Understanding Potential Menthol Tobacco Bans and their Impact on Communities of Color

This is an unedited transcript.

0:04
Hello, everyone. Thank you for joining today’s webinar, Understanding Potential Menthol Tobacco Fans and their Impact on Communities of Color. I’m Kate Sullivan Hare, Vice President for Policy and Communications at the Alliance for Health Policy.

0:17
For those who are not familiar with the Alliance, Welcome. We are a non partisan resource for the policy community dedicated to advancing knowledge and understanding of health policy issues.

0:29
The Alliance for Health Policy, gratefully acknowledge its Robert Wood Johnson Foundation for supporting today’s webinar.

0:35
I’m pleased to turn it over to doctor Avenal Josef, Vice President of Policy at the Robert Wood Johnson Foundation for some opening remarks.

0:47
Welcome to the Alliance for Health Policies webinar on the Impact of menthol Tobacco.

0:53
My name is Avinash Joseph, and I am the Vice President for Policy at the Robert Wood Johnson Foundation.

0:59
The Robert Wood Johnson Foundation is the nation’s largest philanthropy dedicated to improving health and health care.

1:07
We’ve spent significant time over the past 15 years raising awareness of the fact that health is profoundly shaped by who you are, where you live, and how much money you make.

1:19
We are committed to challenging systemic barriers and surfacing solutions that will remake the United States in the name of health equity.

1:28
Black, Latino, indigenous, and LGBTQ communities have long faced inequities that have limited their opportunities for health.

1:38
And for black Americans, these inequities have been exacerbated by decades of targeting by the tobacco industry.

1:46
It’s no accident that nearly nine in ten black smokers use menthol cigarettes, which are easier to smoke and harder to quit.

1:55
And each year, approximately 45,000 Black Americans die as a result of smoking.

2:02
Earlier this year, the FDA announced it would issue proposals to ban menthol cigarettes and flavored cigars.

2:10
Today, we will hear from tobacco control experts about the disparate impact of menthol tobacco products, especially on communities of color.

2:19
And we’ll learn more about the opportunities and challenges of implementing the FDA’s forthcoming menthol bans.

2:27
Public health outcomes are not just about the choices individuals make, but about the choices available to people in any community.

2:35
We hope the FDA will act swiftly to save countless lives and advance health equity in our country.

2:42
Thank you.

2:43
Wow!

2:58
Now, I’ll go over some quick housekeeping items and then introduce our moderator and panelists.

3:03
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3:16
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3:20
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3:35
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3:41
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3:52
A recording of today’s webinar, including today’s slide deck, will be made available on our website soon.

4:00
So, here, with me today, to explore potential Menthol Cigarette Ban as an esteemed group of experts, I am so pleased to be joined by Carole McGruder, founding member and co-chair of the African American Tobacco Control Leadership Council, … Grid, or as a seasoned veteran of California’s tobacco control experience, and has served as an advisor in many capacities.

4:22
In 2010, Ms. McGruder was honored with the Martin Luther King Junior Civic Engagement Award for her tobacco control work in San Francisco.

4:31
Next, I am pleased to introduce Joelle Lester, who directs Public Health Law Center’s Commercial Tobacco Control work, leading a team of 20 attorneys and policy analysts working to support tobacco control policy change throughout the United States.

4:46
The Center does this by providing legal technical assistance to public health professionals and advocates, developing resources on the most effective legal policy measures to reduce legal and policy measures to reduce the burden of disease and death caused by tobacco use in the United States.

5:04
Finally, we have Matthew Myers, president of the Campaign for Tobacco Free Kids. In 19 96, mister Myers helped to found the campaign has been with the campaign since its inception. Initially, he served as its Executive Vice President, and Legal Counsel, and oversaw the campaign’s legal on Advocacy efforts.

5:22
We’re going to launch today’s discussion hearing from Carole, who will provide a brief look of why this topic is relevant, as well as outlining disparate impact of the use of modern tobacco products on various populations. Carole, I’ll turn it over to you.

5:49
Hello, everyone.

5:50
I’m trying to populate my OK, there I am. Hello. So I’m Carol Mcgruder, and I’m a founding member and a very proud co-chair of African American Leadership Council.

6:03
Next slide, please. Next slide.

6:05
Our group, we are based in California, but we have impacted and helped to set the priorities for tobacco control, commercial tobacco control in the United States. Founded in 2008, and we are kind of the last african american tobacco control advocates standing after some budgetary cuts and constraints in California, and we have been working ever since on this issue amongst many others. Next slide, please.

6:30
So we found a lawsuit last year against the FDA, because of their lack of action on the issue of manpower which they were mandated to do.

6:40
Next slide.

6:43
Next slide, and then advance, yes. So are there are co plaintiffs in the lawsuit?

6:48
With us, the action on smoking and health, the American Medical Association, and the National Medical Association and the National Medical Association is african american doctors who formed their own association when they were not allowed into the AMA at the time.

7:03
And, but we’ve all been working together in the AMA actually help, too.

7:07
Bring in the enemy. So, we do have our America’s doctors are Standing with us on this issue. Next slide, please.

7:14
So, because of that lawsuit, and I know Matt and Joel are going to talk about this in more in depth, But, because of our lawsuit, that prompt at the FDA, not to act on our lawsuit, but to act on a citizen petition, that had been about several, many years ago, as well. And so, they’ve committed to taking Menthol, too, to making a proposed rule to take Menthol and little cigars cigarillos off the market, which were left in the original Tobacco Control Act at the time. Next slide, please.

7:42
So, at the time when President Obama seems like a century ago, signed the Family Smoking Prevention and Tobacco Control Act, all flavors, except menthol were taken out of combustible cigarettes.

7:55
And it was generally accepted that Flavors Hooke Children and so, we’ve seen no more demonstration of that than with the the epidemic of Teen vaping in our country that swept our country right under the noses of adults and parents.

8:08
And, and we see the power of these flavors. But Menthol is the Mother Lode of all flavors. Next slide.

8:15
So the initial exclusion of Menthol from the ban flavors was not based on science. It was based on a negotiation, and so african americans aren’t the only people that smoke methylated cigarettes.

8:28
But because of the pernicious targeting, 80 or 90% of black smoke or smoke methylated tobacco products. And so we call it this trickle down, Public Health Policy, where the public health policies are made really to protect the people who have more agency had more time to deal with the issues in their community. And then it kind of trickles down to the communities and the people who need it the most. Next slide.

8:52
So at the time, when menthol was as colluded, as it was exempted as a band flavor, our community asked who, Who will protect our children who will protect black children? Next slide.

9:05
Who will protect these children?

9:07
Next slide.

9:08
Who will protect these young people?

9:10
Because african american smokers are not born hole as adults with the Newport cigarette in their mouths.

9:17
They go, we go through the same processes, and the same issues as all people do, as we attempt to grow up past adolescence and young adulthood. And so, we want a fair and level playing field so that black children have a chance to get to the minefield of youth and adolescence and come out on the other side as a non addicted adult. Next slide.

9:41
You, thank you. And so this is an abstract that was actually submitted at the World conference in Singapore some years ago, and it documents its call it the least of these. So US.

9:52
Tobacco control policies methylated cigarettes in African Americans. And so in my culture, the people who are at the bottom are the least of these. And we consider ourselves to be that many times the public health policy and this abstract your documents, how all of the major tobacco companies perniciously targeted at the african american community. They had urban programs, they co-opted our black leadership groups, they infiltrated our media, are magazines that we’d love and respected, Ebony and jet, or just full of newport ads.

10:23
They had free giveaways to children, van programs. And this because of this pernicious targeting.

10:29
The legacy of that today in 20 21 is that over 80% of African Americans who smoke smoking a methylated cigarette over 90% of black youth initiate with menthol. And as we’ve seen with the opioid epidemic, addiction is about science and opportunity. It’s not about some particular people in our society are just going to become addicted to products. And so in the tab, tobacco industry had access to our population.

10:55
And so we look at menthol as a human rights and a social justice justice issue. Next slide.

11:01
This is the poster girl for that, the programs of the of the seventies. This is Marie Evans.

11:09
She’s an inner city youth, and that’s a code for black youth.

11:12
She grew up in Boston Public housing. She was given free Newport cigarettes at age nine, addicted to cigarettes at 13, dead at 54.

11:20
And her son was able to successfully Sue and was awarded $152 million by a Boston jury. That looked at the evidence.

11:29
And decided that the value of a Black Woman’s life in Boston was worth $152 million, and some of that was punitive. And the family actually settled for $79 million. Next slide.

11:43
So this is Dave Chapelle, most of you know him. He’s a very famous comedian.

11:47
He was given free cigarettes at the age of 14 in the Metro station in Washington, DC, and that’s how he began his life as an addicted smoker. Next slide.

11:57
This is a picture that we found of him when he was 18.

11:59
And when he talks about this, he talks about how young he looks so that he was obviously a child and under age, But the practices of the industry were to distribute these products in our community, to our children, to black children, and we were living the legacy of that every day. Next slide.

12:16
So because of the inaction of the FDA on this issue, local municipalities begin to act to protect their youth. The first one was the Chicago under Mayor Mayor Rahm Emanuel in 20 13. And he simply created a Buffer zone, 500 foot radius, where these products could now be sold.

12:33
In a city like Chicago, that’s very dance, of course, that took a lot of these tobacco retailers offline. The tobacco industry promptly sued, they litigated Chicago litigated. They prevail. and that opened the door. For all you see today, with all of the local municipalities and states coming online to say, we don’t want these deadly products in our communities. So between 2013 and 2017, there were a lot of municipalities and cities along the way who enacted variations of that.

13:02
But San Francisco in 20 17 became the first major city to take menthol and flavored tobacco products offline so that at this point in San Francisco, you cannot buy a pack of Newport cigarettes. And I’m from San Francisco, is the woman who did this legislation, represents the district that I grew up in. And as a teenager, I bust myself to a better high school. So, I wrote, pass all of the liquor stores and all of the tobacco outlets in my neighborhood, out to the avenues in San Francisco where there were no such outlets.

13:34
And so, I personally have lived this and have seen what these retailers and the inundation of these products does to a community. Next slide.

13:45
So, in California, in 20 20, California became the second state to enact a statewide ban on the sale of these products after Massachusetts. And this was our virtual signing with Governor, Gavin Newsome, and so this was a hard fight.

14:00
And so, next slide, please.

14:02
And the tobacco industry pulled out all the, you know, they put out all the cards. So they actually engage some African American leaders to say that we were discriminating against black smokers, were protecting black smokers. And so, to confuse the issue, so this is actually a March doing … organized in Los Angeles by people who received tobacco industry dollars to say that Senate Bill 793, which was the law to take these products off. The market, was discriminatory against blacks. Next slide.

14:32
This is in Sacramento the day of the vote. And these are this is near an area where there are lots of homeless people. And the industry actually paid black smokers to come and testify that we needed are menthol cigarettes and that it would be racist to take them off the market. Next slide.

14:50
So, African Americans are used as a tool to blunt public health policy for everybody in our country. You know, we’re having a reckoning right now around race. And so, you know, this should be a health issue. It should not be a racial issue.

15:03
Canada, the European Union, they’ve taken these products offline. And there’s no discussion about the racial implications of taking a dairy product offline, but in our country, because of the pernicious targeting of the industry. It’s the exact opposite.

15:16
Next slide.

15:19
So the tobacco industry uses the legitimate concerns of the African American community to block public health policies that will say, Black Lives. They use racism, police brutality, and officer involved killings to say That taking these products offline will create a black market. It will increase officer involved interactions with black people, particularly black men, as Eric Garner in New York City is a prime example of that.

15:43
And so, it offends us that the industry has has use racialized targeting of African Americans. And now they’re flipping it to say that to take these products off is racist.

15:54
Next slide.

15:57
So this is an issue of social injustice for us, the tobacco industry targets everyone, but they’re particularly pernicious in our community and we have so many other issues to deal with.

16:08
And so the tobacco control gets pushed to the back burner, even though it’s killing 45,000 black people every year, and is the largest killer, killing more than gun violence, homicides, other forms of cancer. They’re not related to tobacco combined. So, this is a major issue for our community and one that has been until these last few years kind of silent because we have so many other issues to deal with.

16:31
Next slide.

16:33
This is pave and these are my sisters. And I’m actually proud to be on an Advisory board member for paves, or pave as Parents Against vaping.

16:42
And this is just to contrast the difference in the response, the public response and outcry for what’s been happening in African Americans for decades.

16:50
And what happened when the two when the vaping Industry went after America’s youth. So, these mothers started paid as a national organization now. Next slide.

17:01
They were, they were able to get hearings on the Hill. And if you look there in the left-hand corner, you will see myself and doctor Valerie …. They were able to call on the carpet, the practices of these of these companies that have targeted our children and have so many teenagers now and young adults an addicted to vaping. Next slide.

17:20
And they were able to get a settlement already from Jill, $40 million for North Carolina, one of many states that we’ll be paying, that you’ll be paying.

17:29
And yet, there has been no reparations are no specific. Address, many of these issues for african americans. We’re still out here with what we know in the past 20 years, a million black people have died from methylated Tobacco Products which are easy to start. And they are harder to quit.

17:47
And they numb your lungs so that you can inhale that toxic chemicals, deeper into your, into your lungs, they dilate.

17:55
The RVO lie in the lungs are many things that you know, they say there’s no difference but there’s a big difference between methylated and non methylated tobacco products. Next slide.

18:04
So in fact, we’re asking to be a protected class from the industry. We deserve that and that’s part of our plea as we move forward. But in that we want the FDA to take these products off the market. and so we think that there’s enough evidence out here There’s no no no reason to wait any longer. And we want we would like action. Next slide.

18:25
So that’s the end of my my piece of this. Thank you.

18:30
Thank you so much for that helpful context. It really is truly very powerful to see this all laid out here like that. Now I’m going to turn it over to Joelle.

18:53
Well, you have yourself muted.

19:07
Can you hear me now?

19:09
Yes, we can. OK, I’m so sorry about that. So, I’m just going to add some policy change, details to the really important contexts that Carol provided. And I just wanted to also point out that Kerala is really one of the founders of leaders of the movement for Menthol Policy change in that country. You’re really hearing from someone who’s been at the forefront of this fight, the entire time. So I really applaud Carol and her colleagues at the african american Tobacco Control Leadership Council for all of their good work. That’s gotten us to this point. So, to talk about state and local menthol policy change, first, we have to put it in the federal context. Next slide, please. So, as Carol mentioned, when President Obama signed the Family Smoking Prevention and Tobacco Control Act into law prohibited flavored cigarettes, but exempted menthol from that flavor restriction. Next slide.

20:01
And so much of the advocacy in the first few years after the passage of the Act and the establishment of the FDA Center for Tobacco Products, focused on trying to get the FDA to add menthol to the list of prohibited flavors in cigarettes. As Carol said, Menthol is the most harmful and most widely used Flavor and cigarette. It has more particular harms and making it easier to start and harder to quit. And it’s a dramatic driver of health disparities, both for the African American community, first and foremost, but also the LGBT community and others. And so we filed a citizen petition that Carol mentioned in 20 13, along with 18 other organizations. And this is a photo of myself with doctor Valerie Jaeger and Duck Blocky delivering that petition to the FDA. And we have continued to push the FTA to act, but until April 29th, there wasn’t a very meaningful response to the citizen petition. Or to all of our efforts to press the FDA to act.

20:56
Because it has plenty of evidence and all the authority it needs to get menthol cigarettes and other menthol tobacco products off the market. Next slide.

21:05
So when we weren’t making progress at the FDA, we turned our attention to state and local policy change. And so there are actually a couple of flavor restrictions early on that exempted menthol that followed the bad practice of the Tobacco Control Act made the same mistake, New York City and Providence, Rhode Island. But they were important because they were litigated the same legal issues that Menthol would be litigated on later and the city’s prevailed. As Carol mentioned, Chicago is the first local jurisdiction to include Menthol and its flavored tobacco product restriction, which was incredibly important and confirmed through that litigation. That menthol doesn’t need to be treated differently than other flavors, in sales restrictions of San Francisco, has had the first most comprehensive policy, all flavors, all products, all retailers. And then I just include Duluth Minnesota to show you that it’s not only big liberal cities on the coast that are interested in protecting health and advancing health equity by addressing the problem of menthol many communities have done so next slide.

22:05
So, this is just to give you a little snapshot of how many communities there are very active states. So, you can see Massachusetts. Not all of those include mental automation, and hopefully, they’re going back and adding those in California. And Minnesota are probably the most active, with so many jurisdictions, getting menthol off the market, and then, a lot of big cities, even outside those states.

22:26
Next slide.

22:29
As Carol also mentioned, there are two states that address flavored tobacco products, including menthol through state by legislation, which is, of course, extremely important and delivers the health benefit and the health equity advancement to all corners of the state. Massachusetts was the first one. that law is in effect. It has a very narrow exemption, but otherwise prohibits the sale of flavored tobacco products including menthol cigarettes. California’s law has a few more exemptions, and has not yet taken effect. The tobacco industry response has been very aggressive to the California legislation. They gathered enough signatures to send it to a vote at the ballot at the statewide ballot, and then have also sued in federal court. So the current status of that legislation is pending the outcome of the ballot measure. Next slide.

23:14
I also want to add that tribal governments have been active in addressing menthol and other flavors in E cigarettes. This was largely in response initially to the E cigarette along beeping injuries, which seemed like this huge epidemic right before the actual pandemic, but it was very harmful and concerning. And tribal governments have the authority to do lots of protect health of their communities, and they have been. and so, I just wanted to make sure we’re always including tribes as one of the jurisdictions and policymakers that connect protect health and reduce the disparities driven by a tobacco product use.

23:50
Next slide.

23:53
I mentioned litigation earlier, This has been a really big part of policy change in the menthol context. Slavers generally but, Menthol in particular, the industry does not want to let go of flavors in tobacco products. It is key to their success in attracting and addicting. New tobacco product users. Both New York City and Providence, Rhode Island were sued, as I mentioned, Carol mentioned Chicago’s litigation, Massachusetts communities have been sued over how they determine which products are flavor. The city of San Francisco had there’s referred to a citywide ballot measure, which the Advocates one Public Health prevailed. And then I mentioned that California’s is pending. So I think we can take from this is the tobacco industry really doesn’t want these menthol inclusive flavor restrictions to take effect. It’s going to be a big blow to their business model, which is one of the ways we know it’s going to be very effective to protect health.

24:47
So, that’s just the state and local policy change context fits into the larger and very important federal context. I’ll turn it over to Matt to talk about the FDA.

24:56
Thank you. And, yes. So if we could have Matt Myers join us. We look forward to hearing from you. Thank you, Joel.

25:03
Thank you.

25:05
It’s my pleasure to be here. And my pleasure to be here with two of my partners who have worked with us on these issues across the country in over the decades. So it’s incredibly important. I wanted to start with this five, because as important as the state and local action is it has been the driver of change.

25:24
We need to realize that unless we have a national solution, do be portions of our country, where african Americans and other people of color simply won’t be protected. So, next slide, please.

25:38
That makes the time we’re in right now, particularly unique. We do, in fact, have a unique opportunity today that we haven’t previously had.

25:48
We have a confluence of factors, a concern about health equity, unlike anything we’ve seen in our country in years past a president, and an administration that is deeply committed to these issues.

26:02
And, fortunately, this is an issue that doesn’t depend upon Congress coming together in reaching a solution.

26:11
The 2009 Act, while it didn’t directly deal with the mental issue, did, in fact, give FDA the authority on its own to address these issues.

26:24
So, it’s a critical factor there, that this is one of these social problems that we have, where we not only have a solution, we have an agency with the authority to act on its own, if it has the political will to do so, and we come together at a critical juncture.

26:40
Because is both Jo Ellen, Carol have noted, on April 29th, the US.

26:45
Food and Drug Administration announced its intention to advance a product standard, to, in fact, eliminate menthol cigarettes, but need to look at the wording very carefully. What they say is, there, they’ve announced a product standard where they’re going to work towards issuing a proposed standard.

27:04
That makes this time, for all of us, particularly important to understand, because it’s not what’s happened, but what has to happen going forward, for whether or not the hope and promise of, finally, pack, you know, menthol, becomes the reality. Next slide.

27:24
Next slide, please.

27:27
What we need to, Actually, because we got back one slide, I just missed that you’ve done it. I need to understand this isn’t the first time we’ve had the opportunity, but it is the most important opportunity.

27:37
We have Congress in 2009 didn’t did instruct FDA to act swiftly quickly. It told it to immediately convene a Tobacco Science advisory Committee to study the issue and make recommendations. It told the committee that it had to act within a year.

27:54
Next slide.

27:57
The Tobacco Science Advisory Committee at FDA did its job.

28:01
In July 2011, it found that the scientific evidence demonstrated that the removal of menthol cigarettes from the marketplace would benefit the public health in the United States.

28:12
The FDA then conducted its own study, enrich an identical finding with regard to it.

28:19
So at the time that the petition that Jo Ellen Carol reference was filed, we were already primed. FDA had made the scientific findings that were necessary.

28:29
But the critical lesson for our current moment is, they made the scientific findings, but didn’t. It didn’t act for purely political purposes. Next slide, please.

28:41
four years later, we had another opportunity.

28:44
In 2017, then, Commissioner Scott Gottlieb announced his intention to issue a regulation to eliminate the sale of menthol cigarettes. And, in fact, in March of 2018, he issued an advanced notice of proposed rulemaking.

29:02
But once again, the process stalled out and it didn’t show up because of a lack of scientific evidence. It stalled out because of a lack of political will on behalf of the administration.

29:13
Next slide.

29:16
Which brings us to where we are today and the critical place of where we are today is both Carol and Joelle no noticed commented: two things are obvious.

29:28
one is menthol cigarettes, create an unprecedented harm to our most vulnerable communities, particularly people of color.

29:38
And I’ve had a devastating impact solely because of the tobacco industry is marketing to these communities.

29:45
And second, the scientific evidence is now clear unequivocal and substantial.

29:52
There is no scientific reason for FDA not to act.

29:56
So let’s talk about what the next steps are and why what we do as a community is absolutely critical.

30:03
First, FDA said, it would act within a year. What does that mean?

30:06
It means that we’ll issue a notice of proposed rule, that’s a notice of proposed rule within a year, but a year is a very long time.

30:16
We need to make sure our voices are heard, to, say to FDA, into the public There is no need to wait for a year. You’ve been studying this issue for over a decade. It is time to move in time to move now.

30:29
Our voices need to be clear, sustain, an unequivocal on that.

30:35
Second, once FDA finally issues its Notice of Proposed Rule, that is the start of the process, not the finish of the process.

30:44
By law, FDA has to ask for public comment.

30:48
Traditionally, public comments are a minimum of 60 days, normally, at least 90 days, and in this case, could well be longer during that period of time.

30:58
Everybody concerned about this issue across the board needs to make sure that we do two things: one is that we submit detailed scientific comments that outline the reasons in support for banning menthol cigarettes into we need to push FDA to move rapidly to review those comments.

31:19
Because we know the tobacco industry will do, as they have done before, submit literally hundreds of thousands of comments, um, in large part, just to delay the process.

31:30
So, it’s important that our voices be heard in two ways. Demand that FDA prioritize this and move quickly. In, second, provide FDA, the scientific, and public support to do so quickly.

31:42
We also need to be ready for the arguments that we know they’ll make, even though they have no merit.

31:47
They will argue that menthol does not make the product more toxic. They will bring out their old bugaboo the claims that a ban on menthol cigarettes will create a black market.

31:57
I should tell you, they claim that whatever tobacco control measure we ever do, don’t claim that this country doesn’t have the resources to help smokers quit.

32:06
We need to address that issue directly.

32:08
And lastly, amazingly, even in 20 21, they will claim that Menthol does not lead to more smokers for more death despite all the evidence to the contrary.

32:20
Next slide, please.

32:23
What that means is that what we do going forward is the most important thing that can happen.

32:30
We need to participate in the FDA process.

32:33
I know the FDA process appears opaque, but it needs to be subject to public input scientific input in community input.

32:45
We need to engage in the process.

32:47
We need to remind FDA every day why it’s so important to act and to act quickly.

32:54
We also need to understand something else.

32:57
The tobacco industry will try to get Congress to intervene with FDA, so we need to make sure that members of Congress understand that they should not intervene, They should let FDA do the job. And those who care about the health of our communities within Congress need to speak up.

33:13
Last week.

33:15
Once FDA issues a rule, the likelihood is that the tobacco industry will, too.

33:22
In any event, the rule by law can’t take effect within, less, within a year, and during that period of time, we have to expect the tobacco industry to sue.

33:31
Again, we have a role to play at that juncture.

33:34
We need to encourage the FDA to move swiftly to oppose the litigation.

33:39
And we need to lend our voices to that litigation, just as a T CLC and others have done in the lawsuit that’s currently pending.

33:48
In order to make clear to the court, the FDA had more than enough scientific evidence to move, and that there is more than enough political support to justify that.

33:58
We need to engage.

34:00
We have started a process, we have a unique opportunity, but what we do, not just over the next six months, but over the next couple of years, will be critical to whether this hope turns into reality.

34:12
Thank you.

34:18
Great. Thank you so much, Matt.

34:21
Um, I’d like to turn this over now to the audience for their questions. Remember, you can use the questions panel of, you can use the questions panel of the audience interface to submit your questions at any time.

34:35
And now, while questions populate in the queue, I don’t want to start with a few opening questions to our panelists.

34:41
Some of you have touched on this in your opening remarks, but we’ve gotten a few questions already, so we’d like to dig in a little bit deeper, How effective are bans? Have they been successful with other tobacco products at the state level or in other countries?

34:58
And I’ll welcome any or all of your.

35:02
Let me tell you pretty quickly, with a couple of things. one is Canada has already banned the sale of menthol cigarettes. And what they found was, it didn’t lead to a significant black market. It did lead to dramatic increase in the number of individuals who previously smoke menthol cigarettes in quitting altogether.

35:21
So, the net public health gain was substantial in real.

35:25
What we’ve also seen is that as is Carol began, we know that flavors hook kids close to 50% of all kids who start smoking in the United States across the board start with Menthol cigarettes.

35:41
The elimination of the availability of those products will have the most dramatic impact on reducing the number of young kids who start and provide us the tools to work with communities across the country to help people quit the public health gains been measured. The study out of the University of Michigan talked about the potential impact in terms of literally hundreds of thousands of lives and health care costs.

36:09
And I’d like to go onto a Hugo Carol.

36:12
What I want to say, is that, though, the rush to measure whether these bands are effective, which, at best, you know, it’s been a few years. So we’ve had decades of this predatory activity and now we pass a law, the law is the beginning of the change, not a magic bullet or solution. And there are many things that need to accompany the law, which include cessation services for people to get off of these addictive products and envy and us, putting pulling together a comprehensive package to support this, this, this, this process. So, to look at, to look at these bands and say, well, do they work well? We really haven’t had time to see what the effect is. And there was a study out of San Francisco that was flawed because they measured. they started to measure whether you’d hit stop vaping or smoking before the law actually took place before they had actually taken their products off the shelves.

37:07
So, you know, there are lots of speculation, but we know that these products have killed a million people, black people in the past 20 years. So, let’s move forward and let’s make it work, if there’s tweaking that needs to be done in the future, then let’s do that.

37:26
That was part of what I was going to say, Carol, and I would also just add that the FDA has a lot of authority to adopt companion policies, and to robustly implement and enforce its pre-market review authority. Matt referred to illicit trade, which is always as that also stand with. Something the industry always throws up whenever there is a strong public health policy proposed and the FTA also has tools that it is not deploying to deal with that issue. So for example, the FDA is supposed to implement a track and trace program to make it easier to track the tobacco products and reduce an illicit market and they haven’t done that. So we’re asking the FDA to do all of these things as well as get menthol cigarettes off the market. And I will say the citizen petition that. We file, in 20 13, also, call on the FDA to ramp up cessation services, and supports that, Would both help people quit and reduce any demand for adolescent market.

38:21
That’s exactly what I wanted to get to next.

38:23
So, he did have a question: What supports are possible to facilitate cessation by those who Now prefer flavored products? What can be ready to go? What interventions are or are more comprehensive?

38:38
And is there still funding to direct such efforts?

38:42
Great, OK, yeah, no, to a couple of things.

38:46
one is, there are significant cessation services already available, but, as we work on this policy, it’s going to be important that states and communities do better outreach than they have ever done before, to make sure that people know what services are available.

39:04
Second, many of us are supporting legislation in Congress to expand cessation coverage for everybody on Medicaid, and to fund programs to make sure that everybody on Medicaid is made aware of the availability of those services.

39:21
And the products that are have been approved by FDA to assist smokers to quit.

39:29
A critical thing to understand is that the United States Preventive Health Services Taskforce has on several occasions looked at E cigarettes and found that the evidence is inadequate, including the menthol cigarettes. to conclude that they are safe and effective, waived out, people quit.

39:45
So what we need to do is use those tools that we have in the services that we have to assist smoker’s. We need to make a nationwide commitment.

39:53
We’re going to help every smoker, and we can do that if we make sure they have the political commitment to do so.

40:02
And we also need to shift how we categorize smoking. We have a cessation Chair, doctor Karen Beard. And we want smoking to be seen and nicotine addiction to be seen as a chronic disease.

40:15
When people have diabetes, when they have high blood pressure, you don’t give them one intervention.

40:19
And if it doesn’t work, you say, OK, too bad for you. So if you get a nicotine patch and you don’t stop smoking, you know, that’s it for you. For this year or next year, we need to embrace this issue. It’s a chronic disease.

40:31
And the money that we would save as a nation, if we can get and and have innovation or on cessation we’re stagnate there have been so little innovation with cessation. So, you know, we just sent two men to the out into space this past week, so let’s put our in our intention and our focus on creating better cessation strategies and solutions to, to liberate millions of Americans.

40:59
who are addicted and slaves to these products that are killing them.

41:05
I would just add even that, you know, I wouldn’t say it’s even an accurate characterization to say, anyone prefers flavored products. The products are addictive.

41:14
They are addicted to these products and they are addicted because they, the products are pushed on communities.

41:19
And so I think, I agree with whole heartedly with Carol that we need to approach this as helping people free themselves from addiction. And think about it as meeting the medical needs of the addicted targeted smokers, remembering that they were children when they started. And really reject the idea that there’s a free choice to be made when addiction is at the heart of something. I would just add that one of the that’s that’s an industry talking point. And one of the resources included in the handout today is actually an ACL You letter. That was essentially a combination of industry talking points, also. So I think you have to be very careful and questioning when you see something that says black people liked this product more. As Carol said, this is a product pushed on the Black community adults prefer Menthol product that is that is just accepting the industry’s view that these products are Spring Pleasure, and are chosen which they bring harm health devastation, and it’s an addiction.

42:20
I just had a question from an audience member. What is it that makes tobacco more addictive with menthol for people of color?

42:29
I guess, I imagine, is for anybody, but But what is it about Menthol, that makes them the Menthol as an anesthetic. So it noms your throat?

42:39
So that initial smoking, where your body would just rejected the, menthol helps to number, it helped a dial it dilates the lungs, the …, so that the, the toxins that go deeper into the lungs and people can hold the smoking longer.

42:55
It masks when people start to have symptoms from smoking, it masks those symptoms.

43:01
No black men when they go in with lung cancer, it stage for their debt there, you know, and that’s another issue. But, and that was one of the things that doctor Phil Gardner, or other co-chair, when he was saying how we die so much more in there. And there’s a lot wrapped into that because we don’t have access to healthcare. You know, there are many things that go into this equation, but the menthol cigarette is one of the vectors that we can control. And we can make sure that not another generation of my children have your children are gonna be addicted to these products and, and, and as adults, you know, we’re, we’re telling the young people, resist, you know, resist the media, resist the marketing. It’s our job to protect our children so they don’t have to go through a minefield to get through the other side.

43:47
It’s our job as adults as thinking people, as agency, for our people to take that off the table to take that off the table so they don’t have to endure that.

43:57
I mean when we punish children who who are addicted to E cigarettes now, we should be punishing ourselves because that happened on our watch. We didn’t know what, you know, this social marketing, the influencers. All our kids are addicted now and now we want to kick them out of school because they are addicted to a product when they need treatment. You know, so, so, that’s, that’s on the adults of our country.

44:19
You know it there’ve been studies, it’s been well known for for over a decade.

44:25
And there have been an increasing number of studies that document exactly how nicotine interacts with the brain when delivered through a menthol cigarette in a more powerful, more rapid way so that the studies show didn’t menthols smokers of all demographics.

44:44
Who try to quit, have a more difficult time to do it. It’s not a particular subsection or a particular group. It’s anybody who is addicted to menthol smokers. The data shows clearly they try to quit at or above the same rates as non menthol smokers.

45:01
But they don’t succeed.

45:03
And it’s because, not because they aren’t strong willed. It’s because of the chemical interaction of menthol that combines with tobacco smoke.

45:12
That creates a more powerful addiction that he does we even with, with with cigarettes.

45:19
Thank you. I’ve had a question about some state efforts.

45:24
And specifically to the letters from state attorneys general asking the FDA to fan Menthol help and how many state AG’s have acted?

45:35
If anyone happens to know, There were 23 state AG’s who signed the initial letter, at least one other signed a subsequent letter with regard to it. It’s hard to know what impact that has within FDA. Our hope is that, in fact, FDA will take those things very seriously.

45:54
In addition, I guess, most people don’t realize, but when the State of North Carolina settled its lawsuit, I’m against Joel a couple of weeks ago, Later that afternoon, the Attorney General of wrote wrote of North Carolina wrote to FDA and said, You need to take all flavored tobacco products off the market.

46:13
It’s not something that we, as a state are in it that in a position to do, so the voices have been consistent, ScienceBase and strong that they need FDA to take action. Our hope is that this FDA will listen.

46:31
I think also the ages have been important because they can vary authoritatively addressed the issue or the specter of an illicit market and they are the ones who are doing a lot of the enforcement and compliance and their states. They know a lot about illicit markets and they address that in the letter that they said to the FDA. And I think that’s really important to have those voices added to the debate, rather than sort of this red herring argument only from the industry.

46:57
And it’s my understanding that North Carolina, their settlement with Joel is allowing Joel to leave Menthol. Shapes Menthol cigarettes on the market there in North Carolina.

47:06
So, I would encourage the other attorney generals that are still negotiating with Joel to not allow that to happen, to make them take menthol These cigarettes, these vaping products, they have not been. They have not been approved by the FDA cessation. There is a big switch and jewel is really trying to make a move on the African American community. They don’t donate at seven point five million dollars to me, Harry College, and one of the few African American medical institutions and colleges.

47:35
And so we know that the shift will be to our community. So these products have not been proven to be good for cessation. Most people are dual users. And Joel, their nicotine level in the US is twice that of dual products that are sold in Israel and in Europe.

47:51
So African Americans who have high blood pressure diabetes, we know that nicotine constricts the blood vessels and increases the blood flow.

48:00
That’s a recipe for cardiovascular, diseased at you strokes heart attacks.

48:06
And so we want our people to stop, we don’t want them to switch, we don’t want to make Newport customers, lifelong Jewel customers, We want a healthy, vibrant black community, and we deserve that, as others do mm. We’ve had some questions from folks who they must be inside. There must be from the DC. Area where we saw this recently go through the DC. City Council.

48:33
And there, there was a bit of a, some other stakeholders spoke up, just, I just wanted to ask, what are some of the potential effects on other stakeholders, particularly potential revenue shift, or loss with local businesses?

48:49
Yes.

48:50
Yeah, you know, it’s a, it’s a great question.

48:54
First of all, one needs to understand that money not spend on products that kill you, still get spent, so that if there actually isn’t a revenue loss, there’s a revenue shift, And the reality is that virtually every other consumer product that people would use that money for, provides more resources into the community, not fewer resources.

49:16
Second, I think if you’re a retailer, and you’re counting on products that addict and kill young people for your market, you ought to rethink your marketing. Amy, perfectly honest with you with regard to it.

49:28
The reality is that we have seen, is that in States and communities that have tackle these problems, retailers haven’t been hurt, and, in fact, overall, government revenue hasn’t gone down. So, the revenue loss is a red herring. There’s nothing that’s really important and coming out of coal, that it couldn’t be more true.

49:48
Transparent in that is we’re ignoring when you talk about revenue loss, the health care costs that this community is suffering.

49:57
There is an immediate benefit to the community from people who quit from young people who don’t become addicted.

50:05
We see it in quick health care costs, in terms of pregnancy and cardiovascular disease, long term, over chronic disease, so that, for the District of Columbia, and we hope, this week, that the mayor will sign the legislation.

50:20
The actual net impact will be a significant financial benefit, not a loss.

50:29
OK, look forward to seeing a good economic benefit in DC That, hopefully, if the mayor does sign that, legislation had another question about protected classes in countering or addressing the black market argument, how do you ensure that black and brown communities are not, in a de facto sense, targeted and profiled? should certain individuals participate and buying and selling of cigarettes? Can speak? Can can you all say more about what it would mean in practical terms, if African Americans were teens a protected class?

51:07
Well, the protected class that we’re talking about would be we want some type of remedy for this targeting that we have experienced. And we’re actually what the tobacco industry has done to the African American community is in violation of a treaty. That’s called the International Convention for the Elimination of All Forms of Racial Discrimination. There. predatory racial targeting of our community, violates that treaties, and we’re in the process of taking that to the you end up sending in letters and and you’ll be hearing more about that.

51:38
But with regards to the targeting of African Americans, this is something, you know, our country must deal with police reform and this is an issue that the CLC we are front and center on. I had extra slides. I had to take them out, because it wasn’t enough time. But what the FDA is proposing to do is on the manufacturing level so that these products will not be produced anymore. So there will be nothing to smuggle.

52:02
And maybe they’re gonna go bring something in from Europe. You know, and those issues we will take, we will handle as we as they as they happen. But the FDA law that’s being proposed is not about the individuals’ smoker. It’s not about there’s no bond in San Francisco. The lot the places where we passed legislation, there’s no one that’s going to come up to a smoker and say: a police officer. Are you smoking a menthol or non methylated? Cigarette? It is not about the individual. It is about the manufacturer. It’s about the retailers. And so and the end. And we’re working to in California, for example. We’re working with the Attorney General’s office, We’re working with this. This the police chief of San Francisco, stood with us at our press conference, they are taking these products off.

52:45
And so, just as we need to reckon with this, these issues, the, the, the cigarettes have nothing to do with the police reform that we need to happen in our country. And so, as Public Health, we’re approaching that from both angles, and we must, you know, there are people who have been Amadou Jalloh, in New York, was standing on the Stoop when he was killed by the police.

53:04
You know, Eric Gardner was selling Were allegedly selling a single cigarette because of the high taxes. So these are issues that we face. We’re at a reckoning in America. so let’s reckoned.

53:15
No, let’s wreck, and, but we’re not going to leave these deadly products out there, killing more people, than all these other things combine, while we, while we get this thing together, Can I think all of our communities are concerned about that issue?

53:31
You know, so the DC legislation, for example, is explicit.

53:35
The law is not to be enforced against individuals. It’s not to be enforced by the police so that the, we will eliminate that issue.

53:44
Eliminating menthol cigarettes is a social justice issue. Only the tobacco industry could try to twist it in such a way to turn it around.

53:53
It is, The reality is, the social justice is that African Americans are dying at higher rates of lung cancer, heart disease, diabetes, and chronic bronchitis, not because of anything they’ve done, but because of decades of industry targeting 50 years ago, fewer than 5% of african americans smoke menthol cigarettes. The tobacco industry saw that as a target, and targeted that community with devastating consequences weren’t doing, is saying, no longer can you get away with that.

54:23
And precisely because we share those concerns, every one of our organizations, every time we work on legislation, ensures that the enforcement is against retailers and manufacturers, not against individuals, and that there are explicit provisions to protect against police abuse.

54:41
OK, I did have a follow up question for Joe.

54:45
Well, what are the opportunities and challenges of states creating laws and regulations around tobacco versus the federal government?

54:56
Oh, that’s a good question.

54:57
Um, I think that, you know, states and locals have some authority that the federal government doesn’t have, so, for example, use restrictions, like smoke free laws or tobacco free laws are.

55:10
That’s an authority on these states and locals have not the federal government, and then the federal government has some authority that the states don’t have, specifically related to tobacco product standards, like removing menthol, cigarettes, and other tobacco products.

55:24
I think that the challenge is, are similar but different scale. The industry is very engaged in trying to kill effective commercial tobacco restrictions at every level of government. So they do that by lobbying. They do that by suing.

55:40
They do that by trying to repeal at the ballot, they are willing to spend obscene amounts of money to attack both the individual, state or local policy and to intimidate and chill similar policy change from happening in other jurisdictions.

55:56
But I think that the flip side of this is it’s going to take all levels of government thinking big and bold and comprehensively to solve this problem, and the commercial tobacco epidemic, that the FDA reach, The FDA’s authority and reach is cannot be left on the table. We need the FDA to get menthol cigarettes, the menthol tobacco products, in general, off the market in every community in the United States. Including those where they don’t have the political, will to, to enact a more local policy, We need the FDA to handle Internet sales because jurisdictions at the state or local level can try, but the FDA can handle the whole problem in a more comprehensively illicit trade as well. But states have always led the way the states and locals, especially the ones who change how we think about what’s possible.

56:46
And that has been true in every area of commercial tobacco. And that’s to add mental to the FDA is very late to this game. And if it weren’t for the local policy change led by Carol and others, we wouldn’t even be at a point where a Federal regulation was possible.

57:02
I appreciate your response there, and it looks clear what needs to happen next, then.

57:07
Um, I want to thank all of you for your insights on this important topic.

57:12
This is all the time we have for today. Well, I doubt this is going to be the last time we hear about this, but I want to thank all of our panelists for joining us this afternoon.

57:23
We are thrilled to share that our new health policy handbook has been, Has been issued and we would like you to visit our website for a straightforward and unbiased guide to the basics of health policy.

57:37
Also, please join us on July 27th from noon to one for a webinar covering dual eligibility.

57:44
And then on July 29th, also from noon to one for a webinar on rare disease, Please take time to complete the brief evaluation survey that you’ll receive immediately after the broadcast ends, as well as via e-mail, later today. We really value your comments. We read them, we read them out loud to each other, so please leave us a comment.

58:06
A recording of this webinar and additional materials will be available on the Alliance’s website, Carol, Cherwell, and Matt.

58:14
Please, thank you, thank you very much for joining us today.

58:18
Thank you, thank you. And our website is saving black lives dot org. I’ve neglected to mention that, And thank you so much. This has been great. Thank you.

58:26
Thanks.