摘要：The Family Smoking Prevention and Tobacco Control Act exempted menthol from a flavoring additive ban, tasking the Tobacco Products Safety Advisory Committee to advise on the scientific evidence on menthol. To inform future tobacco control efforts, we examined the public debate from 2008 to 2011 over the exemption. Health advocates regularly warned of menthol’s public health damages, but inconsistently invoked the health disparities borne by African American smokers. Tobacco industry spokespeople insisted that making menthol available put them on the side of African Americans’ struggle for justice and enlisted civil rights groups to help them make that case. In future debates, public health must prioritize and invest in the leadership of communities most affected by health harms to ensure a strong, unrelenting voice in support of health equity. Menthol flavoring in tobacco remains a top public health concern. 1 Because menthol makes smoking less irritating, menthol cigarettes can act as a starter product 2 for adolescents: nearly half of smokers aged 12 to 17 years use menthol cigarettes compared with less than a third of smokers older than 26 years. 3 Smoking menthol cigarettes is also linked with higher rates of disease 4 and lower rates of cessation, especially among African American smokers. 5 In the 1960s, the tobacco industry began a campaign of “masterful manipulation” targeting menthols to African Americans. 6 By 2008, 83% of African American smokers smoked menthol cigarettes compared with 24% of White smokers. 3 African Americans bear a disproportionate share of smoking-related health consequences 7,8 even though they smoke at similar rates as White Americans, suggesting that menthol cigarettes may confer greater health harms. 4 Cigarettes marketed as menthol constitute more than a quarter (28%) of the US cigarette market, 9 including leading brands Newport (Lorillard) and Marlboro Menthol (Philip Morris). 10 In 2009, the Family Smoking Prevention and Tobacco Control Act (FSPTCA) 11 authorized the Food and Drug Administration (FDA) to regulate tobacco products. 12,13 The law also established the Center for Tobacco Products, and Tobacco Products Scientific Advisory Committee (TPSAC). Though hailed by some commentators as an important tobacco control opportunity, 14 the legislation controversially excluded menthol from an immediate ban on flavoring additives in cigarettes. 15 As a concession for the exemption, TPSAC’s first order was to make a recommendation about menthol to the FDA on the basis of the available scientific evidence. In March 2011, TPSAC concluded that the “removal of menthol cigarettes from the marketplace would benefit the public health in the United States.” 16 (p225) In July 2013, the FDA released a preliminary scientific evaluation on the public health effects of menthol, confirming menthol’s harmful effects on smoking initiation and cessation, and called for public comment on the report. 17 In September 2013, the FDA extended the public comment period for an additional 60 days, 18 with any potential rulemaking to be announced after that time. We analyzed the policy debate over whether to ban menthol flavoring in cigarettes. We examined, in news coverage and committee proceedings, the arguments made by ban proponents and opponents on this question from the passage of the act through TPSAC’s review of the scientific evidence. We examined how racial disparities in African American use of and health harms from menthol cigarettes were portrayed and whether racial arguments were used in the debate. Regulatory proceedings are a significant source of information about policy debates 19 ; investigating them has established the tobacco industry’s long history of efforts to weaken or defeat regulation of their products by health advocates. 20–22 News coverage influences policy debates by setting the agenda for the public and policymakers, 23–25 and framing the terms of those debates. 26,27 Analyzing news coverage and regulatory documents can reveal the full range of speakers and how they present arguments that advance their divergent goals to policymakers and the public. 28
