The U. S. Food and Drug Administration launched its first nationwide anti-tobacco campaign targeting youth in February. The “Real Cost” campaign targets the estimated 10 million 12- to 17-year-olds “who are open to trying cigarettes or who are already experimenting with them,” according to the FDA. But many public health advocates say it is “too little, too late” to address the popularity of highly addictive mentholated cigarettes among African-American youth. Some municipalities are taking matters into their own hands. Chicago has emerged as a national leader.

Chicago became the first city in the nation to pass a sales ban on menthol cigarettes in December. Sales will be banned within 150 meters (500 feet) of schools as of June 2014.  The move comes after national research and a local task force found evidence that menthol cigarettes—especially Lorillard’s Newport brand—are disproportionately promoted and sold at “predatory” lower prices near schools in low-income black communities. 

Menthol is the most commonly used flavoring in combustible cigarettes. It is a naturally occurring substance found in the spearmint plant. Menthol provides a “cooling” sensation that is appealing to young smokers, according to the U. S. surgeon general.  The FDA was granted regulatory control over cigarettes in 2009 and banned most flavored tobacco products—except for menthol.

“Some hypotheses believe there are two addictions—the addiction to the nicotine and an addiction to the menthol flavoring,” says Alicia Phoenix Matthews, a clinical psychologist and associate professor of health systems sciences at the University of Illinois at Chicago College of Nursing. “A mentholated cough drop [could] become a trigger to increase smoking," Matthews says. “Studies have repeatedly shown that quit rates are much lower among menthol smokers,” and black menthol smokers have a “much more difficult time quitting."

More than 80 percent of black adolescent smokers prefer menthol, according to the National Survey on Drug Use and Health Report: Use of Menthol Cigarettes, published by the U. S. Substance Abuse and Mental Health Services Administration in November 2009. In contrast only one third of white adolescent smokers preferred menthol cigarettes to other kinds.  The report concluded that “cigarettes continu[e] to be a public health problem. This appears to be especially true for menthol cigarettes and adolescents.”

Smoking is the leading preventable cause of death in the U. S. A menthol ban could “prevent up to 600,000 smoking-related deaths by 2050, a third of them African-American,” according to the 2012 annual report of the American Legacy Foundation. “Smoking also negatively impacts health outcomes for other types of chronic conditions such as HIV/AIDS, diabetes and asthma,” all of which disproportionately impact African-Americans, Matthews says. “So there is a tremendous public health impact of tobacco use in the city.”

In July 2013 Chicago Mayor Rahm Emanuel ordered the Chicago Board of Health to seek local policy options aimed at curtailing menthol use among youth. Emanuel’s order came less than 48 hours after the FDA issued its own report that found “menthol cigarettes pose an even greater public health risk than regular cigarettes.”

Four town hall meetings were held across Chicago. The city's Board of Health, along with the Chicago Department of Public Health then released a comprehensive menthol report with numerous recommendations. Matthews’s considerable research on menthol contributed to the findings. The Chicago City Council and the Health Department enacted four recommendations immediately: Menthol sales prohibition boundaries; 50-cent cigarette tax increase; creating public service advertising that targets black youth; and regulating electronic cigarettes. “[The] FDA will probably issue regulations regarding ingredients and marketing—but local governments always have a role in regulating tobacco products,” says Public Health Department Commissioner Bechara Choucair. “This was an issue where Chicago could lead.”

Chicago also became the first large city in the nation to ban indoor smoking of e-cigarettes.  The ordinance passed in mid-January. “New York City followed with a similar ordinance several days later,” Choucair says, and Los Angeles followed after that. In addition, “local governments are following our lead on menthol, such as Alameda County, Calif.,” Choucair observes. “It’s very exciting to see these steps are being replicated nationwide.”