Philadelphia Medicine Winter 2017-18x - 22

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FEATURE

The Menace of
Menthol and Flavored Tobacco
In Philadelphia
By: Akash Desai, Urban Health Policy Fellow, Philadelphia Department of Public Health

he following may not surprise you: tobacco use overall is
declining in the United States. Behind this statistic, however,
lies a more nuanced story. While the adult smoking prevalence
in Philadelphia has seen a slight decrease in the last seven years, it
remains the highest of the 10 largest U.S. municipalities, at 22.4
percent.1 Additionally, some groups, such as non-Hispanic black
Philadelphians, are more likely to smoke. A number of factors
contribute to our city's smoking rate. Among these are the use of
menthol and other flavors in tobacco.

Menthol is added to products for its cooling effect on the throat.
The compound can be derived from peppermint or distilled corn
mill oil, or made synthetically. Many products intended for cold
and sore throat relief contain menthol, such as Vicks VapoRub and
Halls cough drops. In cigarettes, menthol is added to cool the smoke,
reducing the urge to cough. Perhaps as a result, young people are
twice as likely to become daily lifetime smokers when using this
product. In addition, menthol seems to contribute to addiction in
that established menthol smokers have significantly lower quit rates
than smokers of non-menthol brand cigarettes.2
The content and placement of menthol advertising are also important to consider. A 2013 study in Philadelphia found that stores
in majority black neighborhoods were 38 percent more likely to
have exterior tobacco ads than other neighborhoods. Furthermore,
stores in these neighborhoods were 74 percent more likely to have
tobacco ads near products appealing to children, such as toys, candy
and chips.3
The percentage of black adult smokers using menthol mirrors the
growth of this advertising, with a dramatic increase from 5 percent
in 1952 to 82 percent in 2006. Data collected from 2012 to 2014
on smokers of all ages shows that 85 percent of black smokers use
menthol, compared to 29 percent of white smokers.4 National data
22 Philadelphia Medicine : Winter 2018

shows that nearly 71 percent of black teenage smokers report using
menthol cigarettes, compared to 51 percent of non-Hispanic white
teen smokers and 52 percent of Hispanic teen smokers.5 And while
menthol smokers are more likely to try quitting, they have fewer
successful quit attempts.
Flavored tobacco also plays a substantial role in promoting youth
tobacco initiation. Data from the 2014 National Youth Tobacco
Survey shows that among the middle and high school students who
reported current use of one or more tobacco products, 70 percent
used a flavored product.5 In Philadelphia, youth use of cigars and
cigarillos nearly tripled between 2011 and 2014. Cigarillos come in
a variety of flavorings that seem designed to appeal to kids, such as
fruit punch, mint chocolate chip and French vanilla. The chemical
flavorings used are identical to those in Kool-Aid, Jolly Ranchers
and Life Savers.6 Furthermore, cigarillos are sold in brightly colored
packaging and as inexpensively as 5 for 99 cents, often located
next to candy displays in corner stores. The amount of tobacco in
cigarillos is also important to consider. Whereas a cigarette usually
contains about one gram of tobacco, cigarillos generally contain
three times that amount.
Philadelphians are coming together to address the abundance of
these products in our city. Faith leaders, youth advocates, community
development corporations, medical professionals and others are
leading the discussion on the prevalence and impact of mentholated
and flavored tobacco. The Tobacco Policy and Control Program at
the Philadelphia Department of Public Health continues to support
this dialogue through engagement with our partners, policy efforts
and outreach. One of our initiatives is Break the Cycle, a dynamic
campaign raising awareness about mentholated and flavored tobacco
within communities most targeted with these products. The campaign is currently being distributed through radio ads, social media

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Table of Contents for the Digital Edition of Philadelphia Medicine Winter 2017-18x