It is no secret that quitting smoking significantly reduces the risk for a wide range of diseases and early death. However, tobacco use remains the leading cause of preventable death and disease in the U.S., with LGBTQ+ individuals among the populations who have been targeted by Big Tobacco. Lesbian, gay, and bisexual (LGB) adults1 have a smoking rate of 16.1%, meaning about one in six LGB adults smoke cigarettes compared to about one in eight (12.3%) heterosexual adults2.

The FDA recently announced two proposed rules to end the sale of menthol cigarettes and all flavored cigars. Menthol cigarettes make it easier to start smoking and harder to quit. That is why flavors, including menthol, are one of the primary reasons kids start using tobacco products (currently, nearly 19 million people smoke menthol cigarettes). The use of menthol is highest among Black and brown communities and the lesbian, gay and bisexual population.

We discussed menthol cigarette use and the current FDA proposed rules with Dr. Jamie Garfield, Associate Professor of Thoracic Medicine and Surgery at Temple University. “It's well known that menthol cigarettes make it easier to start smoking and are also harder to quit. When comparing quit rates among those who use menthol compared to those who don’t, they have a more difficult time and less successful quit rate.” Garfield continues, “there’s something about these products that are more addictive, the cravings are more intense.”

Dr. Garfield also points to the need for more current data from the last major dive into LGBTQ+ tobacco use rates (population data from 2010). “Over the past 10 years since this data was published, we have seen a dramatic rise in people who have identified as LGBTQ+, so we suspect that the percentage of menthol and tobacco users is dramatically higher.”

According to the CDC, approximately 36% of LGBT smokers report smoking menthol cigarettes compared to 29% of heterosexual smokers3. Tobacco companies have advertised at LGBT community events, contributed to HIV/AIDS organizations, and are visible at gay pride festivals. “Project SCUM” (Project Subculture Urban Marketing) was launched in the 1990s by RJ Reynolds company specifically targeting rebellious, nontraditional characteristics of the LGBT community. “Tobacco is a social justice issue. People within the LGBTQ and African American communities may be motivated when they know they have been targeted. They can take control of the ways in which they have been exploited,” says Garfield.

How would this change make a difference for tobacco prevalence? "Some projections say that within 2 years of the institution of a menthol ban in the U.S. the number of combustable cigarette smokers could decline by as much as 20%," Dr. Garfield also laid reference to an example out of Canada where menthol sales were ended across the country from 2015-2018. The study looked at smoking rates for both menthol and non-menthol users; both types of smokers saw significant quit rates, but the rate was even higher for menthol tobacco users. “22% of Canadians who smoked menthol cigarettes quit compared to 15% of non-menthol tobacco users.”4 Garfield explained how this data was applied to a potential menthol prohibition in the United States, explaining how “over 700,000 daily smokers would quit smoking in the presence of a menthol ban, and over 1.3 million of all smokers would quit in the face of a menthol ban.” The relative risk improvement for these subgroups of African Americans and the LGBT community would be significant.

The bottom line: “If the FDA were to move forward with this and take menthol products off of the shelves, there would be a dramatic reduction in current combustible cigarette use in adults, especially for those within Black and LGBTQ communities.”

The American Lung Association is advocating for the public to submit their comments to the FDA by the August 2, 2022 deadline at Lung.org/ActonMenthol. Removing menthol cigarettes from the market would create an enormous positive impact for public health. One study estimates almost one million smokers would quit smoking within 17 months of the end of the sale of menthol cigarettes5.

If you or someone you know needs help to quit smoking, learn more about our Freedom From Smoking cessation program. Freedom From Smoking has helped more than one million people quit tobacco use for good. Additional featured information on LGBTQ+ History month and resources are also available on our website.

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