interacts with nicotine, people who spokethe menthal cigarettes are more likely to continue

(08:01):
smoke than smoking, which puts themat higher risk for tobacco related diseases.
And we already know that there's adisproportionate effect of those diseases in those ethnic
and racial groups. Doctor Lisa Harrisis our guest on the Community check in.
She is the senior vice president andcorporate medical director for the Excellist Blue
Cross Blue Shield Health Plan. Andon this community check and we are talking

(08:22):
about menthal cigarettes. It was intwenty twenty two that the FDA really started
to make some very bold move Sofar, their recommendations have not gone into
place, and there's probably still goingto be a lot of pushback, of
course from the tobacco industry as thisgoes. But broader speaking, doctor,

(08:43):
this is not just a health issue. This is a health equity issue,
and that's I think what we're reallygetting at the core because there are certain
segments of the population, as wesee by the numbers, that are literally
being preyed upon and exploit it,and they are suffering disproportion and a health
impacts as a result of this.That's right. So when we talk about
health equity, we're talking about disparitiesin healthcare based on racial and ethnic data.

(09:09):
And so you're right, it isn'tjust a health issue. It's a
health equity issue because certain segments ofthe population are being preyed upon, targeted,
and exploited and are suffering the healthimpacts as a result. So here's
some of the things that are occurring. Smoking related illnesses are the number one
cause of death, number one amongBlack Americans, surpassing all other causes of
death, including AIDS, homicide,diabetes accidents, and you know, we're

(09:33):
talking about homicide almost every day.But if we stop and think that smoking
related illnesses are now the number onecause of death among Black Americans. Cigarette
smoking causes more than four hundred andeighty thousand deaths each year in the United
States, and more than one infive deaths. It's ten times more likely
to have US citizens that die prematurelyfrom cigarette smoking then have died and all

(09:54):
the wars fought in the United States. Think about that, all the people
that have died in all the warsof the United States, we have ten
times more people that are dying prematurelyfrom cigarette smoking. It causes ninety percent
of all lung cancer deaths, andwomen die from lung cancer each year,
more so than from breast cancer.It causes eighty percent of all deaths from

(10:15):
COPD or chronic obstructive pulmonary disease.And it increases the risk of death from
all causes in men and women.And the risk of dying for a cigarette
smoking has increased in the last fiftyyears. So even though we've been decreasing
the amount of cigarette smoking, that'sthat menthol with the higher level of nicotine
that's impacting and targeting susceptible populations.That's creating a health disparity. I wonder

(10:37):
if you can speak a little bitto it about a little bit about the
why, maybe just sort of ingeneral terms. Nicotine as I understand it
as someone who did smoke for wellover fifteen years, it's an addictive product.
What is it maybe about the chemicalresponse that our bodies have or can
have when you add that additive.Is there is there something on that biological

(11:03):
level that just takes those chemicals andsays, you know, nicotine, Oh
I like that. Add the menthol. Oh I really like that. Yeah.
It's like, you know, um, just really like I said before,
a double whammy. So it's like, oh, you know, here's
the nicotine, and your brain becomesaddicted to it and likes it, It
gets stuck on it and wants moreof it, and then menthol just enhances

(11:24):
it, so you're not even feelingthe ill effects of the nicotine. So,
as we said before, that irritationin the lungs and in the back
of the throat and the nose,changes in your taste sensations are all suppressed
by the addition of the menthol.And so if you increase the amount of
nicotine and add menthol and then targeta specific population, you got a customer

(11:46):
for life. Yeah, and you'vegot something there that is more potentially as
deadly, if possibly even more deadly, than any of the street drugs that
we wind up hearing about. Andthis is one that is perfectly legal and
sold of overcounters, and the marketingis you're right, it targets. It's
very colorful and I'm not aware,you know, when I go into stores,

(12:09):
I'm maybe not one hundred percent knowingwhat I'm looking for. But those
who are selling to these communities arevery aware of how to target black communities,
black consumers and promoting the products despitewhat is known about the adverse health
effects. That's right, and youknow, and supporting community activities and providing
sponsorships, so it's you know,it's pervasive throughout the community. And if

(12:31):
you think about it, it's estimatedthat forty percent of excess deaths are due
to mental cigarette smoker in the USand that was between nineteen eighty two eighteen,
and those were African Americans. Despitethe fact that African Americans only make
up twelve percent of the US population, twelve percent of the population, forty
percent of excess deaths doesn't make sense. African Americans ages eighteen to forty nine

(12:52):
are two times it's likely to diefrom heart disease than whites. African Americans
ages is thirty five to sixty fourare fifty percent more likely to have high
blood pressure than whites, and smokingcontributes to each and every one of those
conditions. Increases the risk for highblood pressure, increases the risk for heart
disease. So you're disproportionately affecting apopulation that's predisposed to have these these impacts.

(13:16):
If we look at the Census PureProjections twenty twenty, life expectancy at
birth for Blacks our seventy seven years. We've seen just recently an increase in
perinatal deaths for African Americans. Thematernal health at maternal health equities are increasing
for African Americans. Non Hispanic whiteshave a projective life expectancy of eighty years,

(13:37):
and the death weary for Blacks andAfrican Americans is generally higher than whites
for heart disease, stroke, cancer, asthma, influenza, pneumonia, diabetes,
HIV AIDS. And it's not becausewe have a genetic predispecial predisposition to
having this disease. Is it's inaquity and healthcare that's creating all of these
problems. So target population don't havea good way to respond to it and

(13:58):
treat it, and people end upbeing adiosly impacting. Yeah, we have
seen over the last few years,in particular, how you add one thing
on top of the next on topof the next, and we're talking about
menthal cigarettes and the impact on thecommunity. Then over the last few years
we've added the COVID nineteen pandemic andthe disparities that have been very well shown
and documented in different communities as well. According to the and according to the

(14:20):
CDC, they published modeling from themhave estimated that a fifteen percent reduction in
smoking within forty years if menthal cigaretteswere no longer available in the US.
Estimate that between three hundred twenty fourthousand and six hundred and fifty four thousand
smoking attributable deaths could be avoided overthe course of forty years. You make

(14:45):
one small move in one direction andthe compounding improvements that can happen are just
staggering. So let's talk about someof the things that can be done when
it comes to because the FDA istrying to move the needle, but of
course there is always going to bebarriers to that. So what can be

(15:05):
done? What can all of usdo? Yeah, so there's a lot
that we can do. So studiesof US policies have shown that restricting the
sale of flavored tobacco products reduce asa proportion so as you were just stating
that it's absolutely important that if wehave policies in place, we can restrict
the sale. Evidence in other countriessupports the fact that public health benefits,

(15:26):
the public health really benefit benefits inremoving mental cigarettes from the marketplace. So
in Ontario, Canada in twenty seventeen, they had that law right and so
they showed high rates of quit attentsand quit successes. And we know that
adults who smoked mental cigarettes before thelaw went into in fact, we're more
likely to have report having cigarettes thanthose who had smoked non mental cigarettes.

(15:48):
So the legislation really helps to improveit. And there's just so much that
we can do. If we canenforce some of those policies, then you
will be restricting the sale and theadverse effects of those sales. Had forgotten
that Canada enacted a ban before.It's a few years before the FDA really
started to to ramp up this again. According to information that you can that

(16:11):
you can find available through the CDC, is that after Canada banned menthol cigarettes,
about one and a half million peoplewould It was looking at about that
reduction in sort of an annual rateof those who are putting cigarettes down,
you know, because they're like,Okay, well I like the taste of

(16:32):
the menthol. That's the reason Idid this. I like the flavored products,
and so now I don't need it. So they've seeing and we have
some real time data to be ableto look at it to see how things
are going. So let's talk alittle bit about those those community strategies or
what communities can or are considering whenit comes to trying to move the needle,

(16:55):
because it's a big needle to move. So the first thing right would
be to prohibit sale of menthol andother tobacco products. That would be the
big win. You know, I'msure that tobacco industry would lobby strongly against
that, but absolutely if we couldprohibit the sales. The other thing to
do is just raise the price ofmenthal and other tobacco products. That would
prohibit price discounts, so if it'stoo expensive to purchase, you can reduce

(17:18):
the number of people that are purchasingit. Curb the advertising and marketing of
mental I mean, we really needto address that inequity and marketing and making
sure that they're not marketing to youngpeople into targeted populations make sure that people
who are using tobacco products have accessto evidence based quitting resources, so counseling,
medication, connecting with their primary careprovider, and tailoring messages about cessation

(17:42):
to help better reach people who usementhol products. And we remember there there
is some ads on TV for alittle while about the effects of smoking that
were really very graphic, and thatwas on for a little while and then
they just more recently have not beenpresent again. And I think those types
of even though it upsets people,well, you have to understand the impact
of tobacco use. And I thinkthose types of very graphic advertising is beneficial

(18:07):
to people to help them quit.And then educational initiatives that describe targeted tobacco
industry marketing tactic tactics to really hitthem at the route to show what the
tobacco industry is doing, who they'retargeting, and why in addition to warning
about the ricks of tobacco product use. Doctor Lisa Harris is the senior vice
president and corporate medical director for theExcellist Blue Cross Blue Shield Health Plan.

(18:30):
She has our guest here on theCommunity check in. We are talking about
menthal cigarettes and as we mentioned,a couple of times, and you heard
earlier in the program, they aremarketed heavily and specifically towards certain populations.
So when it does come to that, maybe this goes along with the resources.
What can parents do and parents inblack families, in Hispanic families,

(18:53):
in Asian American families, the onesthat are getting disproportionately targeted. How can
parents be proactive in helping their kidsidentify those messages and how they're being delivered
straight to them. You know,talking to your children really has a huge
impact. And I know we oftenthink that they don't listen to us,

(19:15):
or they don't hear us, orthey're not responding to us, but talking
to our children can really have ahuge impact as to why all forms of
tobacco products are harmful. We canenforce and talk about tobacco free school policies
that really address all types of tobaccoproducts and then implement school prevention and cessation
programs that are free from the tobaccoindustry influence. And I mean because that's

(19:41):
where the conversation can start. Itstarts around dinner tables, or it starts
in churches, it starts in barbershops, it starts in wherever the community
is to start getting that going.Now, let's talk about the health professional
role. Also. Knowing that thereare disparities and access to care and in
those abilities for people to not onlyget that care but trust that care,

(20:07):
how can health professionals start to peelthat back to start to make an impact,
to have the right kind of resourcesavailable. So we really have to
make sure our health professionals understand thatmenthol is related to tobacco use and what's
being done by the tobacco industry withrespect to implementation and tobacco products, and
then really reinforce with our healthcare professionalsthat menthol products are disproportionately marketed to specific

(20:33):
groups of people. If our providersknow that, then they'll address it in
a different way. Also talk aboutthe different types of tobacco products and the
use and the risk of using Ithink most health professionals are aware of that,
but really encouraging patients to quit usingtobacco products, to reinforce information and
cessation types of medication, counseling,etc. And connecting to the evidence based

(20:56):
quitting resources. It never hurts toask, you know, when I was
practicing, I pretty much ask itevery single visit about tobacco use and interesting
quitting. Now let's talk about howcommunity partners like Excelist, Blue Cross,
Blue Shield can be part of thatsolution. Now what role are they going
to play and do play? Yeah, you're our health plan is you know

(21:17):
your partner and with Excellist, wesay everybody benefits. So know your health
plan benefits. Know that many healthplans cover patches, gum of replacement products.
Talk to your provider about your options. Then there's other resources you have
take advantage of quit smoking resources suchas New York State Smoker's Quitline and that
has a lot of useful information andyou can call the quit line at one
eight six six New York Quits orvisit their website at New York Smokefree dot

(21:42):
com. So our health plan isyour partner and making sure that you have
availability of resources to help you quitsmoking again. That number is one eight
six six n y quits. That'sone eight six six six nine seven eight
four eight seven, or you canfind it on demand at nysmokefree dot com.

(22:04):
There are a number of resources thatare available and in many cases doctor
they are free. They are justavailable. All you have to do is
go and ask for them. Somaybe somebody in the community does not have
that primary care point of contact.They're kind of in that limbo area,
and many people are in a lotof communities that they can just reach out

(22:25):
with a phone call or with aweb click and they can start the conversation.
Absolutely, your life and your healthis worth it, so take the
time to look into trying to quitsmoking before we wrap up in our final
few moments here that we have onthe program. You know, this conversation
really got going very strongly with theFDA last year. It is still kind

(22:47):
of in limbo from your perspective.What is there anything that can be that
can be done to help push politicsforward on this, because that's where it's
really going to come down to.You have to get health and you have
to get politics together to create thesebands that are going to be able to
have legs and be able to standand keep going. What can happen How

(23:07):
can we keep the needle moving forwardin the conversation moving forward, So making
sure that we're utilizing resources like this, having podcasts, keeping it in the
front line of people's information, sothat we're covering all media aspects to ensure
that people are aware that this isa real issue, that it's a real
problem, and that specific groups arebeing targeted. Let's keep it in the

(23:30):
forefront of our minds. Yeah,let's make sure that we are having the
right conversation. It's not just aboutsmoking in general. It's about how certain
types of a product are pushed towardsspecific groups of people because they know they've
got them on the hook, andit's hard to get off the hook when,
especially when it comes to menthal andthe effects that it can have on

(23:52):
the body. You might not thinkthat, oh, it's just a taste.
No, it's not just a taste. And you can find out more
if you are struggling with this yourself. If you would like to learn more
again, those resources at one eightsix six ny quits or at ny smokefree
dot com. They are complimentary resourcesand are available to you whether you are

(24:15):
an Excellist Blue Cross Blue Shield memberor not. Doctor Lisa Harris is the
senior Vice president and Corporate medical Directorfor the Excellist Blue Cross Blue Shield Health
Plan. We've only scratched the surfacewith menthal cigarettes, but I want to
thank you for contributing to our communitycheck In conversation Doctor, Thank you so
much for having me and addressing thisvery important tapping. Thanks for joining us

(24:36):
on Community check In. A presentationof Excellist Blue Cross, Blue Shield at
iHeartRadio. Podcasts of Community check Inare available on the iHeartRadio app or wherever
you find your favorite audio content.For more ways to stay safe, healthy,
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