DALLAS -- The massive growth in popularity of menthol cigarettes over several decades is the result of the tobacco industry’s intense and persistent targeting of Black communities, women and youth – a campaign the industry continues today with new products and marketing campaigns. These are the findings of a new research study by Stanford Research into the Impact of Tobacco Advertising (SRITA), a research unit of Stanford Medicine, and the American Heart Association, the world’s leading voluntary organization focused on heart and brain health.
The report comes as the Food & Drug Administration weighs public comments on draft rules to remove menthol cigarettes and flavored cigars from the market, and as a growing number of states and localities act to stop the sale of menthol cigarettes and other flavored tobacco products. Massachusetts and 160 localities nationwide currently restrict the sale of menthol cigarettes, in addition to other flavored tobacco products. In November, California voters will consider a ballot measure to prohibit flavored tobacco products including menthol.
“This study is a compelling addition to the overwhelming evidence showing that tobacco companies directly target populations including Black communities, women and youth with menthol cigarettes, which make it easier to get hooked and are much tougher to quit than other tobacco products,” said Rose Marie Robertson, M.D., FAHA, deputy chief science and medical officer of the American Heart Association and co-director of the Association’s National Institutes of Health/Food and Drug Administration-funded Tobacco Center of Regulatory Science. “Nearly a century of disgraceful behavior by the tobacco companies has made clear that menthol and other flavored tobacco products threaten public health and perpetuate inequities – they should no longer be sold.”
Menthol cigarettes are used by 85% of Black people who smoke and 44% of women who smoke, compared to 30% of non-Hispanic white people who smoke. More than half of teens who begin smoking start with a menthol brand. Numerous studies have shown that the cooling sensation of menthol cigarettes makes them easier to inhale deeply, which leads to a higher dose of nicotine and a stronger addiction as compared to other cigarettes.
The study finds that disproportionately high use of menthol cigarettes by Black people, women and youth, as well as others including Hispanic people (48% of Hispanic people who smoke use menthol brands), is not the result of organically evolving consumer preferences over time. Rather, it is the result of decades of high-dollar marketing campaigns explicitly targeting these populations.
The industry’s efforts continue today in a market dominated by categorical menthol brands such as Newport, Kool and Salem, which are joined by menthol extensions of major cigarette brands including Marlboro, Camel and Pall Mall. One measure of the tobacco industry’s strong emphasis on menthol is the number of menthol variants sold in the marketplace. For example, Marlboro cigarettes are sold in 11 menthol variants, including Black Menthol, Smooth Ice and Bold Ice; Camel sells 12 types of menthol cigarettes, including Crush Smooth and Crush Rich; and market leader Newport offers seven menthol variants, including Smooth, Boost and Boost Gold.
Tobacco companies’ recent tactics: flavor bursts, additives and greenwashing
The study finds that tobacco companies have evolved their products with capsule cigarettes, which contain a sphere of flavored liquid in the filter that when squeezed produces a burst of intense flavor. Known as “crushers,” “clickers,” “kickers,” “infusers” and “squeezers,” capsules serve as a flavor booster in menthol cigarettes and are sold on the U.S. market by Camel, Marlboro, Lucky Strike, Newport and Pall Mall.
Capsules and other innovations including infusion cards, infused paper, flavor caps and flavor stones also serve as on-demand menthol additives in unflavored cigarettes. These post-market additives enable sellers to circumvent restrictions on menthol tobacco sales. Tobacco companies also attempt to sidestep sales restrictions by offering numerous menthol and mint varieties in categories including e-cigarettes, cigarillos, chewing tobacco, snus and hookah that are currently regulated differently than traditional cigarettes.
Another new industry marketing tactic is the depiction of menthol products as “organic,” “additive free” or “plant based”. This trend, which the study calls the “greenwashing” of menthol cigarettes, continues years of tobacco industry efforts to hide the health hazards of tobacco use to the public. A federal court in 2006 found that several major tobacco companies had violated civil racketeering laws following decades of lying to the public about the health threats of smoking.
“Our report shows that since at least the 1930s, tobacco companies have systematically preyed on targeted populations with menthol cigarette promotions intended to get more people to start smoking a product that the companies know is both harmful to health and exceedingly difficult to quit,” said Robert K. Jackler, MD, principal investigator, Stanford Research into the Impact of Tobacco Advertising and Edward & Amy Sewall Professor, Stanford University School of Medicine. “By continuously rolling out new marketing campaigns and innovating their products to avoid oversight, the tobacco industry is intent on recruiting new tobacco users and continuing to threaten public health.”
A long history of industry targeting
The study is the result of exhaustive research of tobacco industry marketing and internal corporate correspondence since the 1930s, including company advertisements targeting specific consumer segments by skin color, gender and age over the course of decades. The study also includes excerpts from numerous internal company documents reflecting the industry’s sophisticated marketing approaches in areas including:
- Building a menthol market in Black communities – The report examines tobacco industry efforts to sell more menthol products within Black communities by deluging urban centers with menthol cigarette advertisements on billboards, buses and subways, distributing free “starter packs” and discount coupons, and featuring prominent Black athletes and entertainers in menthol advertisements in leading Black newspapers and magazines.
For example, industry documents show that Newport employees handing out samples in predominantly Black communities from a Newport van were instructed to “assertively ask people to accept samples of Newports” as part of an overall effort to “provide aggressive promotional and advertising support for the brand.” A 1981 RJ Reynolds corporate document stated that “the Black segment has been identified as the Brand’s Special Market priority” for its Salem brand.
- Seizing on menthol’s popularity among women – The report states that when tobacco companies discovered that women were early adopters of menthol brands, they responded in kind with marketing campaigns such as Kool’s “Lady, Be Cool” and Salem’s “For More of a Woman,” and with brands targeting women such as Virginia Slims (“You’ve come a long way baby”), Eve and Capri.
The Eve brand, launched in 1971 by Liggett & Myers, intentionally chose both a “feminine package design” and a “truly female name,” according to industry documents. Philip Morris Executive Larry Williams indicated that the name Virginia Slims, launched in 1968, was chosen because “most women like to think of themselves as slim.”
- Targeting youth – Internal company documents reveal a consistent focus on attracting youth smokers since the 1920s. An internal RJ Reynolds document from September 1927 states “School days are here. And that means BIG TOBACCO BUSINESS for somebody. Let’s get it. And start after it RIGHT NOW.” In other internal correspondence, companies adopted acronyms such as “YAS” (Young Adult Smokers) and “FUBYAS” (First Usual Brand Younger Adult Smokers), referring to the targets of their youth-oriented advertising campaigns.
Lorillard’s 1984 promotion plan for Newport noted that: “Newport's franchise represents the youngest demographic profile in the industry. This profile is enviable in terms of it being an ‘in’ brand, as well as insuring future viability as long as these smokers stay within the Newport franchise.” The patently youth-targeted “Alive with Pleasure” campaign established Newport as a dominant youth starter brand, the best-selling menthol brand, and the second best-selling cigarette in the U.S. after Marlboro. Internal Newport documents reflect that a primary market for Newport cigarettes was young African Americans. Newport’s 1992 brand plan revealed that the products was targeted “primarily to young ethnic adult smokers ages 18-24,” and that “the ethnic market could be a major source of new business for the brand that we plan to exploit it.”
- Financing music festivals – From the Newport Jazz Festival that began in the 1950s, to the Salem Spirit Concert Series in the 1980s, to tobacco-sponsored concert series today including Kool MIXX, Marlboro’s Vinyl Vibes and Salem’s Stir the Senses, tobacco companies continue to recruit new users across populations through music events. The Family Smoking Prevention and Tobacco Control Act prohibited music and art event sponsorships by cigarette and oral tobacco brands, but not by cigars or emerging nicotine products such as e-cigarettes and heated tobacco.
- Obfuscating the harms of smoking – For much of the last century, tobacco companies attempted to reassure a public increasingly worried about the health consequences of smoking through marketing campaigns with claims such as “More Doctors Smoke Camels,” and “Got a cold? Smoke a Kool.” Today, menthol tobacco advertising continues to include health reassurance messaging with the use of proxy terms such as “natural” and “organic” tobacco.
“Exposing the ways tobacco companies target people in disadvantaged communities with products that threaten their health is core to the American Heart Association’s commitment to battling systemic racism,” said Michelle A. Albert, M.D., M.P.H., FAHA, volunteer president of the American Heart Association, immediate past president of the Association of Black Cardiologists and Walter A. Haas-Lucie Stern endowed chair in Cardiology, professor of medicine at the University of California at San Francisco. “To promote public health and achieve health equity, we must enact proven public policies that prevent the industry from engaging in practices that have contributed to the loss of millions of lives from tobacco use.”
