What Is the FDA Doing to Reduce Tobacco-Related Health Disparities?

In honor of Black History Month, FDA officials held a webinar underscoring the need to address those disproportionately impacted by tobacco-related health disparities. Health officials also highlighted proposed regulations on menthol and nicotine levels in cigarettes.

According to the CDC, Black people have been harmed by unjust practices related to the sale of commercial tobacco for centuries. For example, tobacco companies have a long history of trying to influence Black consumers by donating to historically Black universities and focusing advertising campaigns on media with a larger percentage of Black readers.

However, commercial tobacco has also negatively impacted other populations. These include Native Americans, Alaska Natives, Asians, Native Hawaiians, Pacific Islanders, Hispanics, and Latinos. Moreover, LGBTQ+ people and individuals with behavioral health conditions or low socioeconomic status have also been subject to tobacco-related disparities.

According to Michelle Giordano, M.S., community outreach advocate with LiveAnotherDay.org, a substance recovery resource in Georgia, the tobacco industry has implemented several practices specifically targeting Black consumers.

These include:

• Marketing tactics using targeted strategies, such as advertising in Black-oriented media, sponsoring events in Black communities, and using Black models in advertisements to increase the visibility and appeal of their products to Black consumers.
• Price manipulation, such as offering lower-priced products, to increase their market share among Black consumers.
• Offering flavored products, such as menthol cigarettes, which are particularly appealing to Black consumers and considered a significant contributor to the high rate of smoking-related diseases among Black Americans.
• Sponsorship of Black community events, such as concerts, festivals, and sports events, to increase their visibility and reach among Black consumers.

As a result, tobacco-related health disparities persist among Black Americans, as well as other racial and ethnic groups.

The FDA addresses the issue

On Monday, February 13, the FDA’s Office of Minority Health and Health Equity (OMHHE) hosted a webinar — Reducing Tobacco-Related Health Disparities: A Conversation with Dr. Brian King — in observance of Black History Month.

OMHHE Director RDML Richardae Araojo moderated the event. King is the Director of the FDA’s Center for Tobacco Products (CTP) and has almost two decades of experience in tobacco control science.

King said the most significant change he has observed in tobacco regulation and control is the declining smoking rates among all Americans. During the 1950s and 1960s, over 40% of Americans smoked cigarettes, which has fallen to around 11 to 12%. Smoking rates among young people have decreased as well.

However, these declines haven’t progressed equitably.

According to King, the FDA is "seeing a lot of populations that have disproportionately higher rates of cigarette smoking, including by race, ethnicity, and sexual orientation and gender identity, as well as by behavioral health status and also socioeconomic status."

Bringing health equity to the forefront

King explained that the CTP has four primary focus areas to address tobacco-related health inequities.

These are:

• Application reviews for new tobacco products now consider the disparities in use and the potential impact on public health when determining standards.
• The CTP has made considerable strides to incorporate health equity in its enforcement and compliance activities.
• Health communication now addresses the importance of health equity messages, not only regarding the content of the ads but also ensuring these messages are delivered in a way that reaches all populations.
• The agency continues to incorporate health equity into product regulations.

"And we have several of those in the queue, including those to prohibit menthol in cigarettes, and also another proposed rule to prohibit flavorings and cigars," King said.

"We have disproportionate rates of use, particularly among Black Americans," he explained. "We know that about eight in 10 Black smokers are smoking menthols, compared to about three in 10 White smokers."

"And this has been a long-standing disparity that has been perpetuated for a variety of reasons, including targeted marketing to this population for many years," King concluded.

When will the FDA ban menthol?

The FDA plans to implement the proposed rules to prohibit the sale of menthol cigarettes and flavored cigars by the end of this year, explained King. However, the menthol rule will only apply to combustible products — not e-cigarettes.

He also noted that the FDA has authorized 23 e-cigarette products to enter the market — none of which are menthol flavored. Moreover, these tobacco-flavored products have been identified through scientific reviews that the benefits for adult smokers — particularly those who want to quit smoking traditional cigarettes — outweigh the potential risks.

"Our proposal to prohibit menthol cigarettes would have a profound impact on health, addressing those disparities and ensuring that we continue to reduce use among all populations, particularly those that are disproportionately affected," King said.

And it’s not just the Black population. It's also those in the LGBTQ+ population, those with behavioral health conditions, and also [..] those with lower socioeconomic status,"

- Brian King, Ph.D., M.PH.

In addition, because of the highly addictive nature of nicotine, the FDA intends to propose regulations capping the amount of nicotine allowed in cigarettes and certain other combustible tobacco products.

Other ways to reduce tobacco’s impact

Giordano said there are several additional steps government agencies can take to reduce the impact of tobacco-related health disparities.

"Educating Black communities about the dangers of smoking and the tactics used by the tobacco industry can help to reduce the impact of these practices," she said. "This can include information about the health risks associated with smoking, as well as information about the industry's marketing strategies and tactics."

Giordano also suggested that agencies can implement regulations and legislation that limit the tobacco industry's ability to target Black consumers. In addition, community-based programs can help curtail the tobacco industry’s impact by providing education, support, and resources to Black communities.

Several campaigns are already in place to address these issues. For example, the Real Cost Campaign is the FDA's award-winning tobacco prevention campaign for youth

King mentioned This Free Life, geared towards LGBTQ+ folks and Fresh Empire, which focuses on Black and Hispanic communities.

"We've also done a lot of work related to e-cigarettes," King noted. "A good example […] is the Next Legends Campaign," which focuses on Native Americans Alaskan Natives populations and their relationship to e-cigarettes.

Aside from the regulation of products such as menthol, Giordano suggested that increasing taxes on tobacco products, restricting tobacco advertising campaigns, and providing high access to smoking cessation resources may help reduce tobacco use among Black Americans.

Giordano told Healthnews, "in my opinion, in most cases, smoking isn't healthy for the body. If the government can help curtail the use of smoking tobacco, it will be good for people of all races."